Berks County Medical Society Medical Record Summer 2020 - 11

Coronavirus Chronicles: Berks Responds

INTERVIEW WITH DEBRA POWELL, MD
CHIEF, DIVISION OF INFECTIOUS DISEASE
MEDICAL DIRECTOR FOR INFECTION PREVENTION
TOWER HEALTH MEDICAL GROUP, READING HOSPITAL
MAY 29, 2020
MR: Deb, thank you for your time to respond to our questions about
the COVID-19 Pandemic. You wrote the cover article for our Spring
edition of the Medical Record at the end of March. At that time there
were 292,142 cases and 12,784 deaths worldwide; 15,219 cases and
201 deaths in the U.S.; 4,964 cases with 2 deaths in Pennsylvania and
13 positive cases with no deaths in Berks County. Today our numbers
are quite different. Are you surprised or should I say shocked by our
current numbers that of course continue to increase?
Once the pandemic reached the US and started to spread, I
anticipated that the outbreak would exponentially increase. On May
29th, we are approaching 6 million cases worldwide with 360,000
deaths (6% mortality). In the US, we have surpassed 1.7 million
cases with over 100,000 deaths (6% mortality). In PA we have
reached 70,000 cases with over 5,000 deaths (7% mortality). These
numbers are 14 - 113 times the number previously reported at the
end of March.
Initially people were comparing this outbreak with the flu but
by the time the prior article went to press, it was apparent that this
would be much worse. The CDC estimates that the annual burden
of influenza is between 9 and 45 million cases per year with 12,000
- 61,000 deaths. That is total estimated cases of influenza. Death
rate for influenza is estimated to be 0.1%
It is estimated that up to 80% of COVID-19 cases are
asymptomatic. We are testing predominately symptomatic patients
so the total number of diagnosed patients is only a subset of the
total number of infected patients. If this is true, the 6 million cases
diagnosed may equate to 20% of the total number of cases and the
total number of cases may be closer to 30 million cases. If there
have been 30 million cases to date and 360,000 deaths, then the
true death rate would be 1.2% which is 10 times the death rate seen
with the flu. Also remember that we are only 5 months into this
pandemic globally and 3 months in the US. We have flattened the
curve and the total global, US and local numbers will continue to
increase.

MR: By definition of a "pandemic" this has been a worldwide and
national crisis but each individual case treated at a local level. Would
you tell us about your role and some of your experiences these past several
weeks as an Infectious Disease specialist?
Starting in early March, in addition to being the Division
Chief of Infectious Diseases and the Medical Director for Infection
Prevention for Reading Hospital, I was asked to perform this role
for the entire Tower Health system. I am attending many daily
meetings with the leaders of the 7-hospital health system to give
recommendations regarding policies and procedures. We have had
to address issues with the supply chain including PPE shortages,
viral transport shortages, and insufficient testing capacity. We had
to initially stop performing elective surgeries, limit outpatient office
visits, discontinue visitation, and close the hospital's day care center
to decrease exposures. We expanded telemedicine in the outpatient
setting with video and telephonic visits. We started a tele-ICU
service to support the ICU patients across the health system. We are
restarting time sensitive surgeries in a slow and deliberate fashion
to ensure patient and staff safety. I have been asked by many groups
and media outlets to comment on many topics to educate the public
regarding what they can do to protect themselves and others.
MR: Were there particularly unique challenges that you and other
health care staff faced in treating patients?
I think that the biggest challenge that health care providers are
facing in this pandemic is providing care in the setting of limited
scientific information. Since this is a novel coronavirus, we had little
to no evidence to guide us on the best treatment approach. Some of
this data is released prepublication without the usual vetting process.
This is occurring while we are treating patients and we are adjusting
in real time. At Tower Health, we created a Treatment Guidance
Committee early in the pandemic that reviewed the literature and
developed recommendations for treatment based on severity of
illness. This committee included Infectious Diseases, Pulmonary/
Critical Care, Hospitalists, and Pharmacists with specialty in
Infectious Diseases and Critical Care plus ad hoc members from
Cardiology, Hematology Oncology, Nephrology, Neurology, and
Neurocritical Care. As new information is released, this group
reconvenes and the document is revised.
continued on next page >

SUMMER 2020

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Berks County Medical Society Medical Record Summer 2020

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