Behind the scenes of a hospital’s COVID response [PODCAST]

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“In the midst of a COVID-19 pandemic, getting a flu shot has never been more important.

Many people are staying indoors, wearing a mask, and washing their hands frequently. In this environment, patients ask me, “With all this social distancing, do I really need a flu shot this year?” The answer is unequivocally, “Yes!” Even the safest practices do not guarantee that a person won’t catch the flu or the coronavirus. For people who are at high risk of becoming seriously ill from either the flu or from COVID-19, it is critical that they get their flu shots before the start of the flu season in the fall.

A bad flu season could combine with the coronavirus pandemic in the fall and winter. And because both illnesses present with the same symptoms, it is possible that physicians will have to test sick patients for both.”

Grace Lozinski is an internal medicine physician and chief quality officer, Hoag Memorial Hospital Presbyterian, Newport Beach, CA.

She shares her story and discusses the KevinMD article, “The flu shot is more important this year than ever.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Grace Lozinski. She is the chief quality officer at Hoag Memorial Hospital Presbyterian in California, and her colleague wrote the KevinMD article “The flu shot is more important this year than ever.” Grace, welcome to the show.

Grace Lozinski: Thank you, Kevin. Nice to be here.

Kevin Pho: So we’ll get into that article in a little bit, but first off, can you share your story and your journey to where you are today?

Grace Lozinski: Sure thing. So I joined Hoag Hospital back in 2003. I was one of the original hospitalists here at Hoag, and over the past 17 years, I practiced inpatient medicine. About three years ago, I switched over to the administrative side of things and took on the role as chief quality officer here at the hospital.

More recently, I really have been heavily involved in the COVID preparedness efforts at the hospital, working with an amazing team including infection prevention, nursing leadership, clinical leadership, admin leadership, you name it, RT. It’s been an absolute multidisciplinary approach.

Kevin Pho: So we are speaking in the first week of December. From a hospital leadership standpoint, describe some of the challenges and what you’re seeing, because we’re in the midst of another wave of the pandemic.

Grace Lozinski: Yeah, I would call this probably our third surge, the first one being back in April, which seems mild in comparison. We had another one in July, and we are really heading into this third surge, which we anticipate will probably be the biggest surge, quite frankly. Our numbers are increasing, much as they are across the country, but here locally in Orange County, our numbers are definitely increasing over the past two weeks, and we are seeing the admission rates accelerating, particularly over this past week. And so currently our census is pretty significant.

We are fortunate in that we have had a long time to prepare for this. I don’t know if you are aware of this, but we were actually the first hospital in California to take a COVID patient, back on January 25th. And so we have been preparing since that time, and we have a lot of our systems in place already. We have our contingency plans well described and memorialized at this point. But quite frankly, right now it feels like everything else was a dress rehearsal. This feels like this is the real show right now. But that said, we feel confident that we can take care of our community, and we have a lot more experience with COVID, much like other parts of the country as well.

Kevin Pho: So like you said, this is the third wave and likely going to be the biggest wave. From a hospital standpoint, what would you say is the single biggest challenge that you anticipate facing?

Grace Lozinski: What concerns me, what keeps me up at night, is probably staffing concerns. We have done a really good job keeping our staff healthy. We have been very proactive in securing PPE. We have an incredibly active and involved infection prevention program. So I feel our staff is well taken care of and safe. But that said, with the community prevalence being what it is, my concern is keeping our staff healthy enough to take care of the increased numbers that are going to be coming through, despite all of our efforts. So that’s something that does keep me up at night.

And then with some potential changes coming through CDPH with respect to testing health care workers, I am also concerned about the ability to operationalize some of the testing requirements that may be coming down the pike. So those are some things at this point that we are really focusing on.

And then the third thing, of course, and this is also the most exciting thing, is really how to operationalize vaccinations. So those are the three areas right now that I’m really focused on.

