This summer has been quite the roller coaster ride of politics, weather, ongoing pandemic, and more.
First, the Dobbs decision sent shockwaves through our country. It is clear that the impacts of the Supreme Court decision will be profound but the details of state-specific laws remain somewhat unclear. Some experts suggest it will be years before we fully understand all the implications. Last week, our own Drs. Dineo Khabele and Tessa Madden joined Rebecca Wanzo for a thoughtful discussion of reproductive health post-Dobbs. Additional discussions are being held on both campuses in coming weeks.
Climate change has been acutely felt throughout the US. Wildfires in the west, heat waves across the country, and flash flooding here and in Kentucky have had a devastating impact on so many including loss of life and lifetimes of memories. The Medical, Danforth and North campuses all received damage during last week’s floods. Day care centers and schools around the city were impacted including those of Wash U and BJC. If you or your family is struggling as a result of the floods, resources are available. A big shout out to our facilities team, emergency management and WU Protective Services for all their work making sure our campuses are safe and usable.
COVID-19 continues to affect us as well. The BA-5 variant has firmly taken hold. We have very high positivity rates in the community. Many faculty and staff have had COVID or had family members contract COVID. Fortunately, for most of us, the clinical course has been relatively mild. We are seeing stable admissions numbers in the 60-70 range at BJH most days. In good news, we do have good treatments, the vaccine continues to provide strong protection against severe illness, and there are likely variant-specific vaccine boosters coming in the near future. Our strategies for supporting a safe environment continue to be effective – wear a mask when inside on campus and not eating or drinking; don’t come to work or school when sick; and get tested when you have symptoms.
In our world of education, we had lots of big events last month. The first was that our GME office and residency and fellowship programs onboarded a few hundred new housestaff. Welcome to all of you and great job GME leaders and staff!!! The second was our LCME mock visit. It went really well! Of course, there are things we need to work on. In my view, one of the biggest wins was that we know what we need to work on and are actively working on it – go program evaluation and continuous quality improvement! The second big win was the passion with which every person involved in the visit talked about Washington University. In all, we had over 100 people involved including students, residents, faculty and staff. As one of the reviewers said, “This is a truly great place and your students, residents and faculty made us feel it.” A HUGE thank you to Eve Colson, Leslie Blaylock, the ETIU team and everyone who participated in the three-day practice sessions. The ETIU team helped us do a sudden full hybrid shift when I got COVID (fun, fun). And most importantly, a big thank you to every single person who touches the educational programs of our institution – none of this is possible without each and every one of you.
As the summer comes to an end and we prepare for our new students to arrive, I continue to be amazed by all we have accomplished. The roller coaster has been a little bumpy and has taken some unexpected turns but it has also been at times wonderful and always exciting. I feel blessed to be on this ride with all of you!
AOA Class of 2022 Announcement
On behalf of the Washington University School of Medicine Chapter of Alpha Omega Alpha (AOA) Honor Medical Society, we are pleased to announce the Class of 2022 comprising newly elected WUSM faculty, house officers and alumni from across the institution. Congratulations to all!
