Early in the pandemic, Yale Insights talked with Dr. Charles Powell ’19, system chief of the division of pulmonary, critical care, and sleep medicine for the Mount Sinai Health System and the Janice and Coleman Rabin Professor at the Icahn School of Medicine at Mount Sinai. At the time, Powell and his colleagues were just emerging from the devastating first wave of COVID-19, when 350 people were dying from the disease every day in New York City and the staff of Mount Sinai were caring for as many as 2,100 patients while simultaneously researching the brutal new virus. When we spoke again in October 2021, there were 15 COVID patients in the hospital. (The daily case average in New York City has since risen sharply.) The continuing stresses of the pandemic had taken a toll, but, Powell said, a resilient response has made his team and his institution stronger.
Adapted from a phone interview, October 14, 2021.
Q: When we last talked, visitors weren’t allowed in the hospital and you described the halls as eerily quiet during the pandemic’s first wave. What is it like now?
That period when there were no visitors was unspeakably terrible.
Now, everybody has to be masked, but visitors are allowed and the volume of people in the hospital has returned to what it was pre-pandemic. The challenge now becomes gaining competency in discerning grins and frowns behinds masks and reading foreheads and eyes.
I don’t want to call it normal because it doesn’t feel normal. But it’s the new state. It’s likely that we’re going to be wearing masks in a healthcare setting for a long period to come. We’ll have to get even more comfortable with interactions and communicating while wearing masks. And we will.
Q: Who are the patients in the hospital now?
We have 15 COVID patients in our hospital, which is significantly lower than it’s been in a long time and a world away from our peak of 2,100 in the health system. Overall, the types of patients we’re seeing in the hospital are very similar to those we would typically see before COVID.
In the ambulatory clinics, there are new patients who have respiratory problems persisting after recovery from COVID, in the syndrome called PASC [Post-Acute Sequelae of SARS CoV-2 infection or Long COVID] for which we are a major research center funded by the NIH Recover initiative. In addition, we’re encountering more patients coming in for new evaluation presenting with advanced stage disease, particularly those with cancer. Because of the changes in access to diagnostic testing and follow-up care that were necessitated by the pandemic, there are certainly are individuals who have died from diseases that might have been more treatable if detected earlier. This is an indirect and significant impact over and above the 700,000 people who have died directly from COVID in the U.S. to this point.
Q: To what degree have you seen the burnout and resignations that other healthcare organizations and other industries are seeing?
We have 42 faculty in pulmonary critical care and sleep medicine at the main hospital. During the acute phase of the pandemic, 5 left. That is significantly higher than a typical year.
I think many of them left because, like people in other professions, they took stock of how they organize and prioritize their professional and personal time and then made decisions about how they want to structure their lives.
“We’re proud of how we, as a group, responded. We now have more confidence that we can do great things even in the face of great disasters.”
Those who remained—that’s the vast majority—I think, emerged stronger. We learned a lot of lessons about how to cope with severe stresses and with the toll that we confronted during the pandemic. We have grown as a result. We’re proud of how we, as a group, responded and we now have more confidence that we can do great things even in the face of great disasters.
I do see some frustration, especially among trainees who come for a short time of a few years and typically expect to gain experience in caring for a diverse array of complex patients. During the pandemic, they were exposed to a very narrow spectrum of diseases for a long period. They lost out on some experiences that could have enhanced their educational process but gained experiences and learned lessons that were helpful for their education and were fundamentally important to our response. The impact on education is not unique to medicine. Students at every level of schooling are understandably frustrated by the changes to their academic and social experiences resulting from the pandemic.
Q: How was vaccine uptake among the hospital’s providers and staff?
Early on, when it was clear how beneficial the vaccines are and that they are critical to optimally protecting our patients, many of whom are immunocompromised, there was really rapid uptake by physicians, trainees, and nurses. It was slower amongst others in our workplace. Our response to increase vaccine uptake was a robust effort to disseminate information and to directly address questions and concerns from those who were not ready to get vaccinated in a variety of different forums. This was effective.
The next response was the mandate. And that worked too. The number of people who ended up leaving employment at Mount Sinai was very small. People got vaccinated. It was helpful to have the organization-specific mandates backed up by New York’s state mandate for all healthcare workers.
Q: Have you adapted your leadership?
One of many things I learned at Yale SOM was to appreciate the impact that we have as leaders. I’ve been particularly cognizant of the importance of straightforward communication and transparency. From the beginning, I made it a practice to regularly communicate with the team and to be candid and frank, sharing the best information available about the state of the pandemic and what we could expect in the near-term future.
