As September comes to a close, we would like to take a moment and recognize the women physicians in medicine who make UNMC ID the fantastic division it is. Each year during the month of September the American Medical Association honors physicians who have offered their time, wisdom and support to advance women with careers in medicine. At UNMC ID, we are lucky to have a truly impressive roster of medical professionals who satisfy those requirements…and then some.
From top left: Dr. Andrea Zimmer, Dr. Elizabeth Schnaubelt, Dr. Jasmine Marcelin, Dr. Andrea Green Hines, Dr. Nada Fadul, Dr. Susan Swindells, Dr. Kimberly Scarsi, Dr. Subhadra Mandadi, Dr. Alison Freifeld, Dr. Kelly Cawcutt, Dr. Erica Stohs, Dr. Kari Neemann, Dr. Angela Hewlett, Dr. Diana Florescu, Dr. Natalia Castillo Almeida, Dr. Anum Abbas, and Dr. Sara Hurtado Bares, Dr. Catherine Cichon, Dr. Mackenzie Keintz
Above, we feature UNMC ID’s Women in Medicine. You will no doubt recognize many of these photos from numerous recent features on the blog highlighting achievements and ideas from the Division of Infectious Diseases. Additionally, many of these physicians play an active role in advocacy. Underscoring this, Dr. Cawcutt recently spoke at a women in health care conference last Friday, September 16. Dr. Marcelin will also be speaking at a women in healthcare leadership conference next Thursday, September 29. We celebrate all women in healthcare; thank you all for your work, commitment, and expertise!
(Check out the UNMC ID faculty page for bios and more information)
Rounding out the introductions to our recent ID faculty additions, we welcome Dr. Subhadra Mandadi to UNMC. Dr. Mandadi completed her residency training in Internal Medicine at Hurley Medical Center and fellowship in ID at the University of Buffalo. She joins us as an assistant professor working on the Community ID service line. Read on to learn more about Dr. Mandadi!
Dr. Subhadra Mandadi, ID physician who joins UNMC ID as an assistant professor.
Tell us a little about your background.
I am from India. After graduating from medical school, I worked as a physician for a few years before embarking on my journey to the United States. I completed residency training in 2015 and then graduated as a fellow in Infectious diseases in 2017. Wicked problems, from climate crises to global pandemics to antimicrobial resistance among many, surround us, and there is much need for ‘wicked’ scientists to address such issues. I am pursuing MSHS in Clinical and Translational Research at George Washington University to hone my abilities as an independent physician investigator to help address complex problems in Infectious diseases affecting the community.
Why did you choose UNMC?
UNMC is a well-reputed Infectious disease program for its commitment to empathetic patient care, clinical and translational research, academic education, and its perfect amalgamation. My career goals align with the mission of UNMC, and I wish to be a part of its tremendous contribution to the field of medicine. UNMC is widely known for promoting a collegial environment by incorporating psychological safety and establishing an avenue for professional growth and development. I believe UNMC can be a perfect platform to give wings to my aspiration of becoming a physician investigator.
What about ID makes you excited?
Dr. Bartlett wrote about ID, “It would be difficult to find another discipline in medicine with such extraordinary diversity, surprises, value in patient care, and clinical relevance for both domestic and international applications.” I strongly believe in this quote. ID is the most sensible field of medicine to which other disciplines reach out when faced with any perplexing and complex medical situation, even if it is non-ID related. Solving a puzzle and adopting a scholarly approach to patient care challenges makes ID exciting and rewarding.
Tell us something interesting about yourself unrelated to medicine.
I have two beautiful children, my other world, and together with my husband, they are my life coaches. I am training in Indian classical dance. I am an avid lover of cooking, traveling, and watching investigative crime series in my free time, and my favorite one so far is ‘Unforgotten.’ I am currently watching ‘Delhi crimes.’
In a previous post, we explored recent work conducted by UNMC ID faculty on untangling the pathogenesis of COVID-19. Medically speaking, that is only half of the story. In the effort to translate these observations about how SARS-CoV-2 makes us sick into treatments or vaccines, UNMC ID has been no less dedicated. Underscoring this point, read on for a research digest of three recent publications authored by UNMC ID faculty exploring COVID-19 treatment strategies.
Dr. Hewlett, co-author of a recent COVID-19 research article.
In response to another viral outbreak, the Ebola epidemic of 2014-2016, the Centers for Disease Control and Prevention (CDC) designated 56 US hospitals as bona fide treatment centers for Ebola infections. UNMC was one of these sites. Now, with the COVID-19 pandemic, these centers have shifted their efforts to help treat patients with severe presentations of this infection. A recent study, co-authored by Dr. Angela Hewlett, looked at these Ebola treatment centers and how they responded to the current pandemic. They found that nearly 90% of the original facilities were still in operation and almost all of these sites were reported to positively affect the COVID-19 response in their regions. Read the full article here for the details including challenges that these vital centers face for continued operation.