Enyo Ablordeppey – Department of Emergency Medicine & Department of Anesthesiology
Keith Brandt – Division of Plastic & Reconstructive Surgery
Beverly Brozanski – Department of Pediatrics
Christopher Carpenter – Department of Emergency Medicine
Jorge Di Paola – Department of Pediatrics
Allison Mitchell – Department of Anesthesiology
Jean Wang – Department of Internal Medicine, Division of Gastroenterology & Department of Surgery
Nichole Zehnder – Department of Internal Medicine & Office of Medical Education
Katherine Buesser – Department of Orthopaedic Surgery
Alexandra Fogarty – Division of Physical Medicine & Rehabilitation
Matthew Glasser – Department of Radiology
Veronica Groff – Department of Emergency Medicine
Austin Ha – Division of Plastic & Reconstructive Surgery
Bridget Huysman – Department of Obstetrics & Gynecology
Valerie Lew – Department of Emergency Medicine
Sunny S. Lou – Department of Anesthesiology
Rebecca Rimsza – Department of Obstetrics & Gynecology
David Russler-Germain – Department of Internal Medicine, Division of Hematology & Oncology
Kristen Seiler – Department of General Surgery
Nathanael Smith – Department of Emergency Medicine
Anja Srienc – Department of Neurological Surgery
Amelia Van Handel – Division of Plastic & Reconstructive Surgery
Stephanie Fritz – Department of Pediatrics, Division of Infectious Disease
Andrew Kates – Department of Internal Medicine, Division of Cardiology
Ashely Steed – Department of Pediatrics
Eva’s Excerpt July 2022
On June 24, 2022 the Supreme Court released its final decision regarding Dobbs, State Health Officer of the Mississippi Department of Health, et al. v. Jackson’s Women’s Health Organization, et al. This case specifically challenged both Roe v. Wade and a later case, Planned Parenthood of Southeastern Pa v. Casey. SCOTUS overturned all three cases and ruled that the Constitution does not confer a right to abortion; this then gives the authority to regulate abortion to the people and their elected representatives. Several states, including Missouri, have recently or are in the process of passing “trigger laws” that vary by state and put a variety of prohibitions in place that restrict access to and provision of abortions. Missouri’s law, known as the “Right to Life of the Unborn Child Act,” prohibits abortion except in cases of medical emergency and makes performing an abortion in violation of this rule a class B felony, in addition to potential suspension or revocation of professional licensure. Any person providing an abortion must prove “more probably true than not” that the abortion was a medical emergency. The woman who undergoes the abortion is not subject to prosecution.
It is important to note that Missouri law has long held the belief that human life begins at conception and has for 200 years limited access to abortion through a variety of means. Thus, for many years the only abortion clinic in Missouri has been the Planned Parenthood on Forest Park Parkway. Attempts to close this Planned Parenthood have been significant and ongoing throughout the five years I have lived here such that relatively few abortions have been performed in Missouri in recent years. Moreover, no insurer within the state of Missouri, including our Student Health Clinic, has been able to cover the cost of voluntary termination of pregnancy for many years. Most women who require or desire a termination of their pregnancy currently receive this out of state, most commonly in Illinois.
For many women the SCOTUS decision signifies a profound loss of autonomy, control and equity. They fear being forced to carry an unwanted, unintentional, or even physically forced pregnancy (i.e. through rape or incest). They worry that their health or welfare will be sacrificed for the sake of their unborn child without regard to their wishes or that of their partner. And yet, for many this decision signifies an affirmation of their beliefs regarding the sanctity of human life. While there is relative medical clarity about when a fetus is viable outside of a mother, when life truly begins is up for debate and is often associated with religious and moral beliefs that are deeply held. It is imperative that we approach this time with compassion and caring for one another — with a deep desire to understand differences in opinion and the individual stories and histories that shape these opinions.
Some healthcare providers are worried that the sanctity of their relationships with patients— to care for patients as medically necessary and in alignment with their wishes is being obstructed. They may have concerns that their fear of being prosecuted or losing their license will interfere with making sound medical decisions or cause delays in care. They worry that they will watch more women suffer and die. And some healthcare providers have been and may continue to be in deep conflict between their own personal or religious beliefs regarding abortion and their responsibility to provide patient-centered care.
For students and trainees, you may be wondering what impact this will have on your education. We will continue to teach you about when termination of pregnancy may be indicated and the mechanisms available to terminate a pregnancy. We will also continue to teach you how to counsel a patient about options. Students have generally not participated in abortions unless they specifically elected to or as part of a medical emergency. Both options will continue. The ACGME mandates that residents in OBGYN must be provided with training or access to training in the provision of abortions, how to educate patients on the surgical and medical therapeutic options related to the provision of abortions and the management of complications of abortions. This training will continue, largely out of state, as it has been. Students who wish to learn these skills can also do so through these training sites on a purely voluntary basis. Residents who have religious or moral objections may opt out, as before.
More information will come out in the weeks to follow about how this affects operational changes and care. In addition, there will be opportunities for dialogue and to better understand how Wash U will be supporting women and our providers to ensure they get the care they need. In the meantime, for those of you who are suffering in the wake of this decision for any reason, whether you agree or disagree with what has happened, please remember that there are a multitude of resources available to support you. If you are a faculty member or staff, those can be found here; if you are a resident or fellow, they can be found here; and if you are a student, they can be found here.
