Our Columbia Team on the COVID Front Lines

Uptown Manhattan has been particularly hard hit by the virus. It has logged thousands of coronavirus cases, and hundreds of people have been hospitalized. To treat them, NYP/CUMC was utterly transformed. Staff converted exam rooms, operating rooms, entire medical units, and even the Columbia soccer stadium, to housing for intensive care beds – a tripling of ICU beds in a matter of weeks.

In phone conversations and emails this week, six Columbia members described a work world turned upside down. And they presently live a paradox. They’re exhausted, anxious, and isolated, moving through a surreal stream of phone calls and video meetings, quiet streets and empty elevators, and patients often gripped with fear and grief. Members are also feeling closer than ever, buoyed by a fresh sense of purpose and teamwork and the real possibility of better cancer care techniques when the pandemic subsides. The city’s 7 p.m. daily tribute to health care workers – a din of sirens, drums, pans, pots, horns, stereos, claps, bells, whistles, hoots, and shouts – lifts their spirits.

“Every night there’s sirens and applause and even after six weeks, which feels like six years, it’s still so loud,” said Dr. Kevin Kalinsky. “That feels good. Because the city is desolate right now. But at the hospital, the team is unified like I’ve never seen before. We help each other. We rely on each other. Everyone has a shared mission.”

Hem-oncs like Dr. Kalinsky, as well as Drs. Kathy Crew and Dawn Hershman, are now treating patients of all stripes. They not only treat their patients with breast cancer, they treat everyone who is sick enough to be hospitalized or come into an outpatient clinic – people with COVID-19, people with COVID-19 and cancer, even people with heart conditions or liver disease. They split their time between being at home managing patients via telehealth calls and collaborating with colleagues by computer, or at the hospital, where they see out-patients in clinic getting cancer treatment or rotate on in-patient services caring for patients infected with COVID.
 
Caring for such a wide variety of cases is a challenge. “As an oncologist, you’re used to practicing evidence-based medicine and following guidelines,” Hershman said. “All of a sudden, you just have to take into account all the factors in front of you and make the best decision you can today.”

Dr. Lisa Kachnic, SWOG Executive Officer for Multimodality, who is new to Columbia, doesn’t have her own patient roster yet. Instead, she oversees the entire Columbia radiation oncology team – nearly 90 people, including 26 faculty, as well as nurses, navigators, radiation therapists, administrative staff, and others. When the national emergency was declared on Friday, March 13, Kachnic had a single weekend to work with her leadership team to develop a comprehensive virus screening program, a staffing schedule, and help develop new patient protocols at the hospital. While members of her physician and nursing teams have volunteered to help care for ICU patients – including COVID patients on ventilators – her charge is to keep her staff safe, healthy, and working efficiently. She has personally moved water coolers to eliminate virus hot spots, and ensures that a nurse greets all patients with hand sanitizer, a thermometer, and a mask as soon as they step off the elevators onto her floor. She starts her day with a 7:00 a.m. Zoom meeting with department chairs and ends it with an 8 p.m. Zoom call with her faculty physicians. She sometimes navigates two Zoom conferences at one time.

Kachnic sees a silver lining to the pandemic. “Nothing will be the same; we will be entering a new norm. And that’s OK. We’ve made many positive changes, including incorporating remote work in the interest of patient and staff safety, that will ultimately make us more efficient and effective as well as requiring a smaller footprint. The crisis has also been an opportunity – for team-building, culture change and program improvement. My team is awesome and I want to thank them all for stepping up in these difficult times. What we have accomplished together is truly amazing.”

Eileen Fuentes typically works with Columbia patients newly diagnosed with breast or gynecological cancers, developing care plans and navigating for 20-30 patients per week. Now, with the dearth of mammograms and surgical biopsies, fewer patients are being diagnosed with cancer. A new SWOG community advocate representing the Latinx community, Fuentes now manages about three patients a week by phone from her home in Washington Heights. While her caseload has dropped, the complexity of the work has increased exponentially, as she tries to manage care for people who often do not have smartphones or internet access, or who don’t have health insurance, or who do not speak English. Some are undocumented immigrants.

The disparities Fuentes sees each day are wrenching – something every Columbia member cited as a significant concern. Those without language, money, technology, family or friends, or a work from home job are suffering at much higher rates from the pandemic. Investigating the causes of, and solutions for, these disparities through research is a priority for the team. They also want to examine the links between coronavirus outcomes and obesity, inflammation, and immune system response.

With a suspension of all new clinical trial enrollments at Columbia, they’re eager for the return of high-volume, high-quality research. They are also eager for a return to high fives and hugs.

“We are all having this shared human experience together, which is both beautiful and awful,” Fuentes said. “If we didn’t know it before, we now know that we simply cannot live without each other. I have a renewed appreciation for technology and feel that I can use it in a way that I had not previously. But once I am given the approval, I am totally going back to hand-holding and hugs. That’s just me.”

I want to close with the words of Dr. Gary Schwartz, deputy director of the Herbert Irving Comprehensive Cancer Center at Columbia University and principal investigator of our Columbia NCORP. I asked Dr. Schwartz what he’d say right now to his staff, and I think his gratitude is shared by us all.

“I cannot thank the faculty, nurses, fellows and support staff or the patients of our community enough. What each of you has offered of him or herself is extraordinary. In my whole life, I have never seen such an unwavering commitment by a group of exceptional individuals to provide an extraordinary level of medical care to the very sickest of patients under, at times, difficult medical conditions. I can only say how proud I am of each of you and how glad I am to be among you.”