Dr. Castillo Almeida who, along with Dr. Kalil, authored this editorial in the New England Journal of Medicine.
In a research editorial authored by Dr. Natalia Castillo Almeida and Dr. Andre Kalil, the evidence for COVID-19 treatment with the antiviral medication molnupivavir was summarized. Specifically, this article analyzed results from two clinical trials which used this medication in patients with COVID-19. The article concluded that both studies found molnupivavir to be effective at preventing death from this illness, especially when used early in infection and in patients older than 60 years of age. These studies added molnupavir to the growing list of medications with some documented benefit in the effort to fight this pandemic. Read here for the full editorial, including the caveats and detailed benefits to molnupavir treatment.
(Note that knowledge surrounding COVID-19 treatments is rapidly growing, and data surrounding molnupivavir may have been refined since this article’s publication in December 2021)
Dr. Andre Kalil, co-author of a recent article identifying a shift in available clinical trial participants.
Lastly, Dr. Kalil also recently co-authored another publication sounding the alarm on decreasing recruitment of patients into the randomized controlled trials which are the necessary for vaccine and treatment development. The article suggests that this could be due to a multitude of factors, including the observation that, in the time since vaccinations have become widespread, most of those with severe disease are unvaccinated and more likely to be hesitant of clinical trials. This article explores the various reasons cited for hesitancy in certain patient populations as well as expands on how to combat this hesitancy to ensure we can still develop the necessary treatments as the virus continues to shift. Read more here for the full analysis.
A few weeks ago, we introduced three great new additions to the UNMC ID team. Among them, was Dr. Jonathan Ryder, a recent UNMC ID Fellowship graduate who joins UNMC ID faculty as an instructor working on the General ID service line. He is also completing a 3rd year fellowship in Antimicrobial Stewardship. Read on to get to know more about Dr. Ryder!
Tell us a little about your background.
I was born and raised in central Missouri, near Jefferson City. I studied biology and history at Truman State University in Kirksville, Missouri. During college, I attended UNMC’s Summer Undergraduate Research Program. I subsequently attended medical school at UNMC, graduating in 2017. I left UNMC for Indiana University School of Medicine for internal medicine residency, then returned to UNMC for infectious diseases fellowship, which I finished in June 2022.
Why did you choose UNMC?
Dr. Jonathan Ryder, a new addition to UNMC ID faculty.
UNMC has provided me ample opportunities for personal and professional growth, for which I am quite appreciative. When looking for a career in infectious disease, I was always interested in pursuing academia, as I love the teaching/learning environment, the pursuit of new knowledge through research, and providing clinical expertise at a referral hospital. An important part of success in academia is having a supportive environment, which I have found at UNMC. I have found multiple mentors to help me grow in my areas of interest: antimicrobial stewardship, medical education, and infection control. Essential to this supportive environment is the talented faculty. Lastly, Omaha remains a key reason for staying at UNMC, as it is close to family and continues to provide convenient living with plenty of entertainment and adventure.
What about ID makes you excited?
I continue to be excited about ID because of the breadth and depth of the field and the many ways we can contribute to improving patient care. Antimicrobial stewardship increasingly is essential to protecting our available antimicrobials and reducing antimicrobial resistance. Similarly, the field of infection control protects our patients and contributes expertise when novel pathogens arise. The widespread use of antibiotics puts ID at the forefront of medical education, as nearly every specialty uses these treatments. There remains a large need for clinical research in these areas and pursuing new knowledge keeps me interested and excited for the future!
Tell us something interesting about yourself unrelated to medicine.
I greatly enjoy reading history, especially history of science, medicine, and late 19th/early 20th century of US and Europe. However, I have recently started reading more fiction as well, in particular the Dune and Lord of the Rings series, given the recent theatrical productions of these books.
A #PharmToExamTable question about fluconazole dosing, answered by Brady Caverzagie, PharmD, a Graduate of UNMC College of Pharmacy.
