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Aug 03
We All have a Role in Stopping the Pandemic. My Dad Deploys for NDMS. He is Risking His Life for Others.

I need to talk about this patriot for a minute. You can't see, but under this mask is my dad. He just returned home after being deployed by the U.S. Department of Health and Human Services’ (HHS) National Disaster Medical System (NDMS) to fight in one of our nation's COVID-19 hotspots, South Texas.

 


There is power in first-hand accounts. Many of you are probably like I was a few weeks ago, personally untouched by the virus. You've seen all the horrid stories of death on the news. You probably know a few people that have tested positive for the virus, but they haven't died. A coworker's friend's grandfather may have passed away, but still you haven't had to bury any of your own.

The most personal casualty for you up to this point has been your mental health and summer plans, which is no small thing, mind you. But the death is just far enough removed that the initial lock down adrenaline has worn thin and a numbness to it all has set in.

When my dad called me last week, my heart began to pound. I knew that he had deployed with NDMS. He been running off to disasters for more than 15 years now, ever since seeing the devastation caused from Hurricane Katrina. As a member of the NDMS Disaster Medical Assistance Team in Tennessee he sets up medical tents and triages and treats patients who have survived hurricanes, floods, and earthquakes... he was even in Haiti after the earthquake that killed 220,000 people in 2010. He's seen some of the worst natural disasters recorded in our lifetime. But he's never called me on a deployment before. He's never had the time. So when the phone rang, I leapt out of my seat and answered the call. I quickly realized he still didn't have the time, he had TO MAKE the time. For his own well-being, he needed to tell me his story.

 


"I lost count of all the code blues today," he said. I had never heard him so tired, fearful, or overwhelmed. The hospital he was deployed to normally has one intensive care unit (ICU) with 50 beds. He was operating out of the hospital’s fourth make-shift ICU in the basement. The hospital was overrun with COVID. What was one floor of ICU patients had turned into four floors scattered between three different buildings within a matter of days caring for approximately 270 patients. Added to this, was a waiting list from surrounding hospitals desperate to send patients to a hospital where more resources existed.

"We only hydrate before and after our shifts," he said. They were too afraid to lift their masks while they were in the hospital. Death was all around them. Every time the intercom crackled, a room number was announced and the battalion of scrubs scrambled. Another patient, dead. When they changed shifts, the incoming doctors asked for the list of rooms that would not make it through the night...the list was endless.

 


"I looked over at my colleagues in the elevator and I wondered, is it me or you today?" he said. While he was deployed four of the staff fell ill to COVID-19, including the director of the ICU. The more one works, the more tired one gets, the more susceptible one becomes to the virus. NDMS has deployed thousands of health care professionals throughout the U.S. but there still wasn't enough help. During a round, he would call for nurses or respiratory therapists. An hour later they would run in, apologize, and call out the room number that had coded and kept them preoccupied.

"They're all dying alone," he said. He had to call the wife or the son/daughter of the patient and tell them their loved one was not going to make it through the night. The nurses held up iPads as the family wailed on the screen saying their goodbyes. When the call ended, the nurse dialed another number and ran to the next room.

"This is a pandemic," he said.

My dad is home now after serving 14-days of 12 hour shifts. This is what he is trained to do. It’s his personal call to help others when others are at their most vulnerable.

“I’ve already gotten called up for my next mission,” he said to me a few days after his return. As a federal intermittent employee with NDMS my dad can turn down a deployment, and some providers do because of their regular full-time health care jobs in their own communities. I know my dad won’t turn them down. If there is a way he can go, if he can make sure his shifts are covered, he will always go. He always does.

I share this story because I am proud of my father. I hope that his experience can enlighten your decision to practice good protective measures. We all have a role to play. Stay home as much as possible and otherwise practice social distancing, and wear a face mask. I have seen and heard bold displays of willful ignorance in the name of "patriotism." But this is not patriotic. It's traitorous to the medical workers risking their lives to save our countrymen. Just like a bullet can kill a soldier in battle, so can your cough on a vulnerable citizen.

Real patriots wear masks. You can save a life. You can save my dad's life.

For more information on how to help stop the spread of COVID-19, visit the Centers for Disease Control and Preventions webpage “How to Protect Yourself & Others.” For more information about NDMS, and other deployable resources made available by HHS and its Office of the Assistant Secretary for Preparedness and Response, visit www.phe.gov

Are you interested in taking on new challenges to protect health and save lives during disasters and public health emergencies? If so, join our NDMS teams. We are currently hiring physicians, nurse practitioners, nurses, respiratory therapists, paramedics, and physician assistants.