“Dignity of human nature requires that we must face the storms of life.” – Mahatma Gandhi
Eva’s Excerpt June 2022
Today, I want to talk a little bit about gun violence. I am not a public health expert and I am not going to get political—I just want to talk about what we know and offer hope that things can get better.
Let’s start with the facts. Every year, more than 45,000 people in the US die as a result of gun violence and many, many more suffer non-fatal gun injuries. Gun violence affects people of all ages and backgrounds, but has a disproportionate impact on young adults, men, and those who self-identify as racial and ethnic minorities. Guns are generally the weapon of choice for both suicide and homicide in the US, particularly for the young, and as we saw tragically last month, they are the weapons most commonly used for mass killings. These are just the sad facts.
When we allow this conversation to become political, we lose track of these facts and fail to approach these complex problems like the public health problem that they are. We have a lot of experience with public health approaches to solving problems right now. The COVID pandemic has taught us about risk mitigation and layered strategies. We have learned that there is rarely a single or only solution. Instead, we need to approach these challenges with multiple strategies, each addressing part of the problem and studying the impacts of these potential solutions. As we also saw with COVID, each community will have different appetites for each of the potential solutions. From my perspective, that’s okay too. What’s not okay is doing nothing.
So what can be done? We hear a lot about gun laws, and we have evidence of impact in Connecticut. Community programs aimed at reducing violence, educating people about gun safety, and providing community support can also work. Importantly, we need to study various interventions in different environments to see what works where and with whom. In the not so distant past, people thought we couldn’t reduce car accident fatalities or smoking-related deaths, but a combination of policy, education, and safety measures (seat belts, warning labels) have done just that.
I hope we as a society will determine that the current state is unacceptable and begin the hard process of making iterative change. My thoughts and prayers are with the 19 children and 2 teachers who lost their lives in Uvalde, the 4 lost in Tulsa, the 12 killed and at least 38 injured this past weekend in Chattanooga, Philadelphia and around the country, and the many more who have been lost through gun violence this year.
Eva’s Excerpt May 2022
Last week, I had the pleasure of both participating in the planning of our upcoming commencement ceremonies and meeting with our outstanding alumni. For information about commencement, take a look at the University webpage. This is the first year that ALL faculty are invited to both the university-wide event and the School of Medicine MD events. Both will be held at Francis Field. OT, PT, DBBS, and the master’s programs have events leading into commencement and afterward as well. We have exciting speakers lined up and a wonderful series of events planned. I hope to see you there!
As for the alumni, we welcomed back several class years for the reunion, given the impact of COVID. I had the pleasure of speaking about the Gateway Curriculum, and the synergistic impact of the curriculum and scholarships on our student body. My slides are available here for anyone with an interest. I also had the pleasure of seeing several of our amazing faculty and alumni (some who are both) receive recognition for their outstanding contributions to medicine, the school and science. It was so wonderful to see the interest of our alumni in what we are doing educationally, clinically and scientifically—and there is so much to be proud of.
I had a dear friend who each year, as the students, residents and fellows moved to their next phase of training or professional development quoted one or more Irish toasts (she was Irish). I would love to continue this legacy (although will broaden across multiple cultures) and have chosen the following Irish toast this year for all our graduates and those transitioning to new roles in honor of my friend and mentor, Maureen Garrity: “May you get all your wishes but one, so you always have something to strive for.”
While some may hope for a lack of struggle in life, I am now fairly convinced that life is all about the struggle. It is in the struggle that we grow. It is in the struggle that we learn. It is in the struggle that we hope for more, and ultimately achieve more. Each of our students, residents, fellows, faculty and staff have struggled these last few years. We have grown, changed, developed, as people, as teams, and as an organization. We have been imperfect, and we have been glorious. Nevertheless, we have all grown- better, stronger, more capable. We have learned, developed, and changed. We have seen different ways of doing things and different ways of being. We have and continue to strive for more—for a better future for ourselves, our learners, our patients, our community, our Wash U.
