Preparing for COVID-19’s Next Wave: Top tips from the frontlines

As COVID-19 continues to spread at alarming rates across the country and a surge of new infections is shattering previous daily records, top epidemiologists are warning that the worst of the pandemic will hit the United States in the months ahead.

Dr. Anthony Fauci, the nation’s top infectious diseases expert, has warned of a “very tough winter.” So how can healthcare providers prepare? And how will this next wave of the pandemic differ from the spring?

The good news is that we’ve learned a lot since the early days of the pandemic. Doctors are better prepared to treat patients with new therapeutic medications and more knowledge of how the novel coronavirus affects the body. Reports of new vaccines are also promising. However, the challenges for frontline workers facing the next wave of COVID remain significant.

To help health care professionals prepare for the next wave of COVID-19, three recent medical school graduates from the University of Medicine and Health Sciences in St. Kitts are sharing their top tips from the frontlines.

Dealing with COVID denial

We can all agree that 2020 has been tough on everyone, and COVID-fatigue is real. But how should healthcare professionals deal with COVID denial as infection rates continue to climb?

“There is a lot of distrust in the medical community today,” said Alex Zayid,MD, who works on the frontlines in Michigan. “Do not get defensive, rather try to understand why people think this way. For many people, they have resentment towards COVID-19; for some it took their jobs, their homes, and disrupted their lives. Help these patients to understand that medical professionals are there to help, and we are stronger as a unified community getting through this together.”

While the ever-changing scientific data about the virus can be confusing, it’s important to stay on top of the latest COVID-19 research. “Educating patients and showing the data behind current recommendations: social distancing, universal masking, and good hand hygiene are the key,” said Rahul Gossain, MD, a physician in Corning, NY.

Follow the data

In addition to helping to combat COVID denial, research and data are critical in the fight against the spread of COVID. Melissa Alvarez, MD, who works on the frontlines in Pennsylvania, said there are two key factors to consider regarding the data. “The two most important numbers, in my opinion, are the test positivity rate and the daily hospitalizations. If we are getting control of the spread, the positivity rate should be below 5%. If a community is above 5% positivity, that area is at risk for a more large-scale outbreak.”

Daily hospitalization trends are also crucial. “This number is especially important as we hit the winter months, when hospitals usually experience a higher census,” continued Alvarez. “The important thing isn’t just the daily numbers, but what the trend looks like. Have hospitalizations been climbing steadily for the last week? If so, that’s likely a sign that community spread in the area is increasing. It is also a sign to the hospitals that they need to get ready for a higher census than a normal winter season.”

Zayid concurred. “If we learned anything throughout the first wave of COVID-19, it is that trends are real with the spread of this virus,” he said. “In Michigan, we were hit earlier than other regions of the country. This triggered more aggressive regulations out of our state government -- luckily yielding a great response to the virus. Information like this should be widespread throughout the country for other regions to see how different measures work, how the virus is spreading and hopefully predict spikes in other areas.”

Get your flu shot

There is a genuine concern within the healthcare community that a severe flu season, in addition to the current pandemic, will overwhelm our already strained hospitals and medical resources.

Alvarez advocates for flu shots and reminds patients, friends, and family to get vaccinated each year. “This year will be more important than ever to get as many people vaccinated as possible,” she said. “Early is better because it takes some time for your body to get the full effects of the vaccine, so you want to make sure to get it before the flu starts to have wide community spread in your area. Yes, the vaccine is not 100% effective at preventing flu. However, it has been shown to reduce the need for hospitalization from the flu and that is extremely important this winter season. It will be burdensome to our healthcare system to have large hospitalization numbers from two different viruses at once.”

Monitor your mental health

The mental health implications of a pandemic that has infected more than 10 million and killed nearly 240,000 Americans is staggering, and the toll has been especially heavy on frontline workers who are grappling with anxiety, isolation, and depression.

Alvarez said the mental health aspects of working on the front lines were a huge struggle for her at the beginning of the pandemic. “I was very worried about becoming infected with COVID-19 and bringing it home to family,” she said. “It was also extremely difficult to feel like you had nothing to offer patients, and dealing with the amount of death that we saw (there was one night that six COVID patients died during our peak surge), and dealing with the emotions of patient families because they couldn’t even visit their dying loved one. It was a lot to handle.”

What should healthcare workers do when they feel overwhelmed?

“The best piece of advice I can give would be to find someone to talk to about what you’re feeling: a friend, a mentor, a therapist, a family member, a coworker,” she said. “Finding your outlet is important: get lost in music, listen to a podcast, watch Netflix, draw, color, read a book…. something that lets you escape reality for a moment.”

Zayid said that as healthcare professionals, it is quite easy to get lost in one’s work while forgetting to take care of one’s self. “Giving back to others is a passion we share, but you’re no good to your patients if you are not good to yourself. Remember to focus on your wellness so you can come into work each day as the sharpest, most positive version of yourself to provide the best care possible.”

Advice for med students entering rotations

For recent medical school graduates who are headed to the frontlines, the authors agree on several key points:

Follow all best practices and hospital guidelines for safety.

Keep up to date on COVID-19 research and treatment options. The more you know about something, the better you can be prepared.

Listen to your attending physicians and set up a buddy system with a mentor to help navigate the additional challenges of working in a pandemic.

Practice self-care. Remember to eat a healthy diet, exercise, and get enough sleep to keep your immune system strong. Devote time to a favorite pastime to relieve stress.

_{About the Authors}

_{Melissa Alvarez(UMHS Class of 2017), is an Internal Medicine resident PGY-III at Mercy Catholic Medical Center in Darby, Pennsylvania.}

_{Rahul Gossain (UMHS Class of 2012) is a Hematology & Oncology physician at the Guthrie Corning Cancer Center in Corning, NY.}

_{Alex Zayid (UMHS Class of 2019) is a Family Medicine resident at Ascension Providence Hospital in Michigan.}