Jun 29
The Evolution of Influenza Preparedness during the COVID-19 Pandemic

New Federal Strategy Brings Continued Focus to Modernizing the Domestic Development and Manufacturing of Life-Saving Influenza Vaccines

On September 19, 2019, President Trump issued an executive order calling on public and private partners to modernize influenza vaccines to strengthen national security and public health. Today, I am proud to announce that the National Influenza Vaccine Modernization Strategy 2020-2030 has been released.  This strategy is aimed at building domestic capacity and capability through the use of new technologies to speed up the overall process of influenza vaccine manufacturing as well as other complementary medical countermeasures (MCM).

Strengthening Domestic Manufacturing and the Supply Chain

First, we must find end-to-end solutions by strengthening and diversifying influenza vaccine development and manufacturing, and address issues that threaten the supply chain.

We must strengthen our domestic manufacturing capacity to protect the American people from the threat of pandemic influenza viruses. By supporting a stronger vaccine enterprise, we not only enhance our ability to manufacture influenza vaccines, but we also can strengthen domestic capabilities that may be used to address other new and emerging threats.

Alternative manufacturing techniques – including cell-based, recombinant, and other synthetic technologies – have the potential to speed vaccine development and enable us to save more lives during an influenza pandemic. Innovations in adjuvants - ingredients used in some vaccines to help create a stronger immune response in people receiving the vaccine – are already being used to make effective vaccines that use less antigen.

These modern approaches are used to manufacture and optimize many different kinds of vaccines. By diversifying and strengthening U.S. manufacturing capacity and enhancing manufacturing techniques, we can help ensure the timely development of safe and effective vaccines to combat influenza and other emerging infectious diseases as well. 

Promoting Innovation

Next, the National Influenza Vaccine Modernization Strategy calls on public and private partners to push the boundaries of science and find new, innovative ways to detect, prevent, and respond to this old and persistent threat. Influenza viruses are constantly evolving and changing and we must use targeted investments and strong partnerships – including non-traditional partnerships - to help ensure that our response to this threat is one step ahead of the virus. 

Today, there are many potentially transformative approaches and technologies on the horizon - from platform technologies to innovative partnerships to the development of a universal flu vaccine that could provide robust, long-lasting protection against multiple strains of influenza. Moving these and other potentially groundbreaking technologies off the drawing board and into the clinic will require dedication, planning, and targeted investments.

In just a few months, the Trump Administration has spurred the development of a broad portfolio of innovative MCMs to address COVID-19, many of which rely on platform technologies. In fact, all five of the vaccine technologies currently supported as part of BARDA’s COVID-19 vaccine portfolio leverage platforms. By continuing to invest in platform technologies, we may be building our nation’s overall capacity to face persistent health security threats like influenza and new pathogens.

Protecting More People

Finally, the National Influenza Vaccine Modernization Strategy focuses on finding new ways to increase influenza vaccination in America. Although vaccination is the best way to protect against influenza, a shocking number of people – about 55 percent of adults and 48 percent of children during the 2017-2018 flu season – did not get vaccinated to protect themselves and the people around them from influenza.

We must also work to help ensure that new technologies are being developed to enable everyone to get vaccinated. Influenza vaccines must continue to be developed and refined to better protect special populations, including the elderly, young children, and people with special underlying medical conditions – the people who are often most vulnerable to influenza outbreaks and pandemics.

Partners across government and industry must work together to expand access to influenza vaccines, help people better understand the risks they face from influenza vaccination, make it easier to administer the vaccine, and enhance influenza vaccination tracking.

The Path Forward

Effectively protecting the American people from influenza disease, particularly an influenza pandemic, is a daunting challenge. We must take on that immediate challenge. Both federal and non-federal investment in influenza pandemic response is vital to help us prepare for the next influenza pandemic. Investing in enhanced platforms and domestic manufacturing capacity to support MCM, as well as promoting MCM access and uptake, will enhance our nation’s ability to address a variety of pandemic threats beyond influenza.

Now is the time for federal, state, local, tribal and territorial governments, private partners, non-governmental organizations, academia, professional associations, and international stakeholders to come together to embrace, coordinate, and develop next-generation technologies and solutions to combat seasonal influenza outbreaks and future pandemics. Many of the efforts described in the strategy can boost readiness to other emerging infectious disease like COVID-19. To learn more, check out the National Influenza Vaccine Modernization Strategy.