While we do not know that the next struggle will be, I think we all know that there will be one. What I hope for our graduates and alumni, for our current trainees, and for our faculty and staff, is that we have provided you with the knowledge, attitudes, skills, resilience and support needed to face those struggles, overcome them, and yet always have something to strive for. In addition, while you continue in the struggle, I wish you the following:
“For every storm a rainbow, for every tear a smile, for every care a promise, and a blessing in each trial. For every problem life sends, a faithful friend to share, for every sigh a sweet song, and an answer for each prayer.” (Irish Prayer)
Thank You Dr. Deptola and Welcome Dr. Kummer
Dr. Amber Deptola is stepping down from her leadership role directing the Explore Program of the Gateway Curriculum. Dr. Deptola led the creation of the program from its inception, including supervising the development of the Explore Immersion, the Inquiry Curriculum, and providing oversight of the four Explore Pathways. Under her leadership, the Explore program was transformed from a concept to a highly successful and popular curriculum that has positively impacted our first cohort of Gateway students through Phase 1 and Phase 2. She will remain the director of the Medical Education pathway within the Explore program as she puts more focus on this and her clinical work. We are so grateful for her creative vision and organization that has laid a solid foundation for the Explore program.
We are pleased to announce that Dr. Terrance Kummer is taking over the reins as the new Director of the Explore Program. Dr. Kummer is an Associate Professor of Neurology, specializing in Neurocritical care. He received his MD and PhD degrees from Washington University School of Medicine before completing his Neurology residency and Critical Care Neurology fellowship training at Massachusetts General Hospital and Brigham and Women’s Hospital. He is the current director of the Neurotrauma ICU and was the Neurological and Neurosurgical ICU resident education director for five years, a role in which he lead their curriculum renewal efforts. Dr. Kummer is a highly successful researcher, whose laboratory focuses on understanding the cellular mechanisms underlying neuronal trauma and degeneration. In this new role, he brings enthusiasm and a strong record of research success, research and clinical team leadership, and experience as a medical educator.
Eva’s Excerpt April 2022
I want to begin by recognizing our 3rd and 4th year students, Kathy Diemer, Angie MacBryde, Tom De Fer and our Clerkship Directors. Our 4th years just completed the match, in stellar fashion if I do say so! And our 3rd years are now 4th years, having completed the last of the large scale Legacy clerkships at the end of March! I could not be prouder of these two classes. While bearing the brunt of COVID-related changes to classroom and clinical learning, they have excelled in every way— academically, professionally, and as leaders, and it is they who helped us solidify our commitment to social justice in education and more broadly. I would also like to recognize Tom De Fer and the Clerkship Directors for spearheading relentless changes to the clinical curriculum in Legacy throughout COVID, paving the way for many of the changes possible in Gateway. Congratulations to all of you for successfully navigating “the bulge” – that difficult time in curriculum transformation when two classes are in the clinical clerkship environment at once!
In the last month, I have had the occasion to speak several times on the topic of addressing racism in medical education, both locally and nationally. It has caused me to reflect deeply on the last two years and I think it is time to revisit Our Commitment to Addressing Racism in Education to assess the progress we have made and what is still left incomplete. Here is what we said we would do and our progress to date:
We will educate ourselves as we attempt to educate others: We have made significant progress in this domain. We have required bias and antiracism training of all admissions and curriculum faculty and staff. Our Gateway coaches have led the way with the most in-depth training. The School of Medicine Office of Diversity, Equity and Inclusion led by Sherree Wilson has launched the Understanding Systemic Racism Curriculum (modeled on the faculty development provided to our coaches and core curriculum faculty) led by Erin Stampp. They are currently training equity champions to be able to further disseminate this curriculum in a tailored way to each department and program. Our Executive Faculty voted to require this curriculum for all faculty, housestaff, and staff, so as the champion training continues, this will be rolled out broadly to all of us. If you are interested in becoming an equity champion, you can find more information here.
We will investigate and address biases, discrimination, racism and white supremacy culture in all aspects of our educational work: Here we have also made significant progress. Our admissions team in the MD program has implemented holistic review and implemented other practices to reduce barriers to application to WUSM. As I previously commented, we have seen continued increases in applicants and an almost doubling of students traditionally identifying as under-represented in medicine within our classes over the last 2 years. We will have our largest ever Second Look event on the weekend of April 7 with a larger representation of diversity applicants than we have ever had before.