We had these conversations with a regular cadence. I still get feedback from the faculty, trainees, and staff about how important those sessions were for all of us. They created a sense of inclusion and a reality of transparency. That sort of practice is incredibly important for an organization at all times but especially important under the stress of a pandemic.
Another thing I took from my time at SOM was understanding the role of healthcare in society. This pandemic is a societal problem that is based upon a healthcare issue. The impact of interactions between scientists, healthcare, government, and businesses has been exquisitely demonstrated throughout. The development of the vaccines is one example of an extraordinary success.
And while it would have been nice if we had only seen the principles that underlie good business practices embodied to move us forward, we have also seen numerous examples of individuals promoting myths and misinformation. That has hurt our ability to effectively respond to all the threats from this medical problem and has rippling impacts on healthcare, public health, business, and society.
I think we have to focus on, not necessarily quashing the myths, but rather on promoting communication from individuals who can explain the impact of believing in the myths. We need stories that help convince the vast majority of individuals to engage in the types of practices that will allow us all to advance in terms of our quality of life, quantity of life, and sense of well-being. Those are things that we all want.
Q: Are there other changes in healthcare that will emerge from the pandemic?
COVID is terrible on every level. However, from this disaster, there are going to be opportunities to learn to make healthcare better.
Pre-pandemic, setting up a new clinical trial took months. In COVID, we had many very sick patients who could not wait months. We developed a sequential vetting process with parallel processes to accomplish regulatory, human subject, and budgeting reviews with the same integrity and oversight but in a very compressed period of time. Getting from idea to approval within one to two weeks was a norm across multiple medical centers in the country.
Telehealth is another change that stands out. During COVID, the Centers for Medicare and Medicaid authorized payment for telehealth services that previously were not reimbursed. That action by the government made telehealth feasible. Its utility for delivering healthcare to individuals who do not need to make an in-person visit has been demonstrated for patients with COVID and, importantly, for patients with other medical conditions as well.
During COVID, we saw the advantages of implementing remote monitoring of patients. At Mount Sinai we discharged patients home with a Bluetooth-enabled pulse oximeter that measures their blood oxygen levels and transmits the data continuously. Patients could reach the team monitoring them if they noticed any change in their symptoms, but our team could proactively contact the patient if their oxygen levels dropped. We could get patients the services they needed more quickly than we could have otherwise.
Finally, I would add, the experience at Mount Sinai in applying machine learning and artificial intelligence solutions to important problems in COVID have demonstrated the power of these approaches to advance research and to transform medical care. In response, the institutional commitment to these programs is intense and is demonstrated by the creation of a new academic department of Artificial Intelligence and Human Health within the school.
Q: What about the pandemic led to the new department?
Data. So much data emerged from COVID— electronic health data, imaging data, clinical diagnostic testing data, and research data generated by our effort to understand the biology of this disease—that data sciences are the only way to really manage the volume of information and allow integration of these sources of data to quickly identify patterns associated with distinct clinical presentations of patients.
Pulmonary disease is especially suited to the application of machine learning and artificial intelligence tools. For example, integrating sequential chest CT scans with clinical data and laboratory results from patients is helping us learn which presentations of the disease will progress from mild to severe or which patients hospitalized for COVID pulmonary disease are likely to have problems after discharge.
An initiative like this can move forward at Mount Sinai because we have exceptional clinical expertise, rich data, and capabilities to leverage those resources with machine learning and artificial intelligence tools. But what’s also really exciting about these activities is the possibility of leveling the playing field. Large academic medical centers have a high prevalence of patients presenting with complex disorders. Trainees come to hospitals like Mount Sinai to gain expertise and experience in a wide range of diseases because it’s so valuable throughout their careers and this experience is difficult to get. When machine learning and artificial intelligence tools are fully developed, clinicians anywhere in the world, who haven’t trained at a large academic medical center, will be able to tap tested and validated algorithms of diagnosis and treatment for their patients.
Q: How was there the capacity to launch a new department during a pandemic?
This sort of project can happen when you have an environment that attracts bright, creative, innovative individuals who get satisfaction out of being completely immersed in a process that generates answers to important medical and scientific questions. And because this project does happen, the institution attracts new people who are excited by opportunities to do this sort of thing. So it perpetuates.
We are constantly launching pilots to test promising ideas. We allocate resources to let successful initiatives persist and grow. Both of those things have continued through the pandemic.
Q: How have you navigated the long haul of this pandemic personally?
I have taken stock, too. It may sound strange, but I feel invigorated. We contributed to understanding the scientific basis of this disease, the impact of this disease on our society, and the impact of our society on this disease. I’m very proud of that.
And I’m very excited about how the advances we’ve made as a division and as an institution are going to impact our clinical, educational, and research activities around both COVID and many other diseases for years to come.