A unified response

News of a deadly new virus spreading in China grabbed world headlines in January 2020, just as Nancy J. Brown, MD, the Jean and David W. Wallace Dean of Yale School of Medicine and the C.N.H. Long Professor of Internal Medicine was moving to New Haven. When she officially began work on February 1, experts were already monitoring the spread of COVID-19 and planning for worst-case scenarios. A little more than a month later, Brown accepted the recommendation of the school’s education leaders to pull students from their clinical clerkships and halt in-person classes. Yale School of Medicine (YSM) braced for impact as the virus swept over New York City and neighboring Connecticut, filling hospitals and straining clinics’ capacity.

Dean Brown took time to reflect on the events of those first weeks and the months that followed, with challenges that included the long-term effects of closures on the educational and research missions; budget shortfalls; and institutional self-reflection in response to national events—and the ways YSM found opportunities to grow and improve in meeting those challenges.

Yale Medicine Magazine: How did COVID start, from YSM’s perspective? Looking back on the decisions you made, what drove some of the bigger moves?

Dean Brown: Leaders from the School of Public Health, the School of Medicine, the School of Nursing, and the School of Management began meeting at the end of February to consider scenarios and responses. I had not been here long. In fact, I remember standing in line outside a CT DMV to get license plates one Saturday morning while on a conference call with about 40 clinical leaders. After the first Connecticut COVID patient was hospitalized on March 7, 2020, the situation progressed rapidly. The Northeast was hit particularly hard by that first wave.

As a nation, we were not adequately prepared. We did not have the ability to conduct the widespread testing needed to evaluate the scope of the problem. Also, at the beginning of the pandemic, health care providers and hospitals lacked adequate personal protective equipment (PPE) required to treat patients safely. We were receiving and using pallets of PPE from all over the country, and even from international partners. Because of the shortage, we reduced elective surgeries and routine patient clinic visits. To create capacity for patients, our leaders at the Smilow Cancer Hospital moved patients from the top three floors, as these floors had appropriate air handling for the treatment of COVID patients.

YMM: Those swift and decisive responses certainly saved many lives. What other changes or innovations helped stem the tide?

Dean Brown: The most consequential response was our decision to gather experts across the university and health system to collaborate and work across boundaries. One Saturday in March 2020, I was on a call with Paul Taheri (chief executive officer, Yale Medicine), who said, “We need a Manhattan Project style response.” The next day, we convened the first meeting of the COVID-19 Response Coordination Team, or CoReCT. Leadership and faculty from medicine, nursing, public health, engineering, social science, law, development, and the hospital met daily for several weeks. Our initial efforts focused on research and clinical responses. Our communications team established a web presence to facilitate collaboration and to make discoveries available in real time. We benefitted from a project manager who kept us on task. Bidirectional conversations with community leaders enabled us to respond to needs for testing and access to health care, and later to get word out about vaccination. At the same time, our colleagues in sociology and economics addressed the economic impact on the community.

CoReCT was an extraordinary group. It’s rare to find so many leaders and institutions working together toward a common purpose. We changed the way we worked together, and we hope to leverage our learnings to address other challenges.

Other innovations emerged all over the school. Our education team worked tirelessly to create remote learning. Our students led creative initiatives such as the development of a course on the epidemiology of pandemics. Normally educational planning takes months to years; pivoting to socially distanced learning happened in a matter of days.

YMM: After YSM settled into a rhythm and it had become somewhat routine to handle patients, what choices characterized the next phase?

Dean Brown: COVID started out as an infection that was poorly understood. Astute physician-scientists quickly defined the characteristics of patients who were most susceptible to severe infections and the role of the immune function and vascular injury in the illness. As the pandemic progressed from an acute problem to a chronic problem, other consequences emerged. Faculty, students, and staff faced emotional stress every day. Students and faculty had to respond to disruptions of their research programs, as social distancing limited the number of faculty and staff on campus and travel was limited. Nationally, women were disproportionately affected because child care was disrupted, and women often bear the primary responsibility for child care. Physicians and nurses were reassigned to new areas. Some who were unaccustomed to end-of-life care were abruptly faced with caring for patients who died.

We addressed these challenges in a number of ways. The university extended the tenure clock, and the School of Medicine made gap funding available to junior researchers. The only requirement to receive the funding was to meet with their mentorship committees; we used this [requirement] as a forcing function to make sure people were not becoming isolated. The Phyllis Bodel Childcare Center was able to obtain a PPP loan that allowed them to stay open and extended the age of children eligible for care. Our Department of Psychiatry made a wide variety of resources available for people struggling with COVID-related trauma or anxiety. We offered coaching to teams of nurses and physicians we had disrupted when we moved wards to make room for COVID patients.

This work is ongoing. We’re working with communities to stop the spread of misinformation about the vaccine or the virus, and encouraging people to vaccinate. There are also ongoing clinical trials to gauge the extent and nature of what’s being referred to colloquially as Long COVID—the persistence of certain neurological and physiological symptoms long after the infection has subsided.

YMM: How has YSM responded to some of the social and political events that occurred over the past year?

Dean Brown: The national protests that followed the deaths of George Floyd, Breonna Taylor, and others caused many Americans and institutions to look inward to consider racism in our own communities. We gathered in many town halls to listen. We accelerated the development of a strategic plan for diversity, equity, and inclusion. The faculty portion of this plan is now posted on the school’s website.

That goes back to the pandemic, too—COVID-19 disproportionately affected minority communities. It highlighted long-standing health disparities in chronic diseases such as hypertension and type 2 diabetes.

YMM: Any final reflections?

Dean Brown: Being part of the public health advising process for the larger university was meaningful to me as a Yale College alumna. On an even more personal note, my father became gravely ill and passed away in May 2020. He did not have COVID, but I have no doubt that his care was affected by the pandemic. Paradoxically, because of work from home, I was able to be with him near the end when he came home to hospice care. That experience as a family member of a patient only serves to emphasize for me the importance of our work at Yale School of Medicine. Training future physicians and physician associates and assistants who will offer the highest quality of care and treat each patient with compassion and respect, making discoveries that will lead to new therapies and better health for all—this is what it is all about.