1. Nolen, Lindsey

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As the novel coronavirus spreads across the United States, certain areas are being affected at disproportionate rates. Those working on the frontlines of the COVID-19 outbreak in regions that have experienced an initial influx of infected patients, such as Washington state, have been met with the unique opportunity to accrue data and lessons from their work in hopes to share information regarding the pandemic with colleagues across the country.

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Serving as Medical Director of the Seattle Cancer Care Alliance Affiliate Network, Jennie R. Crews, MD, MMM, FACP, has seen dramatic changes taking place across health care as the novel coronavirus spreads. Since the virus was identified in Washington, over 88,000 tests have been administered with over 9,000 confirmed cases and over 400 deaths, according to the Washington State Department of Health (as of April 10, 2020).


In an effort to provide optimal cancer care during the COVID-19 outbreak, Crews and her team have determined ways to optimize safety while simultaneously treating patients. Since oncology patients can be classified as some of the most vulnerable to the coronavirus, her team has needed to rapidly mobilize their forces to meet this challenge.


"Sadly, we were in the unique position of being one of the first areas in the country to need to activate our incident command," Crews said. "We set up our incident command the last weekend in February. We've had a bit of a leap time in addressing some of the issues that came up as a result."


In response, Crews and the Seattle Cancer Care Alliance Affiliate Network have categorized their facility's response in terms of imperative areas of consideration. From human resources to communication and testing, the facility has tried to plan ahead for all possible circumstances and outcomes.


"[Communication] was one of the first things I think our group took on and tackled," Crews said. "We try to send accurate information to our patients about what COVID-19 is, what their risks are, what actions they can take to minimize their risk of getting this virus, and what services and resources are available for them at the Seattle Cancer Care Alliance. There's also been a great need for staff communication because this has been a very rapidly evolving response."


She added that recommendations coming from her facility's infectious disease experts and regulatory agencies are changing on almost a daily basis. This has made the need to keep staff up to date and informed, and the health care system to remain transparent, even more critical.


"We have an email push daily that goes out to our staff, and an internet site they can access that includes resources around COVID-19 and information on our policies and procedures. We've also set up town halls that we are having regularly on a weekly basis so that we can tackle particular topics of interest for our providers and our staff," Crews said. "I can't emphasize enough that we need to over-communicate and make sure people are on the same page whenever possible."


Another category Seattle Cancer Care Alliance focused on in the early days of the spread within the state was testing. The facility determined what the testing procedures and processes would be, what the criteria for testing was, and how staff and patients would gain access to it. According to Crews, her facility was in a fortunate position to have had resources for testing that some of the country did not.


"At the University of Washington, we have a wonderful neurology lab that was one of the first in the country that set up testing for COVID-19. Some of those investigators have national recognition in this disease for their early detection of COVID-19 being present in this country," Crews said. "We are very fortunate to have that as a resource here, and as a result we've been able to provide patient and staff testing pretty readily with an excellent turnaround time."


In addition to testing, the network had to establish a process of what to do in terms of notifying patients and staff with positive results. Crews recalls having to ask the questions: How do we handle situations where a patient or staff member is positive? What do we do with that individual? What do we do if there's an exposure from a staff member or a patient? When can staff return to work as a result of having been sick with or without a positive COVID-19 test?


Inevitably, these questions led to the need to address personal protective equipment and potential supply chain issues. This meant questioning who uses what PPE, to what degree, and under what circumstance. According to Crews, the solution required the balance of protecting the staff as much as possible, but also ensuring an adequate supply chain that will last into the future as the facility anticipated a surge.


"There are a number of models out there that are estimating when the peak number of patients in a certain area will be infected with COVID-19, showing what strain on hospital resources there will be when that occurs," Crews said. "We've been working with our partners in the UW Medical Center system, looking at how we can participate in creating capacity for inpatient needs and how providers can be repurposed to pitch in to help out with these acute patients in the event that a large surge does occur."


In keeping staff healthy and available, the Seattle Cancer Care Alliance Affiliate Network further needed to consider human resources policies and the extension of telehealth. Crews shared that staff members have voiced concern about sick leave, extending their paid time off, child care, and overall well-being. Prioritizing health and safety helped lead to the facility's rapid deployment of telehealth services.


"[We have been] working very closely with our colleagues at the University of Washington to be able to offer these telehealth services so that patients can receive care at home and not need to come into a physician's office," Crews said. "[This is] all in the interest of trying to keep our patient population as safe and as healthy as possible, but not interrupt their cancer care."


Lindsey Nolen is a contributing writer.