Jun 22
Why sepsis solutions can help COVID-19 patients


Assessing sepsis predictive technologies to aid in the pandemic response

In the current pandemic, ICUs worldwide are caring for COVID-19 patients with life-threatening multiple organ dysfunction, in other words, sepsis. This trend provides a stark reminder that sepsis is likely to arise as a secondary confounder of any health security threat, whether in the current coronavirus pandemic or a future public health emergency.

BARDA focuses on developing safe, effective medical countermeasures, such as vaccines, treatments, and diagnostics, against all potential health security threats the United States faces – chemical, biological, radiological, nuclear, pandemic, and emerging infectious diseases. Being fully prepared for those threats requires real solutions for sepsis.

In 2018, BARDA launched the DRIVe Solving Sepsis program to expand the range of tools to reduce the incidence, morbidity, mortality, and cost of sepsis, and to prepare for health security threats. Sepsis, a term still unfamiliar to many Americans, is a dysregulated response to infection leading to organ dysfunction.

Any infection can lead to sepsis – a bacterial infection, seasonal influenza, or SARS-CoV-2. Sepsis is far reaching, affecting individuals of any age from neonates to the elderly, and can be life threatening. The CDC reports more than 270,000 lives are lost to sepsis each year in the U.S., among more than 1.7 million cases. In years with major public health events, like COVID-19 that can lead to viral sepsis, those numbers can climb much higher.

Diagnostics for SARS-CoV-2 infection are critical to the response, but they don’t tell the whole story. Roughly 20 percent of those infected become severely ill and require hospitalization. There’s a need to identify COVID-19 patients who are on the path to sepsis. BARDA is exploring whether technologies that may predict sepsis can aid healthcare providers and COVID-19 patients in early identification of health deterioration before patients fall victim to sepsis. If providers could identify those patients sooner, both in hospitals and remotely in other care settings, those professionals could make informed, strategic decisions about the critical resources needed and better target early interventions to improve patient outcomes.

Pilot studies launched through the Rapidly Deployable Capabilities team, as part of the BARDA-COVID-19 medical countermeasure response, will evaluate utility of these technologies for COVID-19 patients and potentially against any future public health threat to our nation. Since the sepsis technologies are agnostic to the source of infection, validating their use builds real solutions to any emerging infectious disease outbreak.

BARDA partnered with Cytovale and Immunexpress; both are developing diagnostic devices for rapid assessment of blood biomarkers that identify or predict the onset of sepsis. These host-blood-based technologies are being evaluated for their ability to detect sepsis earlier in COVID-19 patients. The rapid turnaround and minimal blood volume needed could provide results indicating sepsis in COVID-19 patients in tandem or faster than molecular SARS-CoV-2 confirmation results.

BARDA also extended our partnership with Beckman Coulter for the COVID-19 response. Beckman Coulter is working with Dascena to develop a machine learning algorithm to predict using their Early Sepsis Indicator results combined with clinical and vital sign data from the Electronic Health Record to determine the likelihood of sepsis prior to the onset of clinical symptoms. These sepsis diagnostic tools identify the risk of severe patient outcomes, providing critical information for clinical management and allocation of precious hospital resources.

In parallel, we are working with the Sepsis Alliance to broaden training and education for healthcare providers to draw the connection between emerging infectious disease, like COVID-19, and sepsis and   the need to monitor the long-term health of COVID-19 sepsis survivors.

Solving sepsis means identifying critical solutions to protect those most vulnerable to infection and to fortify the nation to be better prepared for future health threats. The nation needs technologies that address sepsis of any etiology, including viral sepsis caused by emerging infectious diseases like COVID-19. We will continue to work with innovators and entrepreneurs around the country to advance capabilities and provide validated solutions.

Jun 12
Honey! I just saved a life! Donating blood or plasma can help you save a life in your community

Saving someone’s life can be pretty simple.  As a volunteer EMT and firefighter in my community, I have gone through a lot of training so I can provide life-saving care when seconds count. I am proud to serve on the frontlines of the response to COVID-19, both in my volunteer role and as a responder from the U.S. Department of Health and Human Services.

Yet you don’t necessarily have to do all of that to help people in your community.  Sometimes, all you need to do is dedicate a little time - and be willing to give up about a half a liter of your blood. A single donation can save up to three lives, and it’s a safe way to help others in need, especially as we continue to fight COVID-19.

Much of modern healthcare relies on the steady, regular flow of blood donations. Patients who are getting cancer treatments, organ transplants, treatment for traumatic injuries, and are undergoing many other medical procedures all rely on blood donations.

