March 3, 2022

COVID-19: two years of challenges, lessons, victories

Two years ago this week, the cataclysmic coronavirus known as SARS-CoV-2 arrived in Middle Tennessee.

Crystal Wix, RN, foreground, and care partner Carolyn Forgac work with a patient in the COVID intensive care unit in September 2021.
Crystal Wix, RN, foreground, and care partner Carolyn Forgac work with a patient in the COVID intensive care unit in September 2021. (photo by Erin O. Smith)

It seems like yesterday. It seems like a lifetime ago. Two years ago this week, the cataclysmic coronavirus known as SARS-CoV-2 arrived in Middle Tennessee.

For many health care providers at Vanderbilt University Medical Center, COVID-19 may conjure up feelings of helplessness, trauma and exhaustion at the bedsides of dying patients isolated from their loved ones.

There are joyful memories, too, of amazing comradeship, creativity and determination to achieve what was thought to be impossible — often in days, weeks and months.

The pandemic isn’t over. Fewer than 60% of Tennesseans are fully vaccinated, and at the end of February, more than 1,500 patients were still being hospitalized every day for COVID-19 statewide.

Still, it’s worth noting the two-year anniversary of the pandemic. What follows is a timeline of some of the battles fought, lessons learned and victories won by the brave-hearted VUMC community.

March 2020 — the first month

On March 5, 2020, the same day that the Tennessee Department of Health announced the first confirmed case of COVID-19 in the state, Incident Commander Chad Fitzgerald and other VUMC leaders activated a multidisciplinary COVID-19 Command Center, which initially met several times a day to coordinate Medical Center operations.

From the get-go VUMC had to manage its workforce adroitly, given that a preexisting national nursing shortage was suddenly exacerbated by those who had to quarantine after testing positive for SARS-CoV-2. A labor pool was set up, and employees were cross trained to adequately staff clinical areas of greatest need.

As admissions flooded into the hospital and the newly established COVID-19 ICU, faculty and resident physicians from nearly every specialty filled unfamiliar roles as did registered nurses, nurse practitioners, physician assistants, respiratory therapists and other front-line workers.

To meet the skyrocketing demand for testing, the diagnostic lab team in VUMC’s Molecular Infectious Disease Lab worked round to clock to develop and validate a COVID-19 test. Within six months of confirming its reliability on March 9, the lab had tested approximately 80,000 samples — nearly 1,600 in a single day.

To try to limit the spread of the virus, many visits had to be conducted over the phone. In early March 2020, VUMC’s outpatient clinics were logging fewer than a dozen direct-to-patient telehealth visits each day. Less than a month later, thanks to VUMC Telehealth, the number of daily telehealth appointments had mushroomed to more than 2,000.

May 2020 — the fruits of research

From the beginning of the pandemic, Mark Denison, MD, an internationally known expert on coronaviruses, and his team in the Division of Pediatric Infectious Diseases, evaluated the effectiveness of potential COVID-19 treatments, including remdesivir, the first antiviral drug authorized for emergency use in patients hospitalized with COVID-19.

Days after remdesivir’s approval in early May 2020, VUMC got its first shipment — and was the only medical center in Tennessee that had this life-saving drug. VUMC leaders swung into action and created a multidisciplinary team called COVIDRX to distribute the drug statewide.

By the end of September 2020, when a federal distribution strategy was put in place, the COVIDRX team had responded to more than 1,400 individual patient requests from more than 60 hospitals.

During the past few years, James Crowe Jr., MD, Robert Carnahan, PhD, and their colleagues in the Vanderbilt Vaccine Center have pioneered the development of monoclonal antibodies that can neutralize a wide range of disease-causing viruses.

In early 2020, they obtained blood samples from a couple from Wuhan, China, who, after traveling to Toronto, Canada, were among the first confirmed cases of COVID-19 in North America. Within weeks the VUMC researchers had isolated several antibodies with activity against SARS-CoV-2.

