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Winter 2020

CORONA VIRUS CHALLENGES

WRITTEN BY:

Milissa Bartold

In January of 2020, the world learned that a novel coronavirus had emerged and was infecting human beings. As infections rose, hospitals were confronted with staggering caseloads and limited resources. Early in the pandemic, a startling pattern emerged. The pandemic’s affects could be traced along racial and socioeconomic lines.


As a clinical education program, ICO was immediately faced with a need to adapt how we educate our students and care for our patients. In particular, the clinical nature of our program called for more creative solutions. With all our didactic education already available in-person and online, we knew that pivot would be possible. Faculty quickly adapted to delivering the curriculum over remote technologies, and the academic calendar was adjusted to make labs that needed to be conducted in person possible.

"One of the keys to being able to safely return to in-person visits was in developing protocols for infection control and then training and retraining our providers, technicians and students."

Michael Chaglasian, OD

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Robert Carter ensures the cafeteria remains safe.

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IEI Employees adhere to public health measures.

Academic Administration worked diligently to ensure that students continued to meet educational objectives as close to on-time as possible and that the Class of 2020 met all their program requirements to graduate in May.

 

While Academic Administration worked to meet our educational goals and requirements, the Illinois Eye Institute also recognized that closing was not an option.

 

One of our first challenges was evidenced by the disproportionate impact the pandemic has had on people of color and those with medical comorbidities. Our patient population represents those at the heart of the pandemic impact. Many come to us with pre-existing conditions that place them at increased risk of adverse complications from COVID-19, but who also need to be monitored more closely due to vision threatening conditions such as glaucoma and diabetic retinopathy.

 

Under the leadership of IEI Chief of Staff Dr. Michael Chaglasian, the IEI developed and executed a plan to ensure that they would continue to meet the needs of its most vulnerable patients. The precarious conditions of many of our patients meant that “waiting it out” would not be viable either. As we all shifted to social distancing, face coverings and increased hand hygiene in our daily lives, it became quite clear that business would not go on as usual. The very nature of an eye exam places the doctor and patient in close proximity.

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ICO Cafeteria

Patients are at the heart and soul of ICO and IEI. They partner with us to provide an excellent education for our students and providers by entrusting their care to us. In turn, we commit to ensuring that the barriers they may face in other aspects of their lives do not stand in the way of their vision needs. Over a period of several weeks, Dr. Michael Chaglasian and the IEI team strategized about how to continue to meet the needs of the many patients who required continuity of care during this time. While telehealth was one solution, it became quickly apparent that this could not be a comprehensive solution both due to the nature of the conditions under treatment as well as the lack of access that our patients had to the technology needed for the telehealth visit. It was clear that in-person care needed to remain available to our patients. The IEI team developed a group of providers who would triage and provide care to those patients who could be adversely impacted by interruptions to care management. A staff team was also assembled to help meet the needs of these patients.

 

First and foremost, all consideration had to be given to safely conducting operations both for the patients and the providers. Coordination would become one of the key aspects to the plan: ensuring that the facilities were properly disinfected, sourcing and acquiring PPE (Personal Protective Equipment), developing and adapting operating protocols, and adjusting as new information emerged. The IEI  took a team approach to managing the situation, leveraging the skills of each person and area to help identify the best ways to achieve safe patient care.

For Dr. Chaglasian, one of the keys to being able to safely return to in-person visits was in “developing protocols for infection control and then training and retraining our providers, technicians and students.” Another key was that “we went slow with fewer patients and staff” and ensured that we “dispersed our patient scheduling time, made full use of our space and spread out to ensure we were able to maintain proper distance.”

 

Additionally, there has been a continued review of how things are working and ongoing retooling that relies on the feedback

of the team to improve things such as patient if low and movement within the facility that came “from the front-line staff who know best how to manage our traffic f low.” Diagnostic testing and imaging were another  point of consideration as those rooms are smaller than the typical exam lane. The IEI team worked closely with the ICO Facilities team to ensure that proper safety barriers could be placed to improve safety for everyone when close proximity is required during patient care or interactions.

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Temetrice Rhea greets guests at the Fait Family Eyeware Center.

In June and early July, the IEI operated at about 50% of normal capacity. By August, 80% of the normal capacity was being scheduled. We are currently scheduling about 90% of our usual census. As cases rise again, the IEI has learned a lot abouthow to manage the pandemic as safely as possible. Dr. Chaglasian remains optimistic about being able to continue to safely serve our patients, particularly those with vision-threatening conditions. “Our safety protocols work quite well and should continue to work ... If you do the right thing you should be ok. If you feel you are going too fast, slow down to

be safe.” He also acknowledges that “COVID fatigue” is a serious threat and something that must be continually managed to ensure that proper protocols continue being followed to allow us to safely continue serving patients whose needs do not lessen during these times.

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IEI Waiting Room

There have been many lessons to learn during the pandemic. With a novel virus, scientists were learning in real-time, as well. This reality was enough to put the world in a tailspin. Adhering to pandemic public health measures has impacted every aspect of our lives. Human beings are social by nature and things like social distancing and reducing in-person contact will have an effect. Large scale change, of any type, is a stressor. When you add in a rapidly-spreading and little-understood  virus, it is without question that the stress level increases. Many found themselves unable to pursue their normal avenues of stress reduction as social gatherings were restricted and gyms were closed.

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Connor Robbs and Dr. Yi Pang's research project the "Impact of Mental Health in Optometrists, Ophthalmologists and Students" found that 38.4% of respondents reported symptoms of depression, anxiety or both.

During this time, Connor Robbs ’22 and Dr. Yi Pang collaborated on a research project to consider the “Impact of Mental Health in Optometrists, Ophthalmologists and Students.” The study found that the top three self-reported factors that negatively impacted mental health were “worries about family/friends being infected with COVID-19, worry about being infected with COVID-19 myself and social isolation. The top three activities that helped maintain mental health were: outdoor activities, family time and exercise.”

 

The study showed that ophthalmologists, optometrists and staff had similar self-reported stress levels both before and during the pandemic, however, stress levels for students showed much higher levels both before and during the pandemic.

 

As the pandemic continues to unfold, science and medicine are finding ways to lower the risk of infection and adverse outcomes. Much has been learned, and a new normal is now in place. As medical science advances in knowledge and tools to manage the pandemic, one thing is abundantly clear: each of us has a role to play in the outcome. As a healthcare and educational institution, we are acutely aware that our actions matter. As a healthcare provider to vulnerable populations,our responsibility is even greater. Selfcare and protecting mental health are important parts of managing our pandemic response and giving our patients the best care possible.

 

One thing the pandemic showed was how exceedingly small the world is and how quickly things can change. Things that were taken for granted have become a lot more important. While we all hope to a certain extent that things go “back to normal,” we also need to remember that life is lived moving forward. Through the pandemic we have learned to simplify things to the essentials, prioritizing the most urgent, identifying and caring for the most vulnerable, thinking about others and not just ourselves, delaying gratification in favor of the common good. What if we chose to carry that forward as our “new normal”?