Providing care

Members of the Matthews family

By leading in health care delivery and research, Emory demonstrates its cornerstone importance to the community every day, but especially so when something as serious as a pandemic strikes.

As cases of COVID-19 multiplied, Emory caregivers across the city and state rose to the challenge, with nearly 4,000 doctors, nurses, and allied health professionals treating COVID-19 patients.

Their competence and dedication is evident in the many expressions of gratitude from patients as well as in the encouraging number of patients successfully discharged. Despite the potentially serious risk to every patient who contracts the virus, Emory was able to send home 6,833 of the 7,423 COVID-19 patients who were hospitalized during 2020.

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Helping Elizabeth Matthews beat the odds

If you are Black in America, according to the CDC, you are 1.4 times more likely to contract COVID-19 than whites, 3.7 times more likely to be hospitalized, and 2.8 times more likely to die. Three generations of the Johnson family faced that challenge recently after a call between Elizabeth Matthews, 83, and her granddaughter, Mikisha Johnson, concerned Mikisha and her mother, Barbara Johnson. Elizabeth had struggled to string words together and sounded disoriented.

Seeking answers, the family quickly brought Elizabeth to Emory Saint Joseph’s Hospital, where doctors found that not only had she suffered a stroke; she also tested positive for COVID-19. “I got real emotional when they told me that,” she says. “I was thinking, ‘Am I going to die?’ ”

For months after the COVID-19 outbreak began, it was largely understood as an assault on the respiratory system. What is still less understood, but just as alarming, is the damage the virus may be doing to the brain—from strokes to reports of headaches, seizures, and confusion.

“We are recognizing that COVID-19 actually has a significant neurologic effect,” says Byron Milton III, a physiatrist in physical medicine and rehabilitation at Emory University Hospital who is helping COVID-19 patients cope with dementia-like symptoms and other neurological problems.

Elizabeth’s six days at Emory Saint Joseph’s Hospital helped her get back on her feet. And despite some lingering breathlessness, Elizabeth is delighted that she will be around when her granddaughter has her first baby.

Establishing a national standard of care of COVID-19 treatment

Beyond those cared for at Emory are the many others across the world who benefit from Emory research. By participating in the ACTT-1 (Adaptive COVID-19 Treatment Trial), sponsored by the National Institute of Allergy and

Infectious Diseases, Emory contributed to a national standard of care for COVID-19 treatment. The ACTT-1 study began in February 2020 and included participants from 45 sites in the US and 15 in Europe and Asia. Emory clinical sites enrolled more participants than any other site in the world.

When results were published in November 2020, they showed that in adults hospitalized with COVID-19, the antiviral drug remdesivir resulted in faster recovery, fewer days on oxygen, and lower progression to a ventilator compared with placebo. Says Nadine Rouphael, Emory’s co-lead investigator, “The work of our team contributed not only to the advancement of research and clinical standards but also to helping many of our patients recover and return home to their families.”

Expansion of telemedicine

Two people in a telemedicine visit

Before COVID-19, Emory Healthcare conducted several telehealth visits per week in only two or three specialty

areas. Since mid-March 2020, Emory has conducted an average of 12,000 visits per week across 38 specialties, changing health care delivery for the foreseeable future and possibly forever.

Through Emory Connected Care, patients can consult with their health care providers from home using a webcam or mobile device with a camera. According to Gregory Esper, associate chief medical officer at Emory Healthcare, who leads Emory’s telehealth initiatives: “Ramping up a robust telehealth practice from very few visits a week to around 12,000 has been an amazing transformation.” With about 30 percent of patients preferring telehealth as their mode of care, it will continue to play an important role even after COVID-19.

Through the Emory Healthcare Veterans Program (EHVP), veterans and service members have increased access to telemedicine in 13 states. Since 2015, the EHVP has treated more than 2,300 warriors with a variety of mental health concerns. Treatment efforts include a two-week intensive outpatient program (IOP). During the early weeks of the pandemic, EHVP leaders worked to develop a remote IOP that delivers at-home care.

