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COVID-19 and BMI – What Have We Learned? More insights from the United Kingdom

The COVID-19 pandemic has skyrocketed many fields of healthcare – basic science research, outcome-based research, and epidemiological factors affecting healthcare. We already know obesity affects >4 in 10 adults in the United States and contributes to diabetes, heart disease, ultimately leading to increased morbidity and mortality1.  Based on prior experience, we have learned that obesity is associated with an increased risk of other respiratory viruses, such as influenza. These same patients tended to have a higher risk of hospitalization and death, along with longer lengths of stay and mechanical ventilation compared to patients who have normal weight2.

In January of 2021, researchers used the American Heart Association’s COVID-19 Cardiovascular Disease Registry to look at the effect of obesity across different groups’ mortality, need for mechanical ventilation or both. Analysis of data from 88 hospitals in the US showed that classes I to III obesity were associated with a higher risk of in-hospital death or mechanical ventilation compared to normal weight when these patients are hospitalized with COVID-19. The association was strongest in adults <50 and weakest in adults >70 years of age. This was the first study to show the harmful effects of obesity on COVID-19 outcomes may be limited to people under 50 rather than those that are older and obese. There could be a number of reasons for this observation – including comorbid conditions such as diabetes, hypertension, or even delays in seeking care3. As a critical care provider, this study definitely made me evaluate risk factors for younger patients (and even family members) differently.

In a time where one study is not simply the end-all-be-all, a more recent study from the United Kingdom had a similar message. The study was led by Nuffield Department of Primary Care Health Sciences and had 6.9 million patients – which is an outstanding number! And what did they discover??

Figure A shows patients with low BMI (<18.5) had an increase in COVID-19 related admissions to the ICU along with a steady increase in admissions to the ICU as the BMI increased. Figure B shows a linear association across the whole BMI range for death due to COVID-194.  Dr. Carmen Piernas, lead author of the study said: “Our Study shows that even very modest excess weight is associated with greater risks of severe COVID-19 complications and the risks rise sharply as BMI increases. Also, risks associated with excess weight are greatest in people <50 years, while weight has little to no effect on your chances of developing severe COVID-19 after age 80. These findings suggest that vaccination policies should prioritize people with obesity.” The impact of obesity was most marked in people in the youngest age range of 20-39. The study shows that obesity is not only a chronic disease but also a risk factor for acute illness or death. Taking it one step further, health care providers across the spectrum will have to work harder to help provide evidence-based treatments for patients to help reduce their weight.

One of the most striking aspects of this study was the number of patients they tracked in the outpatient setting who ended up needing to go to the hospital. They tracked these patients in their disease course in hopes of giving us information for people in the general community rather than those already admitted to the hospital. At this time, there is no study looking to see if weight reduction specifically reduces the risk of severe COVID-19 outcomes, but I would be interested in such a study.

There was also a significant interaction between BMI and self-reported ethnicity for hospital admissions and death due to COVID-19, with Black people having a higher risk than white people. It’s unclear as to why this association exists in a country where all the citizens have free access to healthcare. There are a few hypotheses but nothing concrete has been established.

Overall, with the addition of this large study plus what we have known before, we can be confident that obesity continues to have significant health implications. I hope we never see another pandemic but if we do, I’m confident what we have learned over the past year will help us treat our patients more efficiently and effectively.

References

  1. Romero-Coral A, et al. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancent. 2006;368:666-678.
  2. Jain S, Chaves SS. Obesity and influenza. Clinic Infect Disease. 2011;53:422-424.
  3. Hendren N, et al. Association of body mass index and age with morbidity and mortality in patients hospitalized with COVID-19 results from the American Heart Association COVID-19 cardiovascular disease registry. Circ. 2021;143:135-144
  4. Gao M, et al. Associations between body-mass index and COVID-19 severity in 6.9 million people in England: a prospective, community-based, cohort study. Lancet. 2021;

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Finding your first job after training – what I learned from the process.

We all look forward to the day we can finish training and finally become attendings. For me, that day crept up faster than I was ready for. In the midst of a pandemic, not only was I juggling clinical responsibilities, I also had to figure out how to find “my perfect” first job. I tried a number of different strategies but here is what I learned from the process.

