During the COVID-19 pandemic, groceries, housing, and a healthy psyche are as important as ventilators, PPE, and outbreak data. Rising to these challenges and others is a network of partnerships among Yale affiliates, the New Haven community, and the state of Connecticut. An April 17 Dean’s Workshop convened by Yale School of Medicine Dean Nancy J. Brown, MD, spotlighted these partnerships that are, in her words, “collaborating across institutional boundaries for the benefit of our community.” It was the second in her office’s series of pandemic-related webinars.
Shifting COVID-19 patients from overwhelmed hospitals in Fairfield County—home to many people who had been exposed to the virus in hard-hit New York City—to other area hospitals was one of many tasks that fell to Yale New Haven Health (YNHH) and its CEO Marna Borgstrom, who is co-chair of a statewide COVID-19 task force. Grappling daily with epidemiological projections, she and her colleagues work not only to redistribute patients among hospitals, but also to add bed capacity, ventilators, and PPE around the state.
“It literally takes a village and then some to put together our best response,” Borgstrom said.
Some in that village are early risers. Every morning before 7, Borgstrom and YNHH senior vice president and chief policy and communications officer Vin Petrini review a system-wide report about how many patients tested positive, were admitted, were ventilated, went home, or died with COVID-19 the previous day. There are several daily calls—8:00, 10:15, 1:00, and 2:30 p.m.—that connect hospital leaders to city and state officials to discuss the pandemic. Through his daily calls with city of New Haven leaders, Petrini helped put measures in place like an exemption to caps on daycare slots for the children of health care workers. The back-and-forth takes place seven days a week, Petrini noted. “This virus doesn’t stop for weekends or holidays.”
Addressing health disparities
Longstanding social, racial, and ethnic disparities are starkly evident during the pandemic, with African American and Hispanic residents hardest hit by COVID-19 both in Connecticut and across the nation. Yale and New Haven partner organizations are mobilizing to meet urgent social needs made worse by the pandemic, said Marcella Nunez-Smith, MD, MHS, associate professor of medicine and of epidemiology (chronic diseases). They have scaled up grocery delivery, emergency housing, volunteer coordination, and fund disbursement to on-the-ground organizations.
These partnerships are also answering community members’ questions, such as: “Can people on food stamps receive grocery deliveries?” and “Are clinical COVID-19 trials focusing on people of color?” Those topics arose in a recent virtual town hall held by Yale Cultural Ambassadors—a collaboration of local ministers and social service agencies with personnel at the Yale Center for Clinical Investigation, part of the Clinical and Translational Science Awards Program—who work to get accurate, timely information to the public.
“Please consider reaching out to our colleagues with words of support or offers to be of assistance,” Nunez-Smith said.
Handling economic displacement
Policy experts at Yale are also working to place volunteers, connecting them with state and local governments so that they can help small businesses apply for loans, hold legal clinics, and provide data and analytics support. They are even helping the governor’s office deal with unemployment insurance application backlogs, according to David Wilkinson, JD, executive director of the Tobin Center for Economic Policy and an adjunct assistant professor at the Yale Child Study Center. Policy researchers are also proposing ideas—and they are being heard.
School of Public Health economist Zack Cooper, PhD, associate professor of health policy and of economics, was instrumental in getting the Centers for Medicare and Medicaid Services to more than double reimbursement rates for COVID-19 testing, Wilkinson said. “It was exciting to be told that our advice was at least part of what helped them reach that decision,” he noted. In response to an ongoing stream of requests, a volunteer platform will be launched soon, according to Wilkinson. In the meantime, he said, audience members may email him about opportunities.
Vigilant virus tracking
Every day, public health students are phoning nursing homes about COVID-19 cases, according to Linda Niccolai, PhD, professor of epidemiology (microbial diseases). State surveillance of long-term care facilities was making heavy demands on already overworked personnel. So at the March 28 request of state epidemiologist Matthew Cartter, MD, MPH, associate clinical professor, epidemiology of microbial diseases, Yale quickly assembled a team of faculty and students. By April 13, the students had begun contacting the facilities each day for mandated reporting data, then turning those data over to the public health department, thus freeing staff for other important work. Yale experts are also stepping up to do surveillance, epidemiologic investigations, contact tracing, and outbreak response.