We have fully implemented a longitudinal health equity and justice curriculum across Phase 1 and Phase 2 of the Gateway Curriculum grounded in structural competence and anti-racism. Recent AAMC Y2Q data (this is a national survey of all second year students across the country) shows that our first cohort of Gateway students rated the curriculum above the 90th percentile (the highest benchmark) in learning effective tools for recognizing their own biases and contributing to their ability to work in disadvantaged communities. Kaytlin Reedy-Rogier and Audrey Coolman have also developed individual curricula in structural competency and anti-racism for each of the Legacy years and our MSTP students, led by Mackenzie Lemieux created a social justice and anti-racism journal club curriculum. In addition, the Gateway clinical skills curriculum trains students a trauma-informed approach to history taking, physical examination and clinical care. Medical students have the opportunity to practice these skills and gain a deeper understanding of the social and structural determinants of health, as well as the importance of an interprofessional team in addressing these factors during the Ambulatory Immersion, through dedicated partnerships with Affinia and Care STL, 2 local Federally Qualified Health Centers and critical partners in our education mission. Our new Phase 2 students are receiving rave reviews in the clinical environment from faculty, residents and patients alike for the skills they have acquired.
We have also implemented a truly thoughtful competency-based assessment system with an eye toward addressing the equity issues identified in grading in the Legacy Clerkships and incorporating the recommendations of the Committee on Equity in Clinical Grading led by Steve Lawrence and Sherree Wilson. Amanda Emke has worked tirelessly to bring this to fruition. It is still too early to determine if we will see an impact on equity in grading and assessment, but this remains a critical outcome that we are committed to measuring and addressing through this new system of assessment. Amanda, Steve and Kathy Diemer are also currently working with a cohort of highly dedicated program directors to help us design the new Medical Student Performance Evaluation (MSPE or Dean’s Letter) and a new standardized department letter to further support the differentiation of our students while attending to issues of bias and equity when applying to residency.
We continue to work on our learning environment and there remains significant work to be done. Our students and residents experience offensive remarks regarding race, ethnicity and gender at unacceptable rates. To this end, the SAFE committee and the Academy of Educators, with dedicated work by Abby Spencer and our Instructional Design Studio, have implemented training for all faculty, housestaff and staff on microaggressions and upstanding. Jenny Duncan and Lisa Moscoso have presented at departments across WUSM on the new reporting and management process for mistreatment including issues of gender, racial and ethnic bias. Finally, it is critically important that we look at our entire educational program through an anti-racism lens- from pre-matriculation to graduation, programming and policies. The Health Equity and Anti-Racism Committee (a subcommittee of COMSE) chaired by Nichole Zehnder does just this and will be continually monitoring our progress.
We will hold ourselves accountable, admit when we make mistakes, learn from it and continually improve. We also invite our community partners to hold us accountable: Our Program Evaluation and CQI unit is continually gathering data on the curriculum, on student opinion, on the outcomes of our initiatives, and our learner outcomes. We are still too early in the process to see whether we have truly made a difference, but I am hopeful. The curriculum has not gone perfectly, and our students have told us about it. We have relentlessly changed to address concerns and will continue to do so. The early Y2Q data and feedback from our faculty and residents shared above is a good sign that we are making a difference where it matters, but this will be a continual improvement process.
We will disseminate what we learn so others can benefit from it: We are in the process of completing a mixed methods study of contributions to bias in grading led by Donna Jeffe, Jan Hanson, Eve Colson, Maria Perez and Yaheng Lu. I am participating in a national collaborative of medical education senior leaders to build an institutional self-assessment tool for anti-racism, and many of us are engaged nationally in initiatives at the AAMC, and ACGME to further this work. Our Office of Diversity Equity and Inclusion and our Health Equity and Justice team (Kaytlin and Audrey) have been presenting around the country on the work they have been doing.
This is a long article, but it seemed very important to update you all on the progress we are making and where work still needs to be done. I am pretty darn impressed by what we have accomplished to date (in spite of COVID). This will be a long journey and hard work and it is of such critical importance. It will take ALL OF US to ensure our ultimate success in creating a truly equitable and inclusive environment for all the learners, staff and faculty we serve.
Gateway’s Approach to IPE
What I love about sports is that for a team to succeed, each team member must know their role and responsibility even in individual sports like tennis – trainers, coaches, racquet stringers.