  1. Attending job searches is NOT the same as residency or fellowship positions. For many of us, we filled out an application and started clicking away on any and all programs that we thought would help us become physicians. We then interviewed all of the US in hopes a computer algorithm will match us to our first-choice program. This isn’t the approach I took for attending jobs. I only spoke to places I had an interest in working and felt would be a great fit for my first job. It’s important for us to shift away from thinking of a residency/fellowship position as the process is not the same and requires a different approach.
  2. What is my dream job? And more importantly, write it down! One of the most important things I learned is I need to have a clear vision of what type of job I am looking for. Specifically, I first had to decide if I want to work in an academic environment vs community setting vs private practice vs locum, etc etc. This was the key step to focus my target search. More importantly, employers will ask asked me “what are you looking to do?” By having a concrete answer, the process was much more smooth and fruitful.

Other things to consider are how much inpatient time I’d like to do, how to develop an outpatient clinic, and opportunities to be involved in trainee education. For those

who are wanting to do research, is having protected time important and if so, how much time would you

want. By having this road map of your “dream job” before talking to employers will show you are prepared and have done adequate research for your first attending job. It will be up to the employers to then help your roadmap become a reality.

Career development is important for all of us and working for a practice that will support our career goals is important. Having an idea of your 5-year (or 10-year) plan to discuss with an employer will help you gage if the employer can help you grow and develop to achieve those goals.

  1. Utilize your network. There was a point when I was getting nowhere with my job search. Emails were going unanswered, no new jobs had been posted at places I was interested, and everything felt very grim. I then spoke to my program director who was able to help me get in touch with former fellows (and now attendings) at different programs to see if they have something that would suit my dream job.

    I also spoke to several of my co-fellows which turned into all of us sharing where we have interviewed or places we think the other may find as a good fit. Don’t be afraid to reach out if you’re in this position – you have nothing to lose but a lot to gain! Reaching out to mentors is also important as they may have leads on jobs you may not have considered before.

Although this conversation can be extensive and this is not an exhaustive list, I’ll end with this: we put a lot of pressure on ourselves to find the perfect job right out of training. However, the first job doesn’t need to be the last job. You can always look for a better fit – but DO NOT burn any bridges with your current employer!

 

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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February: Black History and American Heart Month

The month of February celebrates Black history and cardiovascular disease – both of which offer unique opportunities. Black History Month celebrates the contributions of African Americans while American Heart Month provides opportunities to highlight the burden of cardiovascular disease. This is no way an exhaustive list, but who have contributed to the history of medicine.

James Derham (or perhaps it was Durham) is believed to be the first Black person to officially practice medicine in the U.S and without a medical degree. It is believed he learned by way of apprenticeships which was a major form of passing skills to those who didn’t (or couldn’t) attend university. He was born a slave and worked for many doctors. He was able to buy his freedom and continue to practice, but by the early 1800s, James disappears from history. Some say he was murdered and others believe he left Philadelphia to practice medicine elsewhere.

 

Vivien Theodore Thomas was born in New Iberia, Louisiana and attending high school in Nashville in the 1920s. Vivien always wanted to be a doctor but due to the Great Depression he was forced to work instead. He eventually, became an assistant to surgeon Alfred Blalcok – most noted for his work in shock and Tetralogy of Fallot. Their hard work (along with Dr. Helen Taussig) created the Blalock-Thomas-Taussig Shunt, an operation that ushered in the modern era of cardiac surgery. In 1976, Vivien was awarded an honorary doctorate and named an instructor for surgery at Johns Hopkins School of Medicine. A great movie I saw about Vivien was Something the Lord Made and highly recommend it.

 

Rebecca Lee Crumpler was an American nurse, physician, and later turned author. She is believed to be the first African American woman to become a doctor of medicine in the U.S, studying at New England Female Medical College. In 1883, she wrote Book of Medical Discourses dedicated to maternal and pediatric medical care. It was the first publications written by an African American about medicine. After the Civil War, she continued to treat women and children in Virgina. She also worked for the Freedmen’s Bureau to provide medical care for freed slaves.

 

Edith Mae Irby was inspired to become a physician after unfortunately seeing her sister pass from typhoid fever. At a young age, she saw health care disparities first hand and believed her sister passed prematurely due to lack of care because her family was poor. This sparked a fire for Edith to become a physician that found her reward in service not wealth. Edith was the first African-American student admitted to the University of Arkansas Medical School in 1948 and believed to be the first black student enrolled in any all-white medical school in the South. This comes 6 years before the Supreme Court’s decision on Brown v Board of Education.