Six antibodies were licensed to the global biopharmaceutical company AstraZeneca for optimization and advancement into clinical trials. Eighteen months later, in December 2021, the company’s combination of two long-acting antibodies, called Evusheld, became the first monoclonal antibody treatment approved for emergency use as an intramuscular injection to protect patients with compromised immunity from SARS-CoV-2 infection.

December 2020 — the arrival of vaccines

At VUMC, Buddy Creech, MD, MPH, Spyros Kalams, MD, and their colleagues conducted clinical trials essential for the approval of two of the first COVID-19 vaccines, which had been developed with unprecedented speed over the course of 18 months.

Denison’s team also contributed to development of Moderna’s COVID-19 vaccine, by analyzing the ability of the vaccine to stimulate robust immune responses against SARS-CoV-2 in a Phase 1 clinical trial. Along with Pfizer’s vaccine, the Moderna product was granted emergency use authorization by the U.S. Food and Drug Administration in December 2020.

As new variants of the virus — delta and omicron — swept into Tennessee in mid- to late 2021, the VUMC researchers continued their efforts to identify broadly protective vaccine candidates.

Country music icon Dolly Parton received her COVID-19 vaccination at Vanderbilt Health Tuesday, March2, from Naji Abumrad, MD, and urged everyone not to hesitate to get their vaccine when they become eligible to receive it.
In early March 2021 country music icon Dolly Parton received her COVID-19 vaccination at VUMC from Naji Abumrad, MD, and urged others not to hesitate to get their vaccine when they became eligible to receive it. (Dolly’s instagram @Dolly Parton)

Equally important to the vaccine effort was the commitment to provide reliable information to the public. VUMC’s William Schaffner, MD, continues to be one of the most frequently interviewed COVID-19 experts on the national news. David Aronoff, MD, and Thomas Talbot, MD, MPH, also have provided frequent advisories to VUMC staff and the community at large.

Another trust builder was Alex Jahangir, MD, MMHC, professor of Orthopaedic Surgery at VUMC, who was serving as chair of the Metro Nashville Board of Health when COVID-19 hit. Metro Mayor John Cooper asked him to lead a newly formed Coronavirus Task Force, and in March 2020 Jahangir began holding daily news briefings on behalf of the task force.


2021-2022 — Communication is key

“Communication is key to everything,” said Kyla Terhune, MD, MBA, associate dean for Graduate Medical Education, who from the beginning of the pandemic has held virtual town halls and emailed regular COVID-19 updates to house staff. “Intelligent, conscientious people do amazing things when they have the information they need to make good decisions,” she said.

VUMC’s President and CEO, Jeff Balser, MD, PhD, agrees.

“The entire region is benefiting from thousands of compassionate and committed VUMC nurses, physicians and staff who are here day and night, so often taking on extra responsibilities without being asked,” he said in his first Medical Center-wide COVID-19 message on March 6, 2020. “You are making a profound difference — and we are all inspired by you.”

Experts agree that 2022 may yet see COVID-19 transition from the wild peaks and valleys of the current pandemic to more stable and predictable “endemic” changes in the infection rate, like seasonal flu. But that doesn’t mean we will go back to a “normal,” pre-pandemic way of working or living.

The wounds are still fresh, as Rebecca (Becca) Tucci, RN, BSN, points out in a memoir about her experiences as a charge nurse in the Surgical Intensive Care Unit to be published this month.

COVID-19 likely will not be the last virulent virus to emerge from a steadily shrinking world, and innovations such as telehealth and Zoom meetings, which found their footing during the pandemic, will continue to transform society.

Hopefully, one lesson stands out: we’re all on this journey together. As the Rev. Sherry Perry, chaplain in VUMC’s main COVID-19 unit, said in November 2020, “as chaplains, we are trained to walk into situations and seek opportunities to bring light into darkness and comfort in the midst of chaos.”

In this respect, Rev. Perry has a lot of company.