July 20, 2020
Dear Members of the Baylor College of Medicine Community,
In general, it takes about three months of regular performance of a new behavior to develop a habit – to incorporate actions into your life that becomes largely unconscious and effortless, like brushing your teeth. In my mind, the crisis in Houston became real with the closure of the Houston Rodeo on March 11. Since that date, we have all been dealing with change on an unprecedented scale. Work changed, the economy slowed, schools closed, we experienced two disease surges (or as some would contend, one long continual surge). Using the Rodeo as a marker, we are now in our 5th month of the crisis – plenty of time to have developed new habits. Today I would like to briefly review the improving data from the past week, while pausing to contemplate what positive lessons we have learned so far. How are we going to be better for having lived through this historic crisis?
We are clearly in a transitional period. The numbers this week are encouraging. For the past two weeks, the R(t) – the measure of community viral infectivity – has been at or below 1.0 due to community masking and distancing efforts. It now appears we achieved our peak of new viral infections during the 2nd week of July. New community cases in Harris and eight surrounding counties, on a rolling average basis, have decreased from about 2,400 daily at peak to around 1,800 (but keep in mind, for most of April and May we were seeing fewer than 400 cases per day, so we are still seeing a lot of new disease). New community cases reflect all positive tests, including people who are asymptomatic or minimally symptomatic.
The decrease in community disease burden in showing up in slackening hospital demand. Across TMC institutions at peak, daily admissions were above 350; we are now below 250. The daily census of patients in non-critical medical/surgical beds is dropping, and ICU patient census – which is expected to lag these other indicators – is starting to drop. In short, all the metrics are headed in the right direction.
To be clear, this does not mean things are easy. Providers in hospitals are still managing high numbers of very sick patients. Faculty, providers and residents in ICUs are fatigued. All tertiary/quaternary hospitals are providing extracorporeal membrane oxygenation (ECMO) to record numbers of patients. There are parts of Texas, particularly in the Rio Grande Valley, that are still squarely in crisis mode. So again, this is not over – just better. Vigilance around masking and physical distancing must continue. When the time is right, we must continue to encourage thoughtful, data-driven reopening decisions.
So, as we ride the backside of the current wave, I would like to reflect briefly on lessons learned – societal, organizational and personal. What new habits, skills and strengths have we developed during this crisis?
On the broadest societal level, I think this is a difficult question to answer. This will no doubt be the subject of many books to come. One lesson learned should be that the U.S. deserves a less fragmented, better-coordinated public health system. I hope this is my only global pandemic, but if we are ever unfortunate enough to experience something like this again, as a nation we must be better prepared.
In terms of institutional lessons, we have had a glimpse of what it means to be a learning health system. The AHRQ describes an learning health system as a system where “internal data and experience are systematically integrated with external evidence, and that knowledge is put into practice. As a result, patients get higher quality, safer, more efficient care, and health care delivery organizations become better places to work.”
I think that summarizes our last five months remarkably well. We have proven that if we have focus and organizational commitment, we can do big things quickly and do them well to improve the health and well-being of our community. The Baylor collection site just “swabbed” patient 10,000 this week. While other labs are challenged to provide timely results, Baylor labs continue to provide region-leading turnaround time for high reliability testing. Our researchers continue to manage productive labs and submit COVID and non-COVID related grants. Telehealth services enable us to provide necessary services to patients, and in a challenging environment, we are ahead of pace to recover all of our pre-COVID patient volume. Psychiatry in particular is performing the majority of their services virtually – including direct services in support of many in the Baylor community – and are on pace to exceed their pre-COVID levels of patient care. Curricula have been redesigned, and new students, residents and fellows smoothly onboarded. I hope a residual Baylor habit is recognizing we can accomplish important things quickly and well.
On a personal level, all of our lives are different than they were. We have faced a ton of disruption and much negative and difficult change. I think it is useful to stop and reflect for a moment on what is better, however small those things might be. What new routines have we established that we find meaningful and valuable? How would you finish this sentence? “In the post-pandemic world, I will continue to…” These habits can be small or large, but pause to think about what they might be. For me personally, two come to mind. In the post-pandemic world, I will continue to…
- Limit my professional travel. Like most of you, I have not been on a plane since February, and have discovered I really do not miss it. I have more time at home, and seem to have been able to fulfill professional obligations fairly well remotely. To be sure, when travel becomes routine again, some face-to-face interactions will and should resume. However, I like being at home with my family and will be more selective about future trips.
- Have Sunday lunch with family. We have a new tradition of sitting down to mid-day Sunday for a family meal (within our household). Although we typically do take-out rather than cook, this feels like a throwback to a less hurried era. Pre-COVID-19, we had limited opportunity for unstructured, leisurely conversation; somehow now it seems to be more important.
In the post-COVID world, what positive thing will you continue to do? Take time to reflect. If you are inclined to share, email me your (brief) sentence, or if you are on Twitter, post using the hashtag #COVIDHabitsBCM.
Senior Vice President and Dean of Clinical Affairs