Madison, Wis. — Flattening the curve, masking up, self-monitoring, social distancing, super spreader. These are just a handful of phrases that became part of our daily vocabulary, courtesy of the COVID-19 outbreak that began one year ago.
Weeks before these terms became commonplace, UW Health began planning for the worst case — well before it was clear we would face an unprecedented pandemic that has since taken the lives of more than 6,000 Wisconsinites, 400,000 U.S. citizens and 2 million individuals worldwide.
It was Jan. 30, 2020, when UW Health treated a Wisconsin resident who just returned from Beijing with mild symptoms suggestive of COVID-19. Fortunately, this individual went straight to University Hospital's Emergency Department upon landing at the Dane County Regional Airport.
"I remember getting a sinking feeling in my chest," Dr. Nasia Safdar remembered after learning that the patient tested positively for COVID-19. Now recovered, this patient was the first to test positive in Wisconsin and only the 12th confirmed case in the United States.
A blip or a pandemic?
"We didn't yet know if this was going to be a blip or a pandemic," said Safdar, UW Health's medical director of Infection Control since 2009. "We had very little information at the time, but my colleagues and I knew we had to prepare for the worst, because the worst was a very real possibility."
UW Health's Hospital Incident Command System (HICS), which is activated to speed necessary response action during emergency health events, began monitoring the situation closely. Soon, the HICS core team was meeting three times a day, seven days a week. Fourteen work groups were formed to address every facet of COVID-19 from testing to supply management.
COVID-19 began spreading quickly throughout Italy and other parts of Europe by early March, making it clear it was only a matter of when – not if – we would soon be hit by a once-in-a-century pandemic.
Soon, large gatherings of people, such as concerts and sporting events, would be cancelled or postponed indefinitely. One of Madison's largest fundraising events – the biennial Friends of UW Health gala benefiting American Family Children's Hospital – went off as planned on March 7 with 1,500 guests in attendance. Had the gala been scheduled just one week later, it would have certainly been canceled.
Life as we knew it was instantly transformed by mid-March. Shelter-in-place orders initially limited travel to grocery and hardware stores or urgent medical visits. Parents began making on-the-fly lifestyle changes, juggling working from home with kids asking for help once classrooms became Zoom rooms. Nightly newscasts started flashing the escalating and heartbreaking counts of COVID-19 cases and deaths.
Non-emergency surgeries, procedures halted
To free up hospital beds and properly train staff for an anticipated surge of COVID-19 patients, UW Health took a drastic step with enormous fiscal implications by postponing elective surgeries and medical procedures.
Meanwhile, plans to greatly accelerate patient access to video and telephone medical appointments were fast-tracked.
"Postponing non-emergent surgeries and procedures was not an easy decision, but retrospectively I think it is clear we did the right thing," said UW Health Chief Quality Officer Dr. Jeff Pothof, who paired with Dr. Safdar as the leading public faces of UW Health's COVID-19 response.
"Some were calling us the 'hysteria hospital,' but I hate to think what would have happened had we not prepared for a surge" which did not materialize at UW Health last spring, but did by the fall when as many as 90 COVID-19 patients were occupying UW Health beds at one time.
Pothof also noted that as a statewide and regional healthcare leader, UW Health's actions signaled the severity of the situation to other hospitals that were still contemplating their response.
Nimble, innovative action at UW
Breaking through slow-moving processes can be challenging in large organizations, but thanks to so many at UW Health who spent days and nights leveraging their expertise, innovative ideas quickly transformed into action.
Within days, UW Health launched its own COVID-19 testing laboratory, opened a drive-up testing site at its Administrative Office Building and facilitated an explosive growth in Telehealth appointments, enabling thousands of patients to get the care they needed without leaving home.
Moreover, thanks to its partnerships with faculty researchers based on the UW-Madison campus, UW Health's COVID-19 response was considerably heightened through groundbreaking inventions and clinical trials. Among them:
Creation of protective face shields for medical staff and an innovative device that instantly made 1,250 seemingly unusable PAPR (powered air purifying respirator) hoods fully functional (UW College of Engineering)
Production of large quantities of hand sanitizer for UW Health (UW School of Pharmacy)
A clinical study to determine the effectiveness of convalescent plasma for patients already infected by COVID-19 (Dr. William Hartman, a UW Health anesthesiologist, is head investigator)
With demands from the public for information growing exponentially, Safdar and Pothof were soon confronted by two extraordinary communication challenges regarding the pandemic response.
First, information was scarce and changing rapidly. Expert advice from those early days – such as don't wear a mask if you don't have symptoms – would soon be proven wrong once it was clear asymptomatic people can easily spread the virus.
"When information was in flux, communicating to our patients, employees and the public was challenging," said Safdar. "They wondered why we are saying one thing today after saying something different yesterday."
As Pothof said, "Science in action is messy, but we didn't want to hold back from changing our tune when new information presented itself. Keeping people safe depends on providing the most accurate guidance possible."
Second, and perhaps even more challenging, was the astonishing degree to which some segments of the public reject scientific facts — a phenomenon for which "there is not an antidote," said Safdar. "In our field, we rely on facts to make assessments and recommendations based on the evidence. What do you need if the truth does not suffice?"
Pothof agrees, acknowledging the strain of trying to keep people safe when some government officials, media outlets and social media platforms embolden the spread of disinformation.
"We did not anticipate the extent to which public figures would work against us by downplaying the severity of the virus or mocking people for wearing masks," said Pothof. "In retrospect, you can see how this opened the doors for those who dismiss basic facts and buy into conspiracy theories."
UW Health: A 'go-to' voice
Pothof and Safdar have led the way in making UW Health a "go-to" voice of authority during the pandemic. Over the past 10 months, UW Health experts have conducted more than 1,000 COVID-19-related interviews with news media outlets ranging from local student publications to NBC's "Today" show.
"The stars aligned for us with Dr. Pothof and Dr. Safdar becoming our primary spokespeople," said UW Health Director of Communications Tom Russell. "Not only are they at the center of our pandemic response, but they clearly understand the vital role communication has in keeping our patients, staff and the public safe. It doesn't hurt that they are also quite skilled in distilling complex information into language that everyone can understand."
In addition to his role as UW Health's Chief Quality Officer, Pothof practices emergency medicine and cares for patients transported on UW Med Flight. Safdar, a widely respected infectious disease expert, received a President's Early Career Award for Scientists and Engineers in 2017, the highest honor bestowed by the U.S. government on outstanding scientists and engineers beginning their independent careers.
Work-life imbalance won't last forever
Achieving a work-life balance during a pandemic has not been easy for Pothof, a father of two girls, ages 6 and 10; or Safdar, a mother of three, ages 8, 15 and 18.
"I wish I could have spent more time at home," said Pothof, "but as my wife keeps reminding both of us, this is not going to last forever. COVID-19 put our field and our institution in the spotlight, so you step up when it's your moment and think about telling stories about it to your grandkids down the road."
Safdar admits there are many days she comes home with little or nothing in reserve.
"My oldest child, who is a college freshman, had to defer a year of college and spend a lot of time caring for the two youngest this past year," she said. "I am very grateful they have been so patient with me." Safdar looks forward to reclaiming more time with her family in 2021, a year she expects will be much better than 2020.
"As more and more people get vaccinated, I'm definitely seeing a light at the end of the tunnel," she said.