Habits.
In general, it takes about three
months of regular performance of a new behavior to develop a habit – to
incorporate actions into your life that becomes largely unconscious and effortless,
like brushing your teeth. In my mind, the crisis in Houston became real with
the closure of the Houston Rodeo on March 11. Since that date, we have all been
dealing with change on an unprecedented scale. Work changed, the economy
slowed, schools closed, we experienced two disease surges (or as some would
contend, one long continual surge). Using the Rodeo as a marker, we are now in
our 5th month of the crisis – plenty of time to have developed new habits.
Today I would like to briefly review the improving data from the past week,
while pausing to contemplate what positive lessons we have learned so far. How
are we going to be better for having lived through this historic crisis?
We are clearly in a transitional
period. The numbers this week are encouraging. For the past two weeks, the R(t)
– the measure of community viral infectivity – has been at or below 1.0 due to
community masking and distancing efforts. It now appears we achieved our peak
of new viral infections during the 2nd week of July. New community cases in
Harris and eight surrounding counties, on a rolling average basis, have
decreased from about 2,400 daily at peak to around 1,800 (but keep in mind, for
most of April and May we were seeing fewer than 400 cases per day, so we are
still seeing a lot of new disease). New community cases reflect all positive
tests, including people who are asymptomatic or minimally symptomatic.
The decrease in community disease
burden in showing up in slackening hospital demand. Across TMC institutions at peak,
daily admissions were above 350; we are now below 250. The daily census of
patients in non-critical medical/surgical beds is dropping, and ICU patient
census – which is expected to lag these other indicators – is starting to drop.
In short, all the metrics are headed in the right direction.
To be clear, this does not mean
things are easy. Providers in hospitals are still managing high numbers of very
sick patients. Faculty, providers and residents in ICUs are fatigued. All
tertiary/quaternary hospitals are providing extracorporeal membrane oxygenation
(ECMO) to record numbers of patients. There are parts of Texas, particularly in
the Rio Grande Valley, that are still squarely in crisis mode. So again, this
is not over – just better. Vigilance around masking and physical distancing
must continue. When the time is right, we must continue to encourage
thoughtful, data-driven reopening decisions.
So, as we ride the backside of the
current wave, I would like to reflect briefly on lessons learned – societal, organizational
and personal. What new habits, skills and strengths have we developed during
this crisis?
On the broadest societal level, I think this is a difficult question to answer.
This will no doubt be the subject of many books to come. One lesson learned
should be that the U.S. deserves a less fragmented, better-coordinated public
health system. I hope this is my only global pandemic, but if we are ever
unfortunate enough to experience something like this again, as a nation we must
be better prepared.
In terms of institutional lessons,
we have had a glimpse of what it means to be a learning health system. The AHRQ describes an learning health system as a system
where “internal data and experience are systematically integrated with external
evidence, and that knowledge is put into practice. As a result, patients get
higher quality, safer, more efficient care, and health care delivery
organizations become better places to work.”
I think that summarizes our last
five months remarkably well. We have proven that if we have focus and
organizational commitment, we can do big things quickly and do them well to
improve the health and well-being of our community. The Baylor collection site
just “swabbed” patient 10,000 this week. While other labs are challenged to
provide timely results, Baylor labs continue to provide region-leading
turnaround time for high reliability testing. Our researchers continue to
manage productive labs and submit COVID and non-COVID related grants.
Telehealth services enable us to provide necessary services to patients, and in
a challenging environment, we are ahead of pace to recover all of our pre-COVID
patient volume. Psychiatry in particular is performing the majority of their
services virtually – including direct services in support of many in the Baylor
community – and are on pace to exceed their pre-COVID levels of patient care.
Curricula have been redesigned, and new students, residents and fellows
smoothly onboarded. I hope a residual Baylor habit is recognizing we can
accomplish important things quickly and well.
On a personal level, all of our lives
are different than they were. We have faced a ton of disruption and much
negative and difficult change. I think it is useful to stop and reflect for a
moment on what is better, however small those things might be. What new
routines have we established that we find meaningful and valuable? How would
you finish this sentence? “In the post-pandemic world, I will continue
to…” These habits can be small or large, but pause to think about what they
might be. For me personally, two come to mind. In the post-pandemic world, I
will continue to…
- Limit my professional travel. Like most of you, I have
not been on a plane since February, and have discovered I really do not
miss it. I have more time at home, and seem to have been able to fulfill
professional obligations fairly well remotely. To be sure, when travel
becomes routine again, some face-to-face interactions will and should
resume. However, I like being at home with my family and will be more
selective about future trips.
- Have Sunday lunch with family. We have a new tradition
of sitting down to mid-day Sunday for a family meal (within our
household). Although we typically do take-out rather than cook, this feels
like a throwback to a less hurried era. Pre-COVID-19, we had limited
opportunity for unstructured, leisurely conversation; somehow now it seems
to be more important.
In the post-COVID world, what
positive thing will you continue to do? Take time to reflect. If you are
inclined to share, email me your (brief) sentence, or if you are on Twitter,
post using the hashtag #COVIDHabitsBCM.
Stay well.
(Note: Between June 2020 through November 2021, I
wrote weekly COVID-19 pandemic updates seen through the lens of a health
sciences university. My intent was to
provide reliable information, acknowledge legitimate concerns, console, and
encourage. Each posting reflects issues
our community was experiencing at that moment in time. I have reproduced selected examples on this
site).
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