While much of campus is a ghost town, doctors at the Washington University School of Medicine and Barnes-Jewish Hospital are busier than ever as they prepare for the spread of COVID-19 in St. Louis.

Photo by Curran Neenan

“There’s a lot of work that has to be done to prepare a medical center like ours for a crisis like this,” Dr. William Powderly, director of the University’s Institute for Public Health, said. “It’s a little bit like moving a large ship in the middle of the ocean—it requires a lot of people working together, and I think what’s really been very gratifying is how collaborative and supportive everybody has been for one another. It’s a credit to everybody.”

Most appointments and operations have been cancelled or postponed, while urgent procedures have been moved up so that they can happen before the hospital is overwhelmed by COVID-19 patients, Powderly said. Some appointments will take place virtually or by phone.

According to associate professor of medicine Dr. Jeffrey Henderson, several divisions of the hospital have assumed new roles, such as helping to manage hospital infection control practices and policies.

The Washington University Medical Campus began conducting health screenings of employees entering select buildings on March 28. In addition to screening at hospital entry points, Barnes-Jewish implemented a no visitors policy with few exceptions and all hospital classes and events are cancelled until May 15.

Although most research has come to a halt, University labs continue to be staffed by “skeleton crews working on the most critical, time-sensitive scientific studies, including the investigation of and potential response to COVID-19,” according to a message from Chancellor Andrew Martin to the University community, March 23.

“We have basic scientists working around the clock in aspects of the virology and immunology of this virus,” Powderly said. “We have our clinical researchers already starting to put in protocols so that we have treatment available for patients. All of that is another aspect of collaboration that has really emerged as we’ve had to knuckle down to prepare for the virus.”

One such potential treatment is the use of convalescent plasma (CCP), collecting plasma from recovered COVID-19 patients for use in the treatment of current patients.

“The hope is that giving passive immunity to sick patients via CCP will speed up their recovery,” Dr. Brenda Grossman explained in a statement to Student Life. “At this time, potential donors must have a negative nasal swab test result and must be symptom free for 14 days.”

Grossman and Henderson are involved in the effort to develop clinical trials for CCP, which originated with researchers from Washington University, Johns Hopkins University and the Mayo Clinic.

“We put together research protocols to try and assess quickly whether this would be a benefit for patients with COVID or in protecting people who are at high risk like frontline health care workers from COVID,” Henderson said. “We got our heads together and developed some protocols to try and answer that question that was submitted to the FDA, because even though we routinely transfuse plasma, the use of it for this particular reason makes it regulated as if it were a new drug, and so that requires some regulatory hurdles to be cleared.”

There are now over 100 people from across the country who are engaged in one way or another with the research network, which has obtained several key endorsements and is currently waiting on approval for a formal study.

“In the meantime, we’ve moved through efforts to obtain immune plasma from people who’ve recovered from COVID and to make that available to blood blanks for use as a compassionate use therapy and in future research studies,” Henderson said.

Grossman has been working with other transfusion experts to coordinate the logistics between the hospitals identifying potential CCP donors and patients and the blood centers collecting and distributing these units back to the hospital to treat patients.

“There have been many conversations between individuals from different blood collecting facilities, blood bank organizations and the Food and Drug Administration (which regulates blood products) to make this happen,” Grossman wrote. “We are hoping that we will be ready to accept donors in the next week.”

As the supply of personal protective equipment (PPE) has become more limited, the hospital has implemented policies to reduce consumption such as limiting the number of visits to patient rooms and safely reusing masks, said Henderson.

“We’ve been prudent in husbanding it and making sure that we are not overusing it and wasting it at this point of the epidemic, in order to have PPE available when we hit the peak,” Powderly said. “Everything will depend on how long this particular crisis lasts and whether we can maintain supplies throughout that period of time, so there is always an element of anxiety around that. We have enough right now, but we can’t predict whether we will have enough, say, at the end of April or the middle of May.”

As of April 1, there are over 1,500 confirmed cases of COVID-19 in Missouri. Safety concerns for both doctors and patients are active topics of conversation.

“We regard that as a risk in both directions—there is a risk of transmission from patient to doctor, [and] there’s always a risk of transmission from doctor to patient,” Henderson said. “That is a risk because COVID symptoms can be very mild, so we are concerned about transmission in general. There’s a lot of people thinking hard about how to maximally protect everybody.”

According to Powderly, Medical students are leading an effort to collect PPE for donation, while others are looking into various ways of potentially recycling or reusing the existing PPE, such as using UV light to sterilize N95 masks.

“Our hospitals and clinics are preparing to meet the medical needs of St. Louisans, and our university communities are stepping up to support protective-equipment drives and other efforts to make sure our health care providers have what they need to stay safe,” Chancellor Andrew Martin wrote in a St. Louis Post-Dispatch op-ed, March 24. “We’re reinforcing our existing capabilities to ensure that we are providing high-quality care to as many people as possible as we head into the unknown. While most of us are staying home, our medical clinicians are reporting to the front line every day, making great personal sacrifices in support of the greater good.”