Right now, the American Red Cross reports an urgent need for blood and platelet donations. As America opens up again, many people are getting medical procedures that were put on hold due to the COVID-19 pandemic. In addition, people who have recovered from COVID-19 can donate their plasma, which can be used as a treatment for hospitalized patients. Volunteer blood and plasma donations are needed to support these procedures as well as other medical needs.

To help meet this critical need, my friends and I agreed we would get out there and donate – and I am proud to say that I was the first one!  

Right now, you have to make an appointment to donate – walk-ins are generally discouraged due to social distancing requirements across the country. I went online and at first it looked like all of the donation slots were full, but I called my local blood donation center, and it turned out they did have times available! They were just having problems with their website. So, I scheduled my appointment and went to my local blood donation center.

Although some people are concerned that they could contract COVID-19 while donating blood, the risk is low and blood donation centers are taking precautions to protect their patients. When I donated blood, I was really impressed by all of the precautions the administrative and healthcare professionals at my area donation center were taking to help keep everyone safe.  They only allowed four people in to donate blood at a time, social distancing measures were in place, and they were sure to keep everything spotlessly clean and sanitize surfaces frequently.

When I arrived, I got a temperature screening, an interview, and a blood pressure test. Next, I sat back while the nurse pricked my arm and just waited until the donation was complete. For most people, the blood donation process is pretty quick. On average, it just takes an hour and 15 minutes to donate blood.

One of the great things about donating blood these days is that you know your donation really helps someone; in fact, I got a notification on my phone when someone received my donation! I turned to my wife and told her that I might have just saved someone’s life. It was pretty cool!

Today is World Blood Donor Day, and it is a great time to consider donating whole blood or plasma to help people in your community. Almost anyone who is in good health and over the age of 16 or 17, depending on the type of donation and the state where you live, can donate. 

If you have recently recovered from COVID-19, you also may be able to donate plasma to help fight the pandemic. Donating convalescent plasma, a possible treatment for the virus, allows you to share your potentially life-saving antibodies with people who are currently hospitalized with severe COVID-19 infections. Donating plasma does take a little more time – about three hours.  In order to donate, you must have a prior, verified diagnosis of COVID-19, but be symptom free and fully recovered at the time of your donation.  You also need to be at least 17 years old, weigh more than 110 pounds, and feel well. If you think you may be able to donate convalescent plasma, check out The Fight Is In Us, which offers a free analytic tool to help you assess your eligibility.  If you are able to donate, you can schedule an appointment at one of the many accredited donation centers across the country

Donating whole blood or plasma only takes a little time – and a prick on your arm – but your donation can be used to help save someone’s life and make your community a little bit healthier.


Jun 11
Hurricane Season 2020: Preparing During the COVID-19 Pandemic

As we enter this year’s hurricane season, our nation has been battling a raging storm of a different type for the past five months – Coronavirus (COVID-19). The Healthcare and Public Health (HPH) community has tirelessly worked to provide care, move resources, and identify measures for treatment and prevention. With the first official day of the 2020 Atlantic and Pacific hurricane season on June 1, and the National Oceanic and Atmospheric Administration predicting above-normal storm activity, the HPH community must look at how to prepare for a unique hurricane response season. 

Responding to hurricanes during the COVID-19 pandemic presents many challenges that are usually not incorporated into regular planning considerations. Some considerations that should be made include:

  • How will facilities and systems respond to a hurricane with already reduced and over extended staff?
  • Are there evacuation plans for those diagnosed with COVID-19 or for high risk populations that have a greater chance for severe COVID-19 illness?
  • What resources and capabilities are currently being heavily utilized during COVID-19 treatment and response efforts, but may be threatened due to potential storm trajectories?

To support emergency managers and public health officials better prepare for all-hazards disasters, while continue to respond to and recover from the COVID-19 pandemic, FEMA has released the COVID-19 Pandemic Operational Guidance for the 2020 Hurricane Season.

Disaster support personnel will be working in a much different environment than they typically see during hurricane season. Response teams should be prepared to lead scalable and flexible response operations, and acknowledge that many aspects of disaster response may be conducted remotely this year. Organizations and communities throughout the nation are embracing adjustments to account for the realities and risks that COVID-19 brings to hurricane season.

For example, plans may look different this year for procuring and distributing personal protective equipment (PPE) to workforce members, first responders, search and rescue teams, logistics support, and field health and medical professionals. Additionally, enhanced safety measures including health screenings, facility cleaning and disinfection measures, and social distancing requirements for onsite individuals will need to be considered.

