Our COVID Response: Remembering What We Found

In just two weeks, Match Day 2020 was transformed from a highly anticipated envelope-reveal celebration in the School of Medicine and Dentistry’s Class of ’62 Auditorium to a log-on-from-home livestream event during which soon-to-graduate medical students clicked open an email to discover their next career steps.

That hasty evolution is a fitting metaphor for the nascent days of the University of Rochester Medical Center’s COVID response. It’s one of a myriad of examples illustrating how an exploding global pandemic triggered a rapid remake across education, research, and patient-care missions.

What seemed unfathomable in 2019, despite reports of a deadly virus emerging in China and Europe, became all too real on March 1, 2020, when the first case of coronavirus was confirmed in New York state. Eight days later, URMC launched a command center to address the approaching threat.

And on March 21, Strong Memorial Hospital reported its first COVID case.

The past year has challenged URMC in ways no one could have imagined. Although our response mirrors the actions of academic medical centers across the country, there’s no denying the Rochester-strong courage, tenacity, and teamwork that got us through an unforgettably challenging year. A year that brought great loss and struggle, but also demonstrated the power of our calling—basic, translational, and clinical science; nimble and innovative clinical care; teaching future providers and researchers in entirely new ways—to reduce fear and bring healing to the Rochester community, our region, and the world.

It's impossible to capture every contribution in a few magazine pages. Here are some highlights that reflect the commitment, talents, and resilience witnessed across our campus (and via Zoom) every day.

Learning Curve

On the heels of their virtual Match Day, with in-person learning halted and clerkship requirements met, the School of Medicine and Dentistry’s Class of 2020 received their medical degrees one month early in a virtual ceremony. In May, virtual commencement ceremonies were celebrated across the university.

Celebrations took creative turns—from online toasts to front-lawn serenades—and the new MDs had options for their unanticipated

free weeks before starting their residencies. Some who stayed in Rochester chose to roll up their sleeves and fill temporary assignments bolstering Strong Memorial Hospital’s staff as COVID cases surged.

For trainees not ready to graduate, a sudden shift to online learning created many new challenges for faculty and students. Then came word that travel and gathering restrictions eliminated the possibility of in-person visits for residency and fellowship candidates—a vital part of recruiting the best and brightest talent to our programs. A multi-pronged approach helped people visit Rochester virtually through a virtual tour, enhanced  websites, videos, and engaging social media strategies.

Graduate Education and Postdoctoral Affairs (GEPA) faced similar challenges. Unable to host applicants at in-person interview weekends, GEPA officials tapped a versatile conferencing platform and ingenuity from the enrollment team to transform visits into interactive online events. The new platform had a side benefit: no longer restricted by domestic travel, interview weekends opened up to an international audience.

Research Reimagined

Throughout the pandemic, URMC has played a lead role in the Coronavirus University Response Team, which closely monitors the evolving situation and develops policies to keep everyone safe. Research operations adopted specific precautions and made policy adjustments to assure safety in human-subject studies. Research faculty initiated new processes to manage laboratory work in the COVID era, leveraged changes in funding opportunities and resources, and made adjustments for students to work remotely when possible.

These changes did not delay or diminish the ability of URMC scientists and clinicians to help lead the national response to COVID. URMC has been engaged in research on vaccines, treatments, immune responses, testing innovations and disease patterns, as well as the virus’s impact on nursing home residents, underrepresented populations, and nursing mothers.

URMC’s COVID research includes investigations of:

• Vaccines, including clinical trials of the Pfizer/BioNTech and AstraZeneca products
• Related outreach with community partners to encourage participation in vaccine trials by people of color
• Treatments, including remdesivir and convalescent plasma
• Immune responses and the potential for previous colds to provide a measure of protection
• Nursing home impacts
• Testing, including phase 3 trials of a $5 test that gives results in 15 minutes
• Nursing mothers and the safety and potential benefits of breast milk
• Effects of COVID on child and adult lungs
• Disease patterns, through the New York State Emerging Infections Program

Caring in a Crisis

Around the world, images of overcrowded health care facilities and PPE-clad clinicians struggling to care for their patients dominated media coverage. In March 2020, as New York City hospitals became the global epicenter of the crisis, URMC leaders prepared for a surge in critically ill patients that could similarly overwhelm Rochester-area hospitals.

It began with a Grand Rounds on March 4, as clinicians met to comprehend the approaching risk and infectious disease specialists shared the latest guidance on how to evaluate and treat COVID patients. Within days, a multidisciplinary COVID response team formed. At twice-daily command center meetings, they plotted how to brace for the imminent threat and protect frontline caregivers. Within a week, the virus reached Rochester as the area’s first COVID-positive patient was tested at Highland Hospital. Cases increased exponentially at first, straining every facet of the UR Medicine clinical operation to address unique new pressures. Amid fears of ventilator, bed, staff, and PPE shortages, teams across the Medical Center joined forces to expand capacity and provide patient care while keeping everyone safe.

Significant infrastructure changes and staff ingenuity helped create an exceptional environment to care for critically ill patients in highly infectious disease units.

• Thanks to extraordinary work by Facilities Engineering, entire units were converted to negative pressure to facilitate intubation and extubation without relocating patients, helping to preserve PPE.
• In early April, a “Dr. Chat Bot” self-screening online tool was launched to help review and track symptoms among staff and standardize health requirements for safely reporting to work.
• A tent was erected outside the Emergency Department, later replaced with a larger engineered structure with climate controls, expanding ED capacity with improved privacy and physical distancing of patients.
• As demand for testing surged, a dedicated team of scientists and collaborators brought URMC’s Laboratory from zero to 1,000 tests a day in just two months. By January, capacity had increased to 4,000 tests per day.

These measures and a strong community response caused COVID hospitalizations to plateau in May, then decline gradually during the summer months. Weary clinical teams had little time to catch their breath, however. A second surge came in early fall, quickly doubling the peak hospitalization numbers from the spring, then tripling and quadrupling them. Armed with COVID care experience and proven treatment regimens, clinical teams doubled down to maintain care for all patients, with minimal reductions in elective procedures.

Countless examples of heroism emerged along URMC’s COVID journey, from the first cases in spring to the launch of vaccine clinics at the end of the year. Physicians, advanced practice providers, and nurses—including recent retirees—stepped out of their comfort zones and eagerly trained for deployment where help was most needed. A team from Emergency Medicine spent a week in April supporting staff downstate at Northwell Health, returning with valuable insight and reassurance that the proper measures had been put in place in Rochester. Innovation led to the in-house manufacturing of face shields and hand sanitizer, and a decontamination process to extend the life of N95 masks. A majority of providers quickly adopted telemedicine, whenever possible, to continue caring for patients with non-COVID issues while minimizing risk of exposure. And patient-care spaces were redesigned to support physical distancing and promote safety as patients were urged to seek care for urgent and chronic non-COVID health issues.

So many talented and tireless people sacrificed to put patients first, even when it meant extended time away from their loved ones. With a vast majority of patient-facing staff fully vaccinated, we can look toward the future with gratitude and hope—while remembering what we discovered in ourselves and our institution during the COVID pandemic.