Life on the frontline
By Carey Manzolillo, MBA
It was noon on January 23, 2020 when Physician Bryan Wilson, M.D. ’11 answered his hospital’s ER phone and learned that another hospital would soon be sending him a patient. The patient had just traveled from China’s Hubei Province the day before viral symptoms. And “oh and by the way,” the caller told him as the hair rose on the back of his neck, “the patient’s roommate also has symptoms.”
With a sinking feeling, Wilson checked a map. Sure enough, the Hubei Province was home to the city of Wuhan – the epicenter of a new coronavirus. He checked his email history for anything at all from his hospital system about the coronavirus. Finding nothing, he set to work alerting the system and thinking through safety for his people – starting with the ambulance drivers who would need to transport the contagious patients to his St. Luke’s hospital.
Wilson and other physicians around the world received their very first message on the virus less than a month before, on December 30 2019 at 11:59 p.m. But at the time, there wasn’t much concern. Coronaviruses were generally labeled as colds and this one was labeled a “cluster of pneumonia cases” in China.
But by the time Wilson received his first patient, there were 830 cases and 25 deaths worldwide. A single U.S. case had been identified on the other side of the country two days earlier. And yet, it would take another full week for the World Health Organization to declare a public health emergency – something it had only done five times prior to 2020. The virus wouldn’t be called COVID-19 until February 2020.
“We didn’t care about coronaviruses before that day,” says Wilson, an emergency medicine and EMS physician at St. Luke’s University Health Network. “Now it’s all that we focus on.”
Suddenly, outbreaks were everywhere. Newspapers filled with stories about COVID-19. But when the public turned to the scientific community to learn more, published “pre-prints” muddied the water with biased, non-scientific “findings.”
“Science is difficult,” said Wilson. “And if you do science badly, you can come out with data-labeled lies that crumble the underpinning of science.”
One such pre-print study held up hydroxychloroquine as a life-saving medicine for patients with COVID-19. But with one close look, Wilson determined that the research was a single, non-controlled, non-randomized trial, littered with bias. More importantly, the treatment didn’t work.
Yet news outlets continued to talk about the study without understanding its flaws and incoming patients clung to the drug as their COVID savior. Pill mills prescribing hydroxychloroquine based on the misinformation made it difficult for Rheumatoid Arthritis patients — who actually needed the drug to control their disease — to fill regular prescriptions.
“No one would listen to us,” says Wilson. “We had patients demanding the wrong drugs because they heard it on a podcast.”
At the same time, better data showed that steroids were making a positive impact.“The truth is that steroids save lives,” says Wilson, pointing out that only two interventions have consistently saved the lives of COVID patients — steroids and forgoing intubation. “But giving steroids too early can also hurt patients — which is another thing no one wants to hear.”
Although intubating non-COVID patients with breathing issues helps to keep them calm and controlled, it became clear to doctors that COVID patients were different. “Intubation was basically a death sentence early on,” says Wilson. “Statistics showed that patients who were mechanically ventilated and on steroids did much better.”
Still other patients were demanding specific (and less effective) steroids, based solely on misinformation. Wilson found that he had to show some patients where to find correct research and then explain to them what it meant in order for them to accept treatment.
One of the first, and ongoing challenges of the pandemic has been knowledge translation, says Wilson. “How do I take all of this information that I’ve learned and share it with others in a way that they can understand? Not just for the lay public, but for paramedics trying to save lives.”
Certified as an EMT at the age of 16, Wilson knew first-hand that most paramedics (prior to COVID-19) rarely wore more than glove protection.
The longtime Boy Scout and volunteer scout trainer learned the lay of the land by juggling life as paramedic with his Albright classes and medical school at Rutgers. Still preferring field sites to the hospital setting, today he works to bring the hospital to his patients, and to train other physicians to do the same.
So he was uniquely qualified to recognize the cultural shift that would need to happen, beginning immediately, with that first COVID patient transport on January 23.
“I could see the science in front of me,” says Wilson. Recognizing that he would have to implement and manage change, he turned to checklists.
“The first thing we needed to do was teach people how to screen for COVID,” explains Wilson. “So creating pocket-sized checklists is how we started to slowly implement change.” A single crew tested each new process before it was rolled out system-wide.
Meanwhile, the mental toll of COVID-19 on healthcare workers was immense. A Mental Health America 2020 survey showed 93% were experiencing stress and 75% were overwhelmed. Most were understandably worried about exposing loved ones.
To Wilson and other hospital staff, the initial overcrowding of hospitals in New York was terrifying. But the sharp rise in the number of patients who were already dead when paramedics arrived was absolutely traumatizing. Dead on Arrival counts before the pandemic averaged five to nine patients each month. In April of 2020, that number spiked to more than 20.
But there was a light at the end of the tunnel in the promise of vaccines. Wilson calls mRNA vaccines a true marvel of science.
“The very first study on an mRNA vaccine was published in 1994,” says Wilson. One of those doctors is now the leading expert in mRNA technology at Pfizer. Says Wilson, “mRNA tech is going to change the world.”
Wilson is proud to note that his immunity expertise was actually learned before medical school at Albright College. He also learned the fundamental differences between RNA and DNA in Albright’s classrooms. Working daily to translate his knowledge for misinformed people, he sometimes wishes his patients had taken the same classes.
“I’d never heard of misinformation or disinformation before this pandemic,” says Wilson, referring to them as political tools.
“Fortunately, I was ready to tackle what I didn’t know and what I needed to learn because I was here [at Albright]; because I spent years learning from some of the smartest people who challenged me to think beyond what I knew. I had some of the best teachers in the world,” says Wilson.
“You can find your strength,” Wilson told a crowd of Albright students. “It’s here – whether it’s academic or personal – you’re going to find something here that’s going to support you as you go forward. I didn’t even see it when it was right in front of me. Dr. Campbell knew where my life was going. She could see what I wanted and Albright gave me all of that. I’m so thankful for how what I learned at Albright allowed me to move forward in this pandemic.”