Although social distancing will be difficult for onsite individuals during hurricane recovery, every effort should be made to follow social distancing guidelines as possible to help prevent further complications during recovery. The Centers for Disease Control and Prevention (CDC) maintains updated guidance and social distancing requirements for COVID-19 that can be accessed by entities and individuals.

Preparation is the best way for communities to stay safe during hurricane season. COVID-19 has introduced the need for extra precautions for individuals and organizations to consider. Disaster supply kits including medications, batteries, water, and food, may now include personal disinfectant and protective items like hand soap, sanitizer, and face coverings and gloves.

In past hurricane seasons, the collaboration of public and private sector leadership through mechanisms such as ASPR’s HPH Sector, FEMA’s National Business Emergency Operations Center, and the Department of Homeland Security’s Cybersecurity and Infrastructure Security Agency Cross Sector Council are key.

These public-private collaborations  have been regularly occurring to coordinate the COVID-19 response  and include  resource sharing, bi-directional information sharing, and advanced action implementation that mitigated the severity of impacts to the nation’s health systems and operations. We see these collaborations continuing into the summer, with, conversations expanding to include identification of threats, challenges, and needs that may be exacerbated in the face of a hurricane or natural disaster. 

The National Hurricane Center is an important source of information to stay aware of developing and approaching storms. The ASPR Technical Resources, Information Exchange and Assistance Center (better known as ASPR TRACIE) is a useful free resource for healthcare responders including best practices and plans. The ASPR Division of Critical Infrastructure Protection produces multiple communication bulletins to provide HPH stakeholders with information, resources, and tools to optimize their abilities to respond, recover, and prepare for threats and incidents impacting the nation’s health critical infrastructure. For more information on how to engage or become a member of the HPH Sector, contact cip@hhs.gov; and join the HPH Sector Highlights listservs today.

Jun 04
emPOWER AI: Harnessing the Power of Artificial Intelligence to Drive Data to Frontline Emergency Responders

In an emergency response, timing is everything. As hurricane and wildfire season gets underway, think back to the 2017 historic hurricanes and wildfires which presented new challenges not only for the scale but also for the impact to critical infrastructure. To help those on the frontline and some of our country’s most vulnerable citizens, emPOWER had to innovate and offer a tool that could deliver data with minimal actions and in seconds.

Three years ago, responders and volunteers rapidly rostered and deployed to areas on the shores and hills of Puerto Rico and U.S. Virgin Islands and in the mountains and valleys of California to help those at risk and adversely impacted. Many of these areas faced communication challenges due to critical infrastructure damage which caused intermittent internet and cellular service that minimized their ability to use the HHS emPOWER Map, a public, interactive map to obtain data on the total number of at-risk Medicare beneficiaries in a geographic area, down to the ZIP Code.

To address critical needs that arose and help save lives, the HHS emPOWER Program leveraged the power of artificial intelligence and mobile device applications to create emPOWER AI, a free, voice-activated tool available on Amazon Alexa and Google Assistant mobile device applications. emPOWER AI instantly puts HHS emPOWER Map data into the hands of every emergency responder in every community.

This award marks a milestone in the HHS emPOWER Program’s efforts to help communities assist electricity and health care dependent populations. Incidents, emergencies, or disasters, such as the 2017 hurricanes and wildfires, disproportionately affect at-risk populations, such as older adults and disabled populations and those with a chronic illness.

Disasters continually demonstrate that people who rely on electricity-dependent durable medical, assistive equipment or devices to live independently in their homes can be rapidly thrust into life threatening situations in the event of a disaster and particularly those that result in a prolonged power outage.  

emPOWER AI gives users accurate, timely data and information to help them Phone showing emPOWER AIanticipate, plan for, and respond to the needs of electricity-dependent individuals in their communities. This data can support emergency preparedness and response activities, such as planning for shelters and recharging stations, evacuation routes and accessible transportation and identifying geographic locations that may require more first-responder assistance.

Local community centers and volunteer organizations can use the data to identify areas that may require additional assistance and possibly offer backup power recharging support as well.  

Are you interested in data-driven support population-based situational awareness in your area? Get emPOWER AI on Amazon Alexa or Google Assistant today as hurricane and wildfire season begin!

emPOWER AI and the HHS emPOWER Program represent ASPR and the Centers for Medicare & Medicaid Services’ dedication to emPOWERing communities to protect health and save lives of at-risk populations prior to, during and after a disaster. To learn more about the HHS emPOWER Program, please visit https://empowermap.hhs.gov/.


