A Reflection on the Early Days of the Pandemic 

Dr. Lynn L. Simpson

It’s been a year since our first COVID-19 positive patient, a year dominated by a virus that ruled our academic and personal lives. It was the winter of 2020, and news of a novel coronavirus from China was spreading but not as quickly as the virus that had already reached our shores.

Upon my return to New York City from a family vacation in March, I learned how quickly the virus had already crippled our fetal therapy program. Two key faculty members were out sick with COVID-19, and other team members were absent due to potential exposures, family illness, or child-care issues related to school closings or lack of daycare. Our robust fetal program was suddenly hanging by a thread – how were we going to manage in the weeks and months ahead?

The beginning of the pandemic was a time of chaos – shortages of personal protective equipment, scarcity of disinfecting wipes and hand sanitizer, mixed messages about wearing and reusing N95 masks, and fear of the unknown. The lack of reliable information and evidence-based recommendations early on added to the pandemonium. Amidst the confusion, we were all taking steps that we thought would protect ourselves and our loved ones. Wearing freshly laundered scrubs to and from work, changing and showering immediately upon arrival home, and in some cases, going so far to arrange separate sleeping or living quarters to protect our partners and families. Older faculty started working from home due to personal risk. Senior and at-risk sonographers chose retirement over working during the pandemic. Face-to-face interactions with colleagues and trainees were limited to lessen possible exposure. Our in-person multidisciplinary fetal meetings were suspended to avoid large group gatherings and potential spread of this deadly virus. The foundation of our fetal program was wavering. Everyone was scared.

Our patients were also scared -- for themselves and their unborn babies. Patients were foregoing fetal evaluations in Manhattan due to its growing number of COVID-19 cases, and others were fleeing the big city to receive care in smaller communities to decrease the risk of contracting the disease. But certain fetal interventions could not be safely postponed, and we knew we needed to be there for these highest-risk patients.

So with limited staff and decreased capacity, we adjusted. To reduce risks to patients and staff, we introduced restrictions on waiting room occupancy, curtailed the number of patients that could be seen each day, and limited visitors and accompanying persons. Masks were mandatory for all – we assumed everyone was positive. We introduced telehealth visits, cancelled non-essential ultrasounds and procedures, and postponed non-urgent in-person care of COVID positive patients. Patients requiring time-sensitive ultrasound-guided procedures and fetoscopy underwent pre-procedure COVID screening as soon as testing became available. We contacted regional, national and international colleagues for advice and to draw upon their collective experiences. The sharing of information among those in the fetal medicine community was comforting and supportive – and led to several collaborative guidelines to assist other fetal programs.1,2

The first few months of this pandemic was a time of uncertainty, straining our team, stretching our resources, and limiting our capabilities to provide prenatal diagnosis and fetal interventions. But this crisis brought out the best in our fetal therapy team, reminding all of us why we do what we do – because we care about people, and we want to help. Little acts of kindness, personal sacrifices, working together to find solutions – everyone was doing their part in holding our fetal program together. People were scared; yet they showed up to work, welcoming our patients to the fetal center. On a daily basis, our team demonstrated compassion, bravery, and professionalism, even when caring for suspected and confirmed COVID positive patients, sometimes under less than optimal conditions and early on, without sufficient testing and personal protective equipment.

This crisis has also brought out the best in the global fetal medicine community. We should all be proud of our ability to adapt to optimize patient care with limited staff and resources and share lessons learned with each other. I am so grateful for our team, my partners here at home, and colleagues around the world who supported our fetal therapy program in the early days of the pandemic, who reached out to see if we were OK. So very, very grateful!


References

  1. Deprest J, Van Ranst M, Lannoo L, Bredaki E, Ryan G, David A, Richter J, Van Mieghem T. SARS-CoV2 (COVID-19) infection: is fetal surgery in times of national disasters reasonable? Prenatal Diagnosis 2020;40:1755-1758. DOI: 10.1002/pd.5702
  2. Deprest J, Choolani M, Chervenak F, Farmer D, Lagrou K, Lopriore E, McCullough L, Olutoye O, Simpson L, Van Vieghem T, Ryan G. Fetal diagnosis and therapy during the COVID-19 pandemic: guidance on behalf of the International Fetal Medicine and Surgery Society. Fetal Diagn Ther 2020;47:689-698. DOI:10.1159/000508254