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May 17, 2020
by Mark David Siegel

Hi everyone:

For me, weekdays are a purgatory of endless Zoom meetings, but weekends serve up time to dream. This morning, it's the end of Covid: the storm dissipates, the all-clear is announced, and we reemerge from our bunkers. Clinics open, subspecialty firms resume, and teaching conferences return.

Of course, there will be no sudden end to Covid; our reemergence will be gradual and tentative.

The number of Covid-19 patients at Yale is finally dropping. From our peak of 450 on April 21, we're down to 245. We still have 90 patients in the ICU, though—more than double our usual maximum—and we will be caring for them for weeks to come.

But a real reemergence starts this week. Tomorrow morning, Fitkin will return to 5-5 as a non-Covid service, and residents will return to clinic to see outpatients whose primary care has been suspended for months. It’s not just that the number of Covid patients has dropped. Thankfully, our residents are healthy. At the height of the pandemic, we secured sufficient PPE, followed strict infection control practices, and, kudos to the Chiefs, created a humane schedule.

The next steps are less clear. Connecticut plans to reopen the economy this week, and this could lead to a resurgence of cases. In addition, the number of patients in surrounding communities remains high and we will likely continue to take patients in transfer. Finally, in just a month, our new interns will arrive, and they will need more direct supervision than the graduating interns need now. All these factors will affect the pace of our reemergence, as we balance competing requests to staff clinic, repopulate the firms, and reinstitute electives, ED rotations, and vacations.

As we reemerge, let’s resolve to use lessons learned from the pandemic to improve our residency. Let’s continue to record teaching conferences and offer remote access to foster participation. Let’s keep thinking about the best ways to staff our services to promote wellness. Finally, I’d suggest we continue holding off on pre-rounding in patients’ rooms; if we've learned anything from the pandemic, it’s that we don’t need to interrupt patients’ sleep to care for them.

Though it may have seemed like our response to Covid unfolded with blazing speed, the preparation took weeks of planning. Our reemergence will proceed more gradually, but it requires just as much foresight. These plans will be informed by our core values: a commitment to exceptional patient care, education, and resident well-being.

Though full reemergence remains a dream, the first tentative steps begin tomorrow. Really.

Enjoy your Sunday, everyone. I'm headed out into the sunshine.


Submitted by Mark David Siegel on May 17, 2020