May 20
A Critical Time to be in Public Service: A Perspective from a Pair of Experienced Doctors Caring for COVID-19 Patients

As critical care physicians, we can think of no more important time to be in public service than now. Across the country, thousands of healthcare professionals and scientists - not only from the private sector but also in the public sector - are fighting to save lives amid the worst pandemic the world has seen in the last 100 years. We are honored to count ourselves among both groups.

As physicians we are treating COVID-19 patients in Intensive Care Units; as professors, we are teaching the next generation of critical care physicians, and while both roles are rewarding, we are just as inspired to be serving the entire nation right now as part of the Solving Sepsis team in BARDA’s Division of Research, Innovation and Ventures (DRIVe). From our unique vantage point, we see firsthand the contribution public service makes to healthcare providers’ day-to-day efforts to save lives.

Experts in government agencies provide timely guidance, like the NIH guidelines for diagnosing and treating patients with COVID-19; they facilitate the sharing of experience across the healthcare community through teleconferences, webinars, and assistance centers like ASPR TRACIE. They offer a systemic ‘bird’s eye’ view of the challenges, the promising practices, and the latest scientific data healthcare professionals need as we carefully balance limited resources to support the best possible patient outcomes for our COVID-19 patients.

Relying on the time-tested tools of partnership, science and education, government experts from our Solving Sepsis team, along with others from BARDA and across HHS, are driving the development of much-needed medical products for this pandemic. Already BARDA is supporting development of 31 medical countermeasures - diagnostic tests, devices, treatments, and vaccines. As advisors to the Solving Sepsis program, we are supporting our Rapidly Deployable Capabilities team on pilot studies of new technologies and tools that may aid in diagnosing or triaging COVID-19 patients. Some of these products, begun under the Solving Sepsis program, are now part of BARDA’s rapidly expanding COVID-19 medical countermeasure development portfolio.

We also are able to bring our expertise to the Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) program. This new, national, public-private partnership will identify the most promising candidate interventions, test them quickly at national scale, and work to ensure that they are available to all who need them, when and where they are needed.

Everyone working on these initiatives is driven by a profound sense of urgency, yet what we’re doing in public service resonates with the two of us for another reason: sepsis. Thus far, data worldwide indicate that up to a quarter of all patients hospitalized with COVID-19 require ICU admission in order to treat the life threatening organ dysfunctions that define sepsis,, and those who die do so largely due to the effects of that sepsis. That means to save lives, scientists need information and medical countermeasures not only for COVID-19 per se, but for sepsis as well. We know our country needs sound science to help solve the mysteries of why, for so many people, this coronavirus infection leads to sepsis and how to overcome it. Ideally, the answers lead to discoveries about solving sepsis no matter its cause.

We hope that as other healthcare professionals look at the battle against COVID-19, they will consider public service as a way to make a difference and contribute to the scientific discoveries that help save lives. To find out about positions that are currently open, visit USAJobs.gov.

May 15
Raising Awareness: Many roads lead to sepsis, even for COVID-19 patients

COVID-19 patients who are ill enough to require admission to an intensive care unit (ICU), often suffer from a major organ dysfunction. As a pair of critical care physicians with more than 80 years of combined service at the bedside in the ICU, we have spent our entire professional lives caring for patients with life-threatening organ dysfunction resulting from infections. We recognize this condition; it’s called sepsis.

While the most widely reported organ dysfunction for COVID-19 patients involves the lungs, many of these patients also have some combination of heart and blood vessel dysfunction, brain and nerve dysfunction, blood coagulation dysfunction, and kidney dysfunction. The severity of these dysfunctions beyond the lungs and the rate at which they are occurring are remarkable—even to experienced ICU staff.

Thus far in the pandemic, ICUs worldwide are reporting that some patients who have COVID-19 severe enough to warrant admission to the ICU require at least temporary dialysis. ICU doctors, nurses, and allied health personnel think of this as life-threatening multiple organ dysfunction due to infection with the SARS-CoV-2 virus. In other words, sepsis.

These patients are far from alone. A landmark study published in Critical Care Medicine in February, found that even before the pandemic, sepsis was increasing, especially among older Americans. While most sepsis is caused by bacteria, sepsis caused by viruses (“viral sepsis”) is familiar. We treat it every year when it is caused by influenza during flu season. Even when caused by less common viruses such as Ebola, the problem – and the treatments we apply — are all aimed at “bad viral sepsis”.

Why is this important?

Timely recognition and treatment of sepsis –bacterial or viral—is key to saving lives. Everyone—professionals and the lay public—need to know the signs of sepsis and the importance of seeking medical attention when sepsis appears. The CDC offers a large collection of educational material to help healthcare providers and patients on the Get Ahead of Sepsis website.