Treatment and study for seriously ill children

Brothers together in a hammock

Although pediatric deaths from COVID-19 are rare, with 94 percent of cases considered mild to moderate, some children can become seriously ill, particularly those with underlying medical conditions. Multisystem inflammatory syndrome, or MIS-C (the “C” is for “Children”), is a condition where children’s body parts can become inflamed.

Says Preeti Jaggi, associate professor of pediatric infectious diseases and a clinician at Children’s Healthcare of Atlanta, “Kids can become ill from COVID-19 requiring hospitalization, just not at the same rates as adults.” MIS-C was first identified at the end of April 2020, so clinical care and research are still in the beginning stages. Jaggi, for instance, has seen about 40 children with the illness.

As well as caring for children with COVID-19 and COVID-related illnesses, Jaggi and her colleagues have conducted studies as rapidly as they can collect data, hoping to find out more about pediatric transmission, manifestation, and treatments. Jaggi also has been involved in studies to describe similarities and differences in the evaluation and treatment of MIS-C at hospitals in the United States as well as to measure SARS-CoV-2 serologic responses in children hospitalized with MIS-C compared to COVID-19, Kawasaki disease, and other illnesses.

As scary as MIS-C can be, most children recover, but there may be lingering problems. “We are tracking everything in these kids,” Jaggi says, “carefully monitoring their follow-up with specialists, like cardiology, to make sure they don’t have long-term issues.”

Two ways to care for our own

As soon as the virus hit, health care workers and first responders in Atlanta stepped up to treat waves of Georgians sickened by the virus. We know too well by now the toll that care exacts, with medical staff sometimes falling ill themselves or suffering from exhaustion and stress.

Emory Giving and the James M. Cox Foundation partnered to organize Feed the Front Line, an initiative to provide meals for the heroes battling the pandemic. More than 100,000 meals were delivered to Atlanta Police and Fire Rescue, Atlanta VA Medical Center, Children’s Healthcare of Atlanta, Emory Johns Creek Hospital, Emory Saint Joseph’s Hospital, Emory University Hospital, Emory University Hospital Midtown, Winship Cancer Institute, Grady EMS, Grady Memorial Hospital, Northside Hospital, Piedmont Hospital, and Wellstar Health System.

Says Kristal Bryant, a nurse at Hughes Spalding, “These generous gifts remind us daily that we have not been forgotten during this uncertain time.” Judith Service Montier, the CEO of Chez Montier, one of the food industry partners, responds, “It’s a real honor to know that the work we are doing is making a difference.”

Pair a warm meal with someone to talk to after a hard shift, and that goes a long way.

Emory’s Department of Psychiatry and Behavioral Sciences (PBS), in league with other behavioral health professionals from the School of Medicine, recognized the contributions they could make to colleagues experiencing stress during the pandemic. They put out a call for volunteers and, in response, more than 100 psychologists, psychiatrists, and social workers came forward to donate their time and services.

They offer free same-day support calls, same-week follow-up therapy and medication management appointments, and department group debriefing sessions to their colleagues at Emory Healthcare, Emory School of Medicine, Atlanta Veterans Affairs, Grady Health System, and Children’s Healthcare of Atlanta. They have even shown up in intensive care units to offer immediate coping help.

Notes the interim chair of PBS, William McDonald, “The COVID-19 pandemic has put significant pressure on our health care system and the frontline workers caring for patients and their families, which is why the Department of Psychiatry and Behavioral Sciences developed a comprehensive plan to support health care providers.”

The new programs are the ASAP Clinic, which provides individual mental health services, and the Caring Communities program, which offers group mental health sessions and a variety of community wellness resources and information.

Professor Nadine Kaslow, who directs Caring Communities, emphasizes “the tremendous emotional stress that frontline health care workers are under and how grateful they are for these easily accessible and helpful services.” She also highlights “how meaningful it is for the Caring Communities and ASAP Clinic team members themselves to provide an array of innovative and responsive behavioral health services.”

Since late March 2020, they have offered hundreds of volunteer hours and more than 600 mental telehealth appointments via Zoom between 6:00 a.m. and midnight daily.

Additionally, Emory Healthcare has launched a “Resilience” campaign urging health care workers to “invest in self-care” and outlining tips for mindfulness, exercise, and nutrition—even play.