Just like athletes, future physicians must learn to work effectively on healthcare teams which are complex and require the cooperation of many different health professionals. In the Gateway curriculum, our approach to interprofessional education (IPE) began with a review of the 4 Competency Domains created by the Interprofessional Education Collaborative (IPEC), a collaboration of 21 national health professional associations (https://www.ipecollaborative.org/membership): Interprofessional Communication, Roles and Responsibilities, Values and Ethics and Interprofessional Teamwork. These competencies are meant to be achieved over a lifetime from training to practice.
With these IPEC competencies and our guiding light of finding “natural fits” where IPE could be highlighted in mind, we began in phase 1 by collaborating with Module leads to integrate the roles and responsibilities of our interprofessional colleagues within what they were already teaching. This ranged from having social workers on panels talking about organ transplant to having physical therapy senior students teaching musculoskeletal exams to Phase 1 Gateway students through clinical vignettes. In this way, phase 1 students saw the expertise our interprofessional colleagues possess and the vital role they play in patient care.
We also focused on integrating interprofessional communication and teamwork. The Center for Interprofessional Practice and Education (CIPE) already coordinated sessions with early learners from all schools on the Washington University Medical Campus (Audiology, Genetics, Medicine, Nursing, Occupational Therapy, Pharmacy, Physical Therapy) to learn about social and structural determinants of health, and interprofessional communication and teamwork. We deliberately integrated what was learned in the CIPE sessions into the Gateway curriculum around communication and health, equity and justice (HEJ) – often highlighting the interprofessional perspective. For example in the HEJ curriculum, we had occupational therapy (OT) faculty and an OT doctorate student teach about housing insecurity and the role OT plays in working with the unhoused here in St Louis.
We further took advantage of the clinical immersions in Phase 1 of the Gateway Curriculum, where phase 1 students are placed on healthcare teams for 3 weeks at a time with no classroom responsibilities. This was a unique opportunity for the students to see and meet first hand our interprofessional colleagues that they had learned about in the Modules. Immersion students were required to interview and shadow at least 1 non-MD health professional working with their clinical team whether that was a nurse, physical therapist, coder, biller or social worker. Through this activity, Gateway students gained a better understanding of the challenges and responsibilities each member of the healthcare team faces. They are then required to incorporate this into their end of immersion analysis on healthcare teams.
Now in Phase 2, the Gateway students are immersed in their clerkships and we are pushing them to further incorporate interprofessional roles and responsibilities, teamwork and communication into their emerging role as a physician. Students on the Neurology clerkship are placed in physician clinics that have interprofessional practitioners integrated into the work flow and also placed them in non-physician centered clinics such as a stroke occupational therapy clinic or the Stephen A. Orthwein Center at Paraquad which is a fully accessible gym for people with disabilities staffed solely by occupational and physical therapy practitioners.
Phase 2 students are also asked to incorporate their interprofessional skills into their decision making. In one of our standardized patient team scenarios, students create a discharge plan for a stroke patient alongside other interprofessional students and receive feedback on their teamwork and communication skills. Moreover, students are required to turn in physician notes that focus on interprofessional team members that should be included in a patient’s care based on the specific needs of the patient and healthcare team and, importantly, how interprofessional teams caring for patients support high value patient care.
As we finalize our phase 3 curriculum, we hope to continue to find “natural fits” for our students to further their skills around Interprofessional Communication, Roles and Responsibilities, and Interprofessional Teamwork. And since phase 3 Gateway students will have spent significant time in clinical areas, we will have phase 3 students begin to explore the Values and Ethics around interprofessional collaboration.
Hopefully at graduation, our Gateway students will have a great base of skills and habits that will help them succeed on interprofessional health care teams as trainees and as physicians and continue their life long journey of interprofessional education and collaboration.
Eva and Steve’s Excerpt March 2022
First, let me send my thoughts and prayers to all of you who have family, friends and loved ones in the Ukraine. There is nothing I can say or do to reduce the fear and sadness many of you are feeling. I simply hope you know that I care and am thinking of you.
In addition to the devastation of war, we are navigating a particularly tumultuous phase of the COVID-19 pandemic. First, let us all recognize that there is good news to celebrate on the COVID front. Our community has seen dramatic drops in the numbers of COVID-19 cases since the Omicron variant caused record levels of transmission over the holidays. We are now at levels lower than at the start of the Omicron surge and still trending downward. We also have continued to get reassuring data throughout the Omicron surge that severe illness is very rare for most people who are up to date with their COVID-19 vaccinations. Very recently, there is also evidence that vaccination significantly reduces the risk of developing long-COVID.