A simple memory aid may also be useful, such as the Sepsis Alliance acronym TIME:

  • T: A high Temperature or fever
  • I: Signs of Infection, such as the dry cough, which has been a common manifestation of COVID-19 progression.
  • M: Mental confusion that is typically precipitated by the low oxygen levels commonly experienced by those affected with SARS-CoV-2.
  • E: Extremely ill, as symptoms accumulate and become more severe, including the subjective sense that things are getting worse.

While all four of these signs may not be present simultaneously, each can herald the decompensation that is sepsis. If you or someone you know has at least a couple of these symptoms, it’s TIME to seek immediate medical attention.

The foundation of sepsis care is supporting the dysfunctional organs so they can recover as the body fights off the infection. Treatments may be necessary to counteract the virus (in this case, SARS-CoV-2) as well as the progression to sepsis and managing the condition. These treatments include anti-viral treatments, immuno-inflammatory treatments, and/or organ-specific treatments. Ventilators are used to support the lungs, dialysis machines are used to support the kidneys, and anticoagulation therapy is used to prevent and treat thrombosis.

While there are general clinical guidelines for the use of such well-established treatments for sepsis, doctors are studying modifications to these treatments so that they are most effective in treating patients whose sepsis is brought on by severe COVID-19. BARDA is supporting clinical trials of some of these treatments being studied specific to COVID-19.

As scientists unravel the “why” behind specific dysfunctions caused by SARS-CoV-2—why the kidneys stop making urine, why blood clots when it should otherwise be flowing, why the lungs fill with fluid—doctors will apply that knowledge to give patients the best chance to recover.

We hasten to add that we are still learning, even as we treat patients every day in our ICUs. Like you, your families, your friends, and your colleagues, we too struggle to find the best way forward. We hope that by bringing our sepsis perspective to the public health emergency, we can help you—and the world—understand just a bit more clearly what the virus is doing and what can be done to control its effects.

Apr 24
Medical Reserve Corps volunteers’ hands felt at every level of the response to COVID-19

A volunteer nurse gathers nasal swabs at a drive-through testing site in Bremerton, Washington. A team delivers food to vulnerable community members in Framingham, Massachusetts. A unit in Columbus, Ohio, conducts temperature checks and assists at a shelter for homeless community members who test positive for coronavirus or COVID-19. Volunteers in New Mexico assemble and pack boxes for food banks. In each community, neighbors, coworkers, kids’ schoolteachers, and patients recognize them.

All have one thing in common: They are volunteers with the Medical Reserve Corps (MRC), and around 250 state and local units are working in all regions across the country in response to COVID-19. They are engaged in many aspects of the public health and medical response to the pandemic, including community outreach, patient testing and monitoring, contact tracing, providing medical surge support at hospitals, and setting up and managing alternate care sites.

The MRC is a national network of volunteers, organized locally, that comprises approximately 175,000 members in some 850 community-based units throughout the United States. They are medical and public health professionals, as well as other community members without healthcare backgrounds.

With a reputation for reliability and expertise, MRC volunteers are often called by local and state authorities to respond to emergencies that strain resources beyond their capacity.

The missions are many and as varied as the needs of the individual communities, and those of their most vulnerable neighbors. There is no way I could recognize even a tenth of the units or their missions in this brief note. But I do want to give a sense, for those who do not know the MRC’s work, of the diversity of demands on each of these units, and their agility and flexibility to respond to them.

Sometimes, a unit provides a good example of both, the diversity and the number of missions that need to be tackled simultaneously. That’s the case of the Dutchess County MRC unit, in Poughkeepsie, New York, whose medical and mental health professionals conducted rounds three times a day with 100 sick homeless individuals who are staying in housing provided by the county.

As Dutchess County was preparing to open a recovery center, an alternate care site to provide services should local hospitals exceed their capacity, around 50 Dutchess County MRC members were trained to operate the facility.

Meanwhile, the unit’s volunteers are staffing a call center seven days a week; and remotely monitoring individuals and families in quarantine. To support the stay-at-home orders and ensure that everyone in the community is cared for, the unit is delivering groceries and medications to individuals in isolation; helping with grocery deliveries from food banks to those without transportation; and providing meals for senior citizens.

More than 1,300 volunteers from the New York City MRC unit have staffed healthcare facilities and nursing homes across the five boroughs, as well as supported mortuary operations at local hospitals.

In the nation’s capital, the volunteers with the District of Columbia MRC unit are assisting with COVID-19 walk-up, drive-through, and clinic testing operations.