In the words of poet laureate Amanda Gorman in the poem titled “The Hill We Climb” she states “we will not march back to what was, but move to what shall be.” This exemplifies both Black History and American Heart Month. Knowing where we came from helps us better see where we are going and I look forward to see where we go.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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2020 Was “Challenging and Creative” According to Dr. Harrington, How Would You Describe It?!

Everyone has different feelings about 2020 but I think it’s safe to say we have all taken the time to reflect on this past year and are filled with a new sense of hope for 2021. I sat down with Dr. Robert Harrington (past AHA President) to get his unique perspective on 2020 and what he looks forward to in 2021.

Dr. Robert Harrington, Immediate Past President, American Heart Association

Reflecting on 2020:

What went well in 2020 from the AHA? At the beginning of the pandemic, the AHA took a conscious effort to adapt as an organization. The AHA quickly pivoted its science and provided rapid response grants. Approximately 700 applications were submitted and the AHA fueled about 20 grants focusing on COVID research. The AHA also was seamlessly able to create a COVID registry based on our extensive experience with “get with the guidelines.” The organization continued to focus on being a voice for our patients with cardiovascular disease and wanting to bring quality evidence to clinicians – a few examples that come to mind include the debating of stopping ACE inhibitors and the effects of QT prolongation medications in patients with COVID.

What was the biggest change/disruption, how did you deal with it? As an academic clinical  researcher, not being able to travel to meetings and conferences was very challenging. The meetings provide key networking that helps keep projects going but now we have less person-to-person contact. As AHA president, I wasn’t able to travel abroad to represent our organization and continue to build on our existing international relationships. Another change we also had to consider was how the pandemic and social distancing would affect the AHA 2020 sessions. Fortunately, our virtual platform was a success and we were continued to deliver pivotal science.

Looking forward to 2021:

How do you define success in 2021? Taking lessons on how to do things differently, for example, shifting to an online platform for fundraising and reviewing grants was successful. We were able to continue to do the work entrusted to us. We have embraced this shift in culture to help our organization grow and continue to be successful. We are also very exciting to see what will be discovered from the COVID registry.

What do you look forward to in the field of cardiology in 2021? The pandemic has fostered a lot of creativity. I think continued exploration in digital technology for patients with be key. Can we better control blood pressure, medication adherence, glucose control, etc via digital technology. This is an area of science and health care that is exponentially growing and it will be exciting to see what else we are able to develop.

Quick Tips for FIT:

How should FIT/Early career clinicians approach 2021? As we move back towards “normal” times, people need to take time off and decompress. We will find relief and gratitude we have gone through such a tremendous pandemic. It’s important to recognize burn-out and even more important for all of us to rejuvenate.

What do you think will cause the most stress and how can FIT/EC navigate it for a better future? My observation this past year (and during my time as an EC professional) it is the constant balance between professional vs personal life. During the pandemic, school closures and lack of elder care for example, have been a huge stressor on professionals. I hope we learned how to do things differently going forward to foster a better environment.

 

The memories of 2020 are still fresh in our minds but after speaking with Dr. Harrington, I too am more hopefully for a brighter, better, and as productive 2021. We have seen a tremendous growth in our community, compassion, and desire to help each other grow. So, good riddance to 2020 and cheers to 2021!

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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COVID-19 Vaccine & Cardiovascular Disease: What We Know So Far

It’s hard to believe the majority of 2020 was spent in a pandemic. The world came to a screeching halt and the entire scientific community worked tirelessly to find ways to keep each other safe. However, we all have experienced highs and lows due to COVID-19. But we were fortunate to have Operation Warp Speed to help produce and deliver millions of doses of safe and effective vaccines against the COID-19 virus.1

It is well known that traditional risk factors such as hyperlipidemia, hypertension, diabetes, and obesity are modifiable risk factors for coronary artery disease. Through the evolution of research, inflammation and infection were also discovered to play a role in developing an acute myocardial infarction (MI).2,3 After the epidemics of influenza in Europe and the US in the early 1900s, it was speculated that there is a relationship between influenza and MI. This was on the basis that excess mortality was due to other causes than influenza, such as heart disease.4 Mechanistically, influenza causes platelet aggregation leading to MI. This finding (along with others) led the American Heart Association and American College of Cardiology in 2006 to recommend influenza immunization as a part of comprehensive secondary prevention in persons with coronary and other atherosclerotic vascular diseases (class I, level B).5