Despite the emerging optimism, there are still important reasons to remain cautious. While the transmission rates are coming down, there is still a moderate level of spread and a measurable risk that we can come into contact with COVID-19 in our daily interactions. Importantly, there are many people who remain vulnerable to the possibility of more serious COVID-19, including those with severely compromised immune systems, those over age 65, and children under age 5 who are not yet eligible to be vaccinated. There are also many more people who, even if they are not at elevated risk for severe illness, may live with or care for someone who is, or may have other reasons for a high level of concern about getting COVID.
Before vaccines were available, universal masking requirements were necessary to prevent serious illness and deaths. Once vaccines became widely available but transmission rates remained high, universal masking served as an important public health tool to reduce the risk of large-scale disruptions to daily operations in our core missions of research and education, and reduced the risk that our healthcare system would be overwhelmed. Masks are still an important tool for personal safety.
The CDC on Friday altered their guidance to say that universal masking requirements are not necessary to prevent a public health crisis in places where hospital systems are not overwhelmed and case rates are less than 200/ 100,000 people- St Louis fits within this group. Individual jurisdictions or institutions may still decide requirements are necessary depending on local conditions. While mask requirements are being relaxed in the County and soon City, we need to recognize the different perspectives of individuals on this campus as we move forward. WashU is a community that cares for each other and the community we work in. As we progressively pull back COVID mitigation on campus in coming weeks and individuals make personal decisions about masking, we must also focus on how we care for each other, even if our own risk perceptions and tolerances are different from our colleagues. To do this, the following things need to be adhered to:
STAY HOME IF SICK;
Even after universal indoor masking requirements are relaxed, it will still be recommended until transmission drops to low levels and remains an excellent tool for personal protection;
Never shame someone or make assumptions about them because they choose to wear a mask or say no to a social engagement;
If you know a colleague or co-worker is at higher risk or cares for others at higher risk, support them, and wear a mask even if the rules don’t require it.
We are in yet another time of change- this one for better overall, but it will not be without angst and fear. Please care for each other and yourself in the process. And begin to prepare personally for policy changes in coming days and weeks to our COVID mitigation requirements.
Eva’s Excerpt January 2022
Happy New Year?
I mean it as a rhetorical question. Without a doubt, we are starting this year in a tough spot. COVID cases are surging with the widespread introduction of the Omicron variant across the US. Unlike prior surges, we are hit hard with not just hospitalizations, but also large numbers of faculty and staff testing positive and unable to work. The COVID Call Center has been overwhelmed with calls and testing sites are packed, so much so that we are unable to perform post-exposure testing on employees through Occupational Health. Even if you have not thus far been impacted by COVID in your home or amongst your family members, you may be struggling with back to school woes, the strains COVID has placed on travel, or the sheer weight of emotion that this wave has brought down on us and the country.
While it may feel like we are reliving the winter of 2021, we are decidedly not. We are blessed with vaccines that are remarkably effective at reducing death, hospitalization and severe illness. That is HUGE! We know so much more about how to prevent the spread of COVID through simple measures like wearing a mask when we are inside or in close proximity to others and washing your hands regularly and before eating, drinking or touching your face. We have adequate personal protective equipment in the hospital and clinics. We know how to run our hospital, clinics, labs and classrooms safely. That is all a LOT different. This is not a happy time, but it is a much more hopeful time than last year, and for that I am very grateful.
Because of the volume of people out—students, residents, fellows, faculty, staff, we will need to be nimble to get through this time. Again, fortunately for us, we know something about how to do that. Some classes may need to move to virtual, regardless of size. We will need to help each other out, in whatever ways we can. We will need to be patient and kind, despite frustrations. And we will need to remember that everyone is doing the best they can given their situation. Finally, and importantly, we need to keep steadfast in ensuring we stay focused on decisions that maintain the success of our critical vision and mission. A special thank you to our clerkship directors and clerkship staff and our OMSE team who are remarkably juggling the launch of Gateway Phase 2, the ongoing Year 3 clerkships, and the moving target that is the clinical environment in a COVID surge. There are no words to express my gratitude.
So, while we may not be starting the new year “happy,” there remains much to be thankful for and, at least I, have a lot of hope for a better 2022.