The state of Louisiana has been hit hard by COVID-19, and the New Orleans MRC unit has responded accordingly by continuously expanding its response missions. Its volunteers are monitoring temperatures at a nursing home and municipal building and providing basic medical support for homeless community members now housed in hotels in the area. The unit also provides logistical assistance at an alternate care site and has physicians, behavioral health, triage, registration, and specimen packaging support personnel working at a community-based testing site.

In Lake Charles, the Calcasieu MRC unit was called into action to support the local community-based drive-through testing site, and MRC volunteers are coordinating the procurement, storage, and delivery of supplies. The unit is also coordinating the logistics and warehousing of the personal protective equipment (PPE) needed to manage COVID-19 response efforts.

The magnitude of the COVID-19 pandemic is only comparable to the unprecedented expanse of the response to it. I’m proud of the work all units of the Medical Reserve Corps are doing, and I’m touched by the willingness and humility of all volunteers to jump into whatever the needed task is at that moment.

MRC units are assisting with call center operations; community education and outreach (e.g., assisting elderly and vulnerable community members with well check calls, temperature monitoring, errands, food distribution, medication pick-up); logistics support (e.g., inventorying and distributing personal protective equipment, setting up drive-through tents and mobile field hospitals); patient case and contact investigations; patient monitoring; community screening and testing operations; and surge support at long term care facilities, health care facilities, and alternate care sites (including emergency isolation shelters).

It is clear to me, once again, that when the MRC volunteers are called to respond to an emergency in their communities, they are also responding to another calling, their own.

They have my gratitude and that of their communities and the nation for their tireless efforts and for their professionalism, dedication, and commitment to serve.


Mar 19
Virtual Wedding Bells

Disaster Medical Assistance Team Helps Unite Father under Quarantine with his Daughter on her Wedding Day

At quarantine sites across the country, some passengers from the Grand Princess are missing important milestones as they wait out their quarantine, but responders from the National Disaster Medical System (NDMS) are committed to making things a little bit easier for them. Earlier this month, NDMS responders helped a dad who was not able to be physically present virtually walk his daughter down the aisle while he was in quarantine. 

Joel Young attends wedding virtually

Joel Young, a resident of the Phoenix, AZ area and a guest in quarantine at the Marine Corps Air Station Miramar was able to participate in the wedding ceremony of his daughter even though he was over 1000 miles away.   Joel coordinated with a company to provide a robot controlled by a tablet device to enable him to attend the wedding remotely.  

“They called it Daddy-Bot," Joel said as he described his proxy during the ceremony.  As the video broadcast went live, wedding guests walked in front of the camera to wave, say hi and to let Joel know he was missed.  

NDMS responder Sarah Caven first met Joel as she and more than a hundred medical and non-medical personnel from NDMS and the U.S. Public Health Service welcomed over 480 guests from the cruise ship that docked in Northern California to the quarantine site at Marine Corps Air Station Miramar.  As part of the required quarantine to protect the American public from the further spread of the COVID-19, guests were moved to housing on the base and provided services to meet their needs.  

Sarah heard that Joel was trying to join his daughter’s wedding, but was a few pieces of equipment short of a solution and she really wanted to help this dad virtually walk his daughter down the aisle.  So she let him borrow her personal iPad and got him an HDMI cable for his TV so he could control and watch the robot acting as his stand-in. 

Joel had a hard time being so far away from his family and coping with the isolation of quarantine, but he was really touched by the support he received from NDMS responders, including Sarah. “Having you guys with me during the ceremony was so nice. I was a contractor on the cruise ship and traveling alone. I was then restricted to my interior stateroom and then placed in a room alone here.  It has been so lonely,” said Joel.

Three responders in PPE with sparkling cider

A few DMAT staff were able to attend the wedding as Joel’s plus one.  Joel had the yellow-gowned staff in personal protective equipment (PPE) poke their heads into the camera frame to wave.  The wedding guests were pleased to see Joel as he wept in joy seeing the beautiful bride in her dress joined in matrimony. “He is a very nice guy and perfect fit for my daughter,” said Joel.  “I am so proud of the couple they will become.”  

Coping with quarantine is hard for many passengers, but the dedicated professionals from NDMS are working to make it easier for the people they are helping at quarantine locations across the country. 

In communities across the country, community spaces are closing and many people are practicing social distancing to prevent the spread of the novel coronavirus, which can be very stressful.  If you are finding it difficult to practice social distancing, check out these tips on coping from SAMHSA’s fact sheet, Taking Care of Behavioral Health: Tips for Social Distancing, Quarantine, and Isolation during an Infectious Disease Outbreak.


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