Kevin Pho: So I talked to a lot of hospital leaders on this podcast, and they articulate very similar concerns to what you mentioned, specifically with hospital staffing. If that becomes a problem, what are some of the strategies to help mitigate that?

Grace Lozinski: Fortunately, the CDC has contingency plans already outlined in their recommendations, so that obviously would be something we could fall back on if need be. But again, we’ve had a lot of time to prepare for this. We do have contingency staffing plans in place, both for physicians, pulling pheno physicians out of the community, for instance, leveraging, for instance, some of our anesthesiologists if we need more critical care, and leveraging our pulmonologists to provide more critical care as well.

And then in addition to that, we have been able to train up a lot of what we call our sub-intensive care nurses to take on critical care patients as well. So we’ve had the benefit of time to really come up with that staffing contingency plan as well. And then, of course, the CDC plans are there for backup if we need to go there.

Kevin Pho: Now, you did mention vaccines, and we’re speaking in the first week of December. By the time this podcast comes out, either the Pfizer vaccine or the Moderna vaccine may already be out in the public. And as you know, these are two-shot vaccines, and logistically it’s going to be a pretty complicated process. So how is your hospital going to roll out such a complicated logistical venture?

Grace Lozinski: Yeah, complicated is the right word. We pulled together a really talented multidisciplinary team. We’ve been discussing, again, the prioritization algorithm, being very thoughtful, basing it on ethical principles, basing it on CDC and CDPH recommendations. And so that’s been our first task, really understanding who’s going to get it first, communicating that as well, and being very transparent around that process. So that is something that’s already ongoing at this point.

And then we are working closely with our leaders in lab, employee health, and medical staff in order to make sure that we have a system in place where we can really make this efficient and operationalize it, and also a way to make sure that we get through as many people as we can based on our allotments. But yeah, it’s very logistically challenging. There’s no doubt about it. But again, knowing that our teams have been working together on very complex scenarios throughout this past year, I really feel confident that we’ll be able to operationalize this.

Kevin Pho: And if you were to anticipate the biggest challenge to the vaccine rollout, what do you think that would be?

Grace Lozinski: It’s a limited resource. I think there is going to be maybe some pushback from some staff who think they should maybe be in a different priority group. So that’s one challenge that I anticipate.

And the other challenge is really going to be just keeping track of everybody who gets it, if people drop out before their second dose, whatnot. If people get sick in between, how do we staff? For instance, if somebody has an adverse reaction to the vaccine, if they’re not able to come to work for a couple of days, things of that nature. Those are the things that I am concerned about at this point.

Kevin Pho: All right, let’s transition into the KevinMD article that your colleague wrote. It’s titled “The flu shot is more important this year than ever.” Now, for those who haven’t read that article, can you just walk my audience through it and share the story of why the hospital decided to share it?

Grace Lozinski: Yeah, so that was written by my colleague, Dr. Philip Robinson. He’s the medical director of infection prevention and hospital epidemiology. And that was, I believe, written back in, I want to say, September, correct me if I’m wrong. But again, it was a way to disseminate the importance of getting your flu shot, particularly this season, knowing that this was going to be a challenging winter because of, obviously, COVID. There was no reason to interject a confounding variable, that being flu. It’s something we could easily mitigate, either in contracting it, or we could easily lessen the severity if we did get the vaccine.

And again, it was to put that message out there: Let’s not make this more difficult than it should be. This is something we could do easily. It’s readily available. We doubled up on our doses here, purchasing our doses, and so we had tons of doses available that we disseminated to staff but also community alike. And again, it’s really just mitigating and taking out that confounding variable so we didn’t have to contend with a “twindemic,” so to speak. We really started that messaging early in the season in order to prepare for, again, the potential of this surge that we’re seeing now.

Kevin Pho: So in my primary care clinic in New Hampshire, I’m still seeing some people who are hesitant even to get the flu shot, even in the context of COVID-19. Now, what are you seeing in your area? Are you still seeing patients still resistant or a little bit hesitant to get vaccinated against the flu?

