CVMC Infection Preventionist Erica Baker and Infectious Disease Physician Dr. Jessie Leyse

Following the Evidence to Keep People Safe: CVMC's Infection Control Team

Posted on Monday, July 20, 2020 by UVM Health Network - CVMC

“Oh my goodness. What are we going to do?”

Late one evening in mid-March, her husband and children in bed for the night, CVMC infectious disease specialist Dr. Jessie Leyse stared at her computer screen, thoughts racing, as she considered the implications of what she had just read. The latest evidence seemed to confirm asymptomatic transmission of COVID-19—people without symptoms were spreading the virus to others.

Leyse immediately forwarded the study to Chief Medical Officer Dr. Patti Fisher and Infection Preventionist Erica Baker, and followed up with a group text.

“We have to mask everybody at CVMC.”

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Two months earlier, as news from China became more troubling, it was clear the pandemic would come to Vermont. To better navigate CVMC’s response in those early days, Leyse had packed up her office in Building C and moved into Baker’s at the main hospital so they could work together in real time. “There was no other way it could have worked,” Leyse says.

On January 21, the U.S. confirmed its first case. Already by that time, Baker says, “it was almost a 24/7 operation,” to review, compare, and analyze vast amounts of new information about COVID-19, and then put that new information into actions that would protect CVMC patients and staff.

“I was sending her articles at like 11 o’clock at night,” says Leyse. “There were maybe five hours a night that we weren’t in communication with each other.” By 7:30 am, they were back in the office, discussing what had changed overnight.

“We were living and breathing the response,” says Baker. “I didn’t see my kids very much.”

As they raced to develop new infection prevention measures, Baker and Leyse realized that CVMC needed to start preparing on a much larger scale.

“There were just so many questions,” says Leyse. “Do we have enough personal protective equipment? How are we safely going to test patients who show symptoms? Where will we care for them?”

Staff were also looking for answers, Baker recalls. “We spent a lot of time in the ICU and the ED—just about anywhere and everywhere—reassuring and educating folks that we were making the best decisions possible with the data we had at the time.”

But the data kept changing, sometimes over the course of the same day. “We would have algorithms that didn't even make it a full 24 hours before we had to change them,” says Leyse. “That was part of my anxiety. I knew we weren’t being consistent, but that's because the data kept changing. Trying to reassure people, when nobody was certain about where things were going next, was difficult.”

In early March, Baker reached out to Director of Quality Patrice Knapp. “We were starting to feel the pinch,” she says. “The phone was ringing off the hook, emails were coming in every minute or two—there were tons of questions. And I approached Patrice and said I think this is something that's going to get big and we need to talk to senior leaders."

CVMC’s Incident Command team held its first formal meeting on March 10, and for Baker and Leyse, Incident Command was a game changer. “I felt incredibly relieved by how quickly and efficiently the team was able to organize and distribute all of the operational responsibilities,” says Leyse.

Baker agrees. “It was an amazing response, everybody just mobilized. I’ve worked here for 20 years and I’ve seen this place come together before, but I was amazed at the amount of work that could be done once you had a lot of hands in it.”

With Incident Command taking the lead in operationalizing CVMC’s response effort, Baker and Leyse zeroed in on the emerging research, which by that time was ramping up significantly. Freed from worrying about logistical challenges, they were able to focus their energies on understanding the nature of the infection itself, synthesizing the latest evidence, and using that information to make safety recommendations to the broader team.

They were also able to take a day off, though they both needed some convincing in that regard. President and COO Anna Noonan told them they had been working nonstop for too long, and that they weren’t allowed to come into the hospital. “She was very…insistent,” says Baker.

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Reviewing the latest evidence for asymptomatic transmission, Leyse realized that universal masking—requiring everyone to wear a mask at all times—was the best course of action to keep everyone as safe as possible. At the same time, conserving personal protective equipment (PPE), particularly surgical masks and N95 respirators, would be critical if CVMC faced a surge of COVID-19 positive patients.

The next day at Incident Command, Leyse shared the studies with her colleagues. “It was a huge relief for me that I didn’t have to make this decision myself, that I could trust the team to look at the data and make the right decision.”

Within days, CVMC changed its PPE policy and established new guidelines to include mandatory universal masking in all CVMC facilities.

Now, with continued low prevalence of COVID-19 in Central Vermont, Leyse has returned to seeing consults and patients in clinic, but she and Baker continue to talk almost every day.

“I still have her on speed dial,” says Baker. “We got through the past few months, but it’s not over yet. The virus hasn’t gone away, so we’re keeping close tabs on what it’s doing in the rest of the country.”

“Based on how CVMC and the State of Vermont responded, I think we did the best that we could have done,” says Leyse. “I feel much more confident that if we do see a second wave, we’re going to be on top of it quickly, know what to do, and get it under control.”