The effects of the pandemic rippled across the department. Below are two programs highlighted as illustrative examples.
Occupational Health
The COVID-19 pandemic created the unprecedented risk of SARS-CoV-2 infection among health care workers (HCWs) and other essential workers. Concerns about COVID-19 were compounded by shortages of personal protective equipment (PPE), initial limited COVID-19 testing, and confusion regarding the routes of SARS-CoV-2 transmission. Yale Occupational and Environmental Medicine Program (YOEMP) faculty and trainees began to address these challenges early on in the pandemic. In April 2020, Carrie A. Redlich, MD, MPH, director of YOEMP and Adam Wisnewski, PhD, senior research scientist, began a longitudinal study to assess the seroprevalence of SARS-CoV-2 among our HCWs and risk factors. By late December, just prior to COVID-19 vaccination, 14% of the 1,000 HCWs enrolled had evidence of prior COVID-19 infection. Redlich and Wisnewski are continuing to assess the immune response to COVID-19 and now the response to vaccination.
In VA Connecticut Healthcare System (VACHS)-focused efforts, Brian Linde, MD, MPH, chief of Occupational Health Services, and Efia James, MD, MPH, chief of Occupational Health, VISN1, have been providing and regularly updating occupational health guidance on COVID-19 for VACT and the New England Region, while Louis Fazen, MD, PhD, designed a new clinical informatics system to facilitate VACT employee COVID-19 vaccination efforts; and Jacqueline Cook, MD, MPH, medical advisor, Occupational Safety and Health, VA Central Office, has been working on COVID-19 polices to protect the Veterans Affairs’ workforce nationwide.
In efforts to protect HCWs across the Yale New Haven Health System (YNHHS), Mark Russi, MD, MPH, director of Occupational Health Services, YNHHS, worked with multiple partners to minimize HCW risks and optimize PPE despite severe shortages. Russi also collaborated with the Centers for Disease Control and Prevention on guidance documents related to HCWs COVID-19 exposure.
As the COVID-19 pandemic quickly started to affect employees across Connecticut, Redlich and YOEMP fellows, including Queenie Ann Abad, MD, and Joseph Zell, MD, MBA, provided educational sessions and guidance on COVID-19 workplace health and safety to different at-risk employee groups in the state, including K-12 school cafeteria workers, hairdressers, and hotel workers, as well as physicians in training. Zell worked closely with the Connecticut Army and Air National Guard on their COVID-19 pandemic response, policies, and protocols. He also enrolled over 2,000 Connecticut National Guard troops in a longitudinal seroprevalence study to better understand COVID-19 transmission and the duration of the immune response in this critical workforce. Redlich and her team also partnered with the Mohegan Tribe to better understand SARS-CoV-2 transmission and immunity among more than 1,200 Mohegan tribal employees and tribal members in eastern Connecticut as they worked to safely reopen.
Yale Program in Addiction Medicine
The COVID-19 pandemic hit individuals who use substances and those with addiction with particular severity. Such substances as tobacco and alcohol can increase the risk of and severity of COVID-19 infection. Physical and social distancing, as well as social and economic stressors introduced by the pandemic, can lead to increased substance use or return to use among those in remission. Changes in the drug supply, including the surging presence of fentanyl, has created a more toxic and lethal environment for the millions of individuals with opioid use disorder in the United States. Evidence indicates that the COVID-19 pandemic has resulted in increased opioid overdose deaths in many parts of the country. Finally, fewer patients are beginning addiction treatment due to limited access as a result of COVID-19 restrictions placed on outpatient and inpatient practices.
The Yale Program in Addiction Medicine addressed these challenges in several ways. Program faculty and trainees worked closely with New Haven community-based organizations and stakeholders to address community treatment and social needs. Faculty also converted all but essential outpatient visits to telehealth; decreased the frequency of monitoring visits when appropriate; and made certain that outpatient program services at eight outpatient sites, including the Emergency Department and Primary Care, remained available for new patients. The inpatient Yale Addiction Medicine Consult Service moved to remote and electronic consultations when appropriate, and broadened coverage to both YNHH campuses to ensure high-quality addiction treatment was provided and to address barriers to discharge, including necessary outpatient follow-up. Addiction Medicine Program faculty and Addiction Medicine fellows continued educational programs and provided general medicine attending coverage. The program created five COVID-19 Addiction Medicine guidance documents for clinicians (adult, pediatric, and hospitalist) and patients that have served as templates for other academic medical centers nationwide. Program faculty published in the Annals of Internal Medicine on the impact of COVID-19 on the opioid crisis. Program research was halted or converted to remote assessments where possible, and program faculty conducted and published studies on safe drug supply and the impact of COVID-19 on naloxone use and outpatient buprenorphine and methadone treatment.
Department of Internal Medicine faculty members participate in a variety of programs, clinics, and centers throughout the Yale School of Medicine, Yale University, Yale New Haven Health System, and Yale Medicine. For more information, visit Internal Medicine.