Based on our past experiences of viral infections and the current pandemic-state, what emerged was that on November 20, 2020, Pfizer and BioNTech (the sponsor) submitted an Emergency Use Authorization (EUA) request to the FDA for an investigational COVID-19 vaccine. The purposed use under a EUA is for active immunization for the prevention of COIVD-19 caused by SARS-CoV-2 in individuals 16 years of age and older; with a 2 doses regimen, administered 21 days apart.1

There are many safety and side effects to discuss regarding the vaccine (any vaccine for that matter) but I’ll be focusing on the cardiovascular risk profile. The most frequent comorbidities were obesity (35.1%), diabetes (8.4%), and pulmonary disease (7.8%).1 Other baseline characteristics included: myocardial infarction (1%), peripheral vascular disease (0.6%), congestive heart failure (0.4%), and hypertension (24.5%).1

Of the serious adverse events, a total of 6 deaths (2 vaccines, 4 placeboes) from the total 43,448 participants occurred. Both vaccine recipients were >55, one experienced a cardiac arrest 62 days after the second vaccination dose and the other died from arteriosclerosis 3 days after the first dose. From the placebo group, only 1 patient died from an MI. Interestingly, 1 patient had ventricular arrhythmia but was known to have cardiac disease. Overall, there was no imbalance in severe adverse cardiovascular events. In general, serious adverse events were uncommon and represented medical events that occurred at a similar frequency in the general population.1

Some of the gaps from the safety reporting of the COVID-19 vaccine includes; duration of protection – as the participants are not more than 2 months out from initially receiving the vaccine, the et of immunocompromised individuals is too small to evaluate efficacy (i.e. heart transplant recipients ), children <16, and pregnant/lactating individuals.

Where does this leave us as leaders in the health community? We can recognize that the benefits do outweigh the risks and continued efforts will be made to monitor the health of Americans. At this point, I believe we can clearly communicate potential cardiovascular outcomes with our patients to help them make an informed decision.

References

  • Vaccines and related biological products advisory committee meeting. FDA briefing documents. Pfizer-BioNTech COVID-19 vaccine.
  • Epstein SE, Zhou YF, Zhu J. Infection and atherosclerosis: emerging mechanistic paradigms. Circulation. 1999;100:20-28
  • Syrjanen J. Infection as a risk factor for cerebral infacrtion. Eur Heart J. 1993;14:17-19.
  • Collins SD. Excess mortality from causes other than influenza and pneumonia during influenza epidemics. Public Health Rep. 1932;47:2159-2168.
  • Smith SC Jr, Allen J, Blair Sn, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update. Circulation 2006;113:2363-72

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Improving Your Experience at a Virtual Conference

2019-2020 AHA FIT & Early Career Bloggers at AHA Scientific Sessions 2019

In 2019, I was fortunate to be an Early Career Blogger for the AHA and attending the scientific sessions in Philadelphia (pictured below). It seems hard to believe that one year later, the same conference is being held exclusively via an online platform. COVID has caused a lot of changes, including the way we strive to provide education and conferences that still have the same impact.

Attending a conference such as AHA can be intimating due to its venue size, the numerous presentations, and navigating your way through the thousands of attendees. I was fortunate to discuss how best to be successful at such a conference and with the transition to an online platform, I want to equip others with a few tools I think will help make the experience enjoyable.

Before

  • Organize your schedule. With the increased flexibility of attending from the comfort of our own homes, it’s critical to plan ahead to optimize what sessions we want to see. Look ahead and block off your schedule so you can be free of distractions during the sessions.
  • Prioritize your time. multitasking isn’t very productive and we may have the urge to answer work emails, phone calls, or text with friends. Focus on making the best use of your time during the presentations.