Grace Lozinski: You know, we are fortunate to live in an area that has, overall, I’d say, a pretty well-informed community. I really feel that they look to Hoag Hospital as a leader in health care, and also they look to us for that kind of sound advice. And so I have not been seeing the same kind of pushback. I think the compliance has been probably better than in most years, and I think that has a lot to do with how we crafted the message to the community. But also, like I said, we are fortunate. We do have a very involved, engaged community at baseline.

Kevin Pho: So I also want to harken back to the COVID vaccines and messaging. So I’m hearing that the side effects potentially of the COVID-19 vaccine can be a little bit more intense than the flu, and that may prevent some people from getting their second shot. Now, from a messaging standpoint, how do you anticipate communicating that message to patients and perhaps being transparent about the potential side effects that can arise from the COVID-19 vaccine?

Grace Lozinski: So I think transparent is the key word here. Already, in our messaging to our staff, for instance, we have been very, very clear that you may experience more intense symptoms, myalgia, maybe low-grade fever, whatnot, that may be a little bit more pronounced than your flu vaccine, knowing that that’s the expectation, but also balancing that with the benefits of receiving the vaccine. And that’s, first of all, hopefully, if it’s as effective as these studies show, not getting the virus in the first place, and then secondly, lessening the symptoms of the illness, essentially, and then thereby decreasing morbidity and mortality.

So I think if we’re really able to demonstrate the benefit, knowing that there may be a trade-off with some more intense side effects, I still feel that within our community, I think most people are very excited for the possibility of this, and also knowing that this may be the way we can develop herd immunity and get out of this pandemic on the other side. So I think that’s the way we’re going to approach it. But we’ll be very clear and very transparent about potential side effects.

Kevin Pho: We’re talking to Grace Lozinski. She is a chief quality officer at Hoag Memorial Hospital Presbyterian in California, and her colleague wrote the KevinMD article “The flu shot is more important this year than ever.” Grace, from a hospital leadership standpoint, do you have any piece of advice that you could give to the practicing clinicians who may be listening to this podcast?

Grace Lozinski: You know, this is, I think, going to be the most challenging few weeks of this entire pandemic for all of us. I think we have to dig deep, remain vigilant, and continue to come together to provide excellent care. I know all of us are tired, but I really feel that we’re coming into the home stretch. But we do need to remain focused. We need to remain unified in caring for the communities that we serve through this pandemic together.

The other thing would be the whole concept of modeling. Our patients are looking to us, some of our colleagues and other professionals, our nurses, our therapists. We’re not, they’re looking at us, or looking at our behavior. So continue to do all the right public health measures, including social distancing, of course, washing your hands, and masking. People are looking to us. We need to continue to remain vigilant and continue to remain diligent in how we are tackling this pandemic in our own behavior, and that includes traveling. If we are preaching CDC guidelines and local health department guidelines, we also have to be very cognizant that, again, we may not be able to travel during this holiday season.

Kevin Pho: And my final question: What is your take-home message that you want to leave with the KevinMD audience?

Grace Lozinski: It’s going to be, again, we need to stay unified and dig deep. We will get through this. There is a light at the end of the tunnel. The vaccine is coming. We are going to be receiving it shortly, and we need to continue to push, push through this, get our communities through it, and again, remain vigilant, not only this time around. But we need to also learn for future reference. This has been an extraordinary time for all of us. Once we do get through this, we have to learn and remember the lessons that came forth and what we went through, and apply those principles in the event of another pandemic coming during our lifetime.

As hard as it is right now, I think for me personally, the best advice I could give is: Let’s not forget what we went through. Let’s take those lessons learned and apply them to future circumstances moving forward, and remain prepared, remain prepared moving forward.

Kevin Pho: Grace, thank you so much for your time and insight, and thanks again for being on the show.

Grace Lozinski: Thank you, Kevin.

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