“It really does give me hope … that we will emerge sooner rather than later from this pandemic,” Niccolai said.
Under New Haven’s manhole covers lies a surprising clue to the local pandemic. Infected people shed the coronavirus in feces, and it can be detected in sewage and treated sludge. Since mid-March, Jordan Peccia, PhD, the Thomas E. Golden, Jr. Professor of Chemical and Environmental Engineering, has led teams of “intrepid and tenacious” students to pry off manhole covers at Yale New Haven Hospital and Union Station and visit the wastewater plant to examine the waste for coronavirus.
In mid-April, viral concentrations in the city’s wastewater were higher than in mid-March—an increase that mirrors the city’s rise in COVID-19 cases. If the team can accurately link viral concentrations in sludge to caseload estimates, “then we can use sludge for a proxy to understand the progression and the wane of the epidemic,” Peccia said.
Medical equipment innovation
Step into the right lab at Yale and you might spot an elaborate device that directs particle-laced air flow into medical masks. Yale engineers answered a March 17 call for help from personnel at the medical school and YNHH. Vincent Wilczynski, PhD, MS, deputy dean of the Yale School of Engineering & Applied Science and James S. Tyler Director of the Yale Center for Engineering Innovation and Design, discussed how his colleagues scrambled to meet a dire need for more personal protective equipment. They put together a coalition of medical faculty, engineers, scientists, staff, students, and engineering alumni throughout New England and from across the country.
The team rapidly assembled a respirator-testing platform to ensure that arriving supplies actually block the virus. At least one respirator type, they found, did not—a catch that could save lives. They also are investigating alternative respirators, ventilator splitting, and the local manufacture of scarce components—such as nasal swabs already being churned out by a campus 3-D printing platform. “This was a classic engineering design process,” Wilczynski said. “It’s what we do within the classroom, it’s what we do in product development, and it’s what we did to respond to this urgent call.”
Resilience to respond to stress
The COVID-19 pandemic is stressful, even traumatic, and how we react to that adversity matters for our health. Some attempts to cope can lead to harm, said Jacob Tebes, PhD, professor of psychiatry and of epidemiology, and in the Child Study Center. To adapt to stress, the nervous, cardiovascular, immune, and metabolic systems undergo physiological shifts in order to achieve stability, or allostasis. If this process becomes chronic, it creates wear and tear called an allostatic load, which in turn can result in disease. For example, common behavioral responses to stress include overeating, gambling, or abusing alcohol or drugs, while common physiological responses include hypervigilance and sleeplessness. But there are ways to build up personal resilience, or successful adaptation despite adversity, Tebes said.
On March 20, a group of Yale faculty psychiatrists and psychologists kicked off a series of Stress and Resilience Town Halls for the Yale medical community. The interactive webinars start with a brief presentation, then ask participants to share stressful experiences and strategies for boosting pandemic resilience. The town halls combine two evidence-based approaches, psychoeducation and mutual support, to build resilience. Topics have included tips to improve sleep, working at home with children, mindfulness techniques, and using poetry to cope. The takeaway, Tebes says: “Everyone experiences stress, and everyone can be resilient.”
A strong and creative community
The Dean’s Workshops have already served hundreds of attendees, and more are being planned, suggesting that the cooperative energy that Yale affiliates, state and local leaders, and community members are bringing to the pandemic crisis seems unlikely to abate any time soon. Brown, who took office as dean in February of this year after a distinguished career at Vanderbilt University, said, “One of the things that attracted me to Yale was this community of New Haven and of the state of Connecticut. This pandemic has brought out what is best in our faculty and our [community] partners—that is, our excellence, our creativity, and our collaborative spirit.”