During

  • Be an active participant. Try to participate beyond listening. I encourage fellows to take notes, ask questions, and get active on social media by using conference hashtags, live chats, and other tools to connect. Several sessions are dedicated to meeting trialists, researchers, and leaders in the community in order to provide the same opportunities as the live conferences did. I believe, it’s critical for us to engage in these sessions.
  • Build your virtual community. At in-person conferences, the audience normally listen to the speakers and may make small talk in the coffee line. With virtual conferences, we all have the chance to engage in more meaningful ways. By being more actively engaged, you can expand your network and start to potentially collaborate with others in the field.
  • Take Breaks: It’s important to recognize we can all fatigue from attending back-to-back-to-back sessions. I always make sure I have a snack, water, and time to stretch. Getting up to walk for a few minutes in-between sessions will help keep you fresh and more engaged.

After

  • Replay. You can easily catch any recorded sessions you may have missed. By being able to watch the sessions later, you can continue to keep the conversation going and continue to expand your network.

There are multiple ways to continue to have an amazing experience at the AHA but participants have to have a few tools to be successful. I believe the above tips are a great pathway to make the most of any virtual conference.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Mastering the Art Of A Virtual Interview

The COVID-19 pandemic has created an entirely new (and robust) world of online platforms. All across the globe classrooms, meetings, conferences, and social get-togethers have become virtual. Companies such as Zoom (Zoom Video Communications, San Jose, California), WebEx (Cisco WebEx, Milpitas, California), and BlueJeans (BlueJeans Network, Mountain View, California) have allowed us to maintain social distancing while maintaining the ability to round as teams, attending meetings, and even conduct interviews. However, for many trainees, interviewing for residency and fellowships is challenging on the best of days but needing to conduct an interview online has its unique set of problems. This past year, as a chief cardiology fellow, I was able to interview a number of candidates. Some did a fantastic job while others struggled. Here are a few tips to help this interview season be even more successful.

  1. Practice makes perfect: One of the great features of Zoom (and others) is the ability to record video calls, making it an incredible tool for interview preparation. You can optimize a lot of in your interview by seeing how the lighting is affecting the way you appear on screen, are you fidgeting too much, and how is the video/audio quality. I would recommend having a few mock sessions with friends, family, and even a mentor to get feedback. It is key trainees get enough practice before the real deal.
  2. Get rid of distractions: In face-to-face meetings, distractions are shared by the interviewer and candidate – we are often able to laugh at them together. However, if your dog or child runs into the room when you interview it’s a lot harder to laugh. Even small things such as text messages, emails, or noises from the outside of your own home can be a distraction that may be hard to recover from.
  3. Maintaining eye contact: This may be one of the trickiest parts of an online interview. If you look at the person you are talking to then the camera doesn’t capture your eye contact. If you look into the camera, then you don’t get to see the body language or facial reactions of the interviewers. I recommend the second option – look into the camera when speaking. You can look down at the screen to get cues about how the interview is going when the interviewer is speaking.
  4. Double-check the date and time zone: Since we are not traveling for an in-person interview, it is important to make sure you have the correct date and time. If you are interviewing with a program in another time zone you do not want to be late because you did not take the time difference into account. This will be especially important for those interviewing on the different coasts, or if interviewing in a state such as Arizona that does not have daylight savings.
  5. Don’t be afraid to ask questions: Training programs have had to adjust during the COVID pandemic so don’t be shy to ask what steps institutions have taken and what is their plan for going back to “normal.” You may have specific goals you want to accomplish during your training – share this on the interview to see if the program will be able to help you fulfill your goals. Remember to ask the most important questions on the interview day that will better inform you about the program, you can always follow up with an email if more questions come to mind.

Interviewing is a challenging skill to perfect however, with preparation and keeping a few of the above-mentioned tips in mind, you can set yourself up for success. You’ll feel more confident and relaxed during your virtual interview by taking these tips into account, and hopefully match at your top program.

Image website addresses:

  1. Panel with female interviewer: https://www.forbes.com/sites/zackfriedman/2018/12/05/most-common-interview-questions/#508966cc8e3c
  2. Online interview image: https://www.wayup.com/guide/community/ey-245237-sponsored-video-virtual-interview-guide-expert/

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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COVID-19: The Road to Recovery

The disruption COVID-19 has caused globally is nothing short of mind-blowing and extremely fatiguing. On a daily basis, new information is released about economic declines, healthcare burdens, and the ever-changing social distancing norms. Across the US, there are varying degrees of social distancing, shelter-in-place recommendations, and acceptance from the community on steps going forwards. We have recently seen protests to open the country and at times horrific images from the community we are trying to protect. No matter where you may stand on these issues, we can agree the road to recovery from this pandemic for America will be long and challenging. The work going forward will require continued teamwork to keep Americans healthy. Here are a few of my thoughts, in no particular order, that we should keep in mind.

  • Pediatric population: the recent decline in outpatient availability has reduced primary care milestones. Many children are delayed in getting their vaccinations as a result of COVID-19. Plans of efficiently having children receive their vaccinations will be instrumental, especially those who will be of school age.
  • Elective procedures: during this pandemic, in efforts to reduce potential exposure various procedures have been postponed. All across medicine, we have delayed elective cardiac catheterizations, ablations, numerous surgeries, and even radiological imaging. Some institutions have started to plan to have extended operating room hours or even full surgical days on the weekend. All divisions will have to consider the same to be able to catch up with the outpatient procedures. Of course, a tremendous amount of resources will need to be dedicated to this endeavor which adds another layer of complexity.
  • Future clinic visits: something we will have to keep in mind is if we will have clinic days where we only see COVID-19 positive patients. Keeping patients in the waiting rooms safe from potential sources of infection will be of utmost importance. Many epidemiologists believe there will be a second surge but it’s hard to predict it’s impact. Of course, the challenge in America is the lack of universal testing therefore there can be patients who have COVID-19 but were never identified.
  • Health Care Reform: the COVID-19 pandemic in America has highlighted the pitfalls of our health care system. A big share of Americans are uninsured and we as citizens carry more medical debt than our counterparts from other developed nations. And one of the single biggest problems, which is largely American, is cost. In my short career, I frequently meet patients who do not seek medical care due to the costs associated with routine care. I’ve had patients fight with me to use their own medications because the same medications in the hospital setting are exponentially more expensive. The downfalls of the American health system, which already placed us behind our peers on many medical outcomes, have been exposed in this outbreak. I don’t know what the right course is moving forward but I hope to be a part of it.

We are continuing to fight the COVID-19 pandemic with all of our strength and energy, but we have a long road ahead of us. If we continue to work together, collaborate, and utilize our resources efficiently, we will continue to be successful.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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COVID-19: The Good, the Bad, and the Ugly

In the 1960s a movie titled “The Good, the Bad, and the Ugly” was released. The plot revolved around three gunslingers competing to find a fortune in a buried cache of Confederate gold amid the violent chaos of the American Civil War. Despite the initial negative criticisms of the movie, it has since accumulated very positive feedback and listed in Time’s “100 Greatest Movies of the Last Century.” The Coronavirus (COVID-19) seems to be running a parallel course. The amount of media coverage surrounding coronavirus (COVID-19) over the past several months is not only shocking but overwhelming. I personally cannot recall any other illness getting as much media coverage as COVID-19 has in the past several months. On a daily basis, we are flooded with updates, changes in clinical practice, number of cases across the country, and recommendations on how to quickly flatten the curve. Here is my take on COVID-19 (and yes, I intentionally end with “the good”).

The Bad: An observation I noted was an uptick of in-basket messages from my patients who were more anxious from social media posts than from traditional news sources. Many patients mentioned posts seen on numerous social media platforms with conflicting information or claims to proven therapies. I combated these messages with clear recommendations from various professional societies but also recognizing we do not have established data in all medical arenas. This seemed to help improve my patients’ anxiety and concerns. Even too much media of any kind can amplify distress, which was evident by my own constant engagement in news sources and social media.

 The Ugly: With social media being a part of everyday life, we all have seen pictures of people buy massive amounts of toilet paper, mounds of sanitizer, and selves stripped of essential goods. As increasing number of regions declared a state of emergency, panic buying was affecting the public. Panic buying occurs typically in a time of crisis resulting in increased prices and takes essential goods out of the hands of people who need it most – for example, personal protective equipment for health care workers. What’s worse is this led to price gouging where masks, sanitizers, and cleaning supplies were being sold at an exuberant price. Fortunately, several businesses across the country established hours for senior citizens to shop in peace and have access to essential good. Several communities started to help combat panic buying by donations and fundraising help offset such behavior to help those in need – keep up the strong work!

The Good: Despite the bad and ugly, COVID has had a positive impact. The biggest change I have seen is how much more cognizant we are about healthy habits. People are not going to work if they feel ill, increasing use of hand sanitizer after being in public, and encouraging proper hand washing techniques to mention a few. Granted, we think these should be the norm but COVID highlighted how this was not the case.

While countries are closing their borders, scientists are shattering their boundaries looking to collaborate with colleagues across the globe. I was able to join in on several fantastic webinars hosted by frontline healthcare staff from across the globe to learn from their experiences so we don’t make the same mistakes for our own patients. Leading institutions in America were holding lectures to share their research, clinical experience, and any clinical anecdotes to help improve patient outcomes. I believe a big part of this movement is due to the fact the virus is not limited to one remote area of the world but has spread across the globe. It is affecting every country and countless citizens – it’s hitting home. Scientists and doctors are standing together, working collaboratively, and are driven to find an effective treatment option. It’s this type of comradery that has helped all frontline health care providers to fight this pandemic.

Although there are is plenty of “bad” and “ugly” surrounding COVID, the amount of “good” is far reaching, inspirational, highlighting the need of team work and intense desire of all of us to help #FlattenTheCurve.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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March Madness – Dealing with the Stressing of Training

March is synonymous with college basketball, winning brackets (or losing in my case), and general merriment. For those of us in medicine, it may have a different meaning – stresses of matching, winter blues, and a general feeling of being burnt out. For me, March was one of the hardest months to get through in training, despite it being my birthday month.

Living in Massachusetts means long winters and I notice the general spirit of trainees tends to drop during this time. The novelty of winter has grown old, as the holidays have passed and we all seem to anxiously await the spring. The grueling winter days make it challenging to be outdoors, inhibiting us from enjoying our hobbies, and in short, tired of being cold. My friends who have trained or are working in cold climates (i.e Minnesota, Michigan, Wisconsin, Vermont to mention a few) have echoed the same sentiment. My personal interactions with interns and residents are often highlighted by fatigue, decreased empathy towards patients, and a desperate need for “the year to be over.” So, what are the tools we can use to help get through our own March Madness?

Here are a few tips and tricks that have helped me improve my wellbeing.

  • Stress to Strength: Growing up, I played soccer, basketball, tennis, tried picking up running (but limited by jumpers’ knee), and occasionally surfing. Clearly, none of these are great activities if it’s cold outside which caused me to feel claustrophobic in the winters. I instead work out in the hospital gym much more to try to stay active and have a positive outlet for when I am stressed. I often get asked, “what’s a good strategy for me to make it to the gym with our crazy schedule?” I’ve realized not everyone wants to go to the gym before work (which is my routine) but having small, achievable goals is the way to go. For example, try going one day before work, one day after work, and once during the weekend. You don’t need to go every single day to be healthy or stress-free. Having a few days per week in dedicated time slots will help create structure and not make going to work out feel like a chore.
  • Mindfulness: Mindfulness is becoming more popular in the west and for valid reasons. It is the ability to pay attention to the present moment with curiosity, openness, and acceptance. We can exacerbate stress if we ruminate about the past, worry about the future, or even engage in self-criticism; and I have been guilty of all 3. I discovered a great app called “Headspace” that helped me with guided mediation and mindfulness. The app has evolved to help fit nearly everyone’s needs and I have recommended it to several friends/colleagues.
  • Making my list, checking it twice: Trainees have so many tasks they need to complete: pre-rounding, rounding, Epic tasks, notes, discharge summaries, more Epic tasks, case reports, quality improvement projects, and if they have time – grocery shopping. I always keep a list of tasks I need to complete – partly because it helps me stay organized, but also my obsessive-compulsive personality LOVES to cross tasks off the list. If you get overwhelmed with the countless tasks you have to do, start keeping a list. This will help create structure, organization, and improve productivity.

 

  • Reach Out: We all need to have friends, family, and colleagues to turn to when we are feeling burnt out. Fortunately, many training programs have resources available from their GME office, which are often underutilized. My clinic preceptor (and friend) Dr. Brigid Carlson has invited me out for coffee, dinner with her family, and always welcomes me to speak to her if I am feeling overwhelmed. Knowing I have someone to turn to has helped me not “bottle things up.”

Although March Madness is traditionally stressful with college basketball, it should not be the same for the workplace. With spring on the horizon, many of us feel the stresses of training but there are resources to help us to continue to be successful.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”