(Reviewed by Andrew Watkins, PharmD)
Cryptococcus spp. are fungal pathogens found in the soil and pigeon droppings. Usually, Cryptococcus spp.do not cause severe or life-threatening symptoms in immunocompetent patients; however, in immunocompromised patients, cryptococcal infections can cause serious complications. Patients who are HIV positive with high viral loads and low CD4 cell counts are especially susceptible to infection with cryptococcal species, which can disseminate throughout the body, including the central nervous system (CNS). Once in the CNS, patients often have a classic meningitis-like presentation including headache, stiff neck, fever, and photophobia. Standard treatment for cryptococcal meningitis in the setting of HIV includes long courses of antifungals, relief of intracranial pressure, and supportive care.1
Antifungal treatment includes three different phases: induction, consolidation, and maintenance. The 2010 Infectious Disease Society of America (IDSA) guidelines for cryptococcal meningitis for HIV-infected individuals recommends induction therapy with liposomal amphotericin at a dose of 3-4 mg/kg intravenously per day along with flucytosine 100 mg/kg orally per day in four divided doses for at least two weeks. Induction therapy continues for two weeks or until clearance of Cryptococcus from the cerebrospinal fluid, whichever comes last. Consolidation therapy follows the induction period and consists of 400 mg per day of fluconazole by mouth for a minimum of eight weeks. The last phase is maintenance therapy which is generally 200 mg per day of fluconazole by mouth for 6-12 months.2
There is not an established fluconazole breakpoint for Cryptococcus spp., from the Clinical and Laboratory Standards Institute (CLSI), making it difficult to determine if the recommended treatment is optimal in the setting of elevated minimum inhibitory concentrations (MIC).3,4 Although the most common fluconazole MIC for Cryptococcus spp. Is 4 mg/L, a systematic review showed the median increase from 4 µg/mL in 2000-2012 to 8 µg/mL in 2014-2018.5 Additionally, worse patient outcomes and treatment failures have been observed in patients with cryptococcal isolates that have higher fluconazole MICs.6 The recent decrease in susceptibility to fluconazole in cryptococcal species is forcing a reevaluation of the appropriateness of 400mg per day of fluconazole in consolidation therapy for cryptococcal meningitis.4,5
Fluconazole works by inhibiting the fungal CYP P450 dependent enzyme lanosterol 14-α-demethylase, which converts lanosterol to ergosterol. Without ergosterol, the fungal cell membrane cannot function properly. Oral bioavailability of fluconazole is excellent at over 90%, making it a good option for long term outpatient therapy. While fluconazole distributes well to the urine and skin, with levels ~10x those seen in plasma, it distributes less well to the cerebrospinal fluid with levels 50-90% of those seen in plasma. The inhibition of human CYP enzymes (primarily CYP 3A4) leads to numerous drug interactions and careful monitoring of these interactions is important during therapy, especially in long courses of fluconazole used in cryptococcal meningitis.7
In the face of increasing MICs and an infection in an area of the body with lower drug penetration, the question becomes what dose will work for consolidation therapy in a patient with cryptococcal meningitis once they have completed induction therapy? Based on a model created to investigate fluconazole use for all phases of cryptococcal therapy, 400 mg daily would reach therapeutic levels of >100 AUC:MIC for 53% of isolates, 800 mg daily would reach therapeutic levels for 74% of isolates and 1200 mg would be effective for 83% of isolates.5 The data from the model can be reconfigured to demonstrate what dose can reasonably be expected to treat a particular isolate based on MIC (Table 1). The guideline driven 400 mg per day dose of fluconazole for consolidation may only be consistently effective for highly susceptible pathogens, leaving the rising incidence of resistant organisms to grow unchecked.
Table 1: Probability of achieving >100 AUC:MIC based on MIC and dose
MIC
DOSE
PROBABILITY
≤2 ΜG/ML
400 mg
>91%
4 ΜG/ML
800 mg
91%
8 ΜG/ML
1200 mg
85%
16 ΜG/ML
1600 mg
68%
Cryptococcal meningitis is a serious infection that needs to be adequately treated, and the MIC of cryptococcal isolates should be taken into consideration, particularly in immunocompromised patients. The guideline dosing for fluconazole consolidation treatment of 400mg daily is likely sufficient for cryptococcal isolates with an MIC of 2 mg/L, however fluconazole MICs among cryptococcal species have been increasing over the past two decades. To adequately reach therapeutic levels in patients with less susceptible organisms, doses of 800-1200mg per day could be necessary. Patients should be monitored carefully because tolerability of fluconazole may become a clinical issue at higher doses. Although limited evidence exists in these situations, an alternative agent may be necessary if MICs exceed 16 mg/L or patients become intolerant to fluconazole therapy.
References:
Dipiro JT, et al. Pharmacotherapy A Pathophysiological Approach. 11th ed. McGraw-Hill 2019.
Perfect JR, et al. Clinical Practice Guidelines for the Management of Cryptococcal Disease: 2010 Update by the Infectious Diseases Society of America, Clinical Infectious Diseases, Volume 50, Issue 3, 1 February 2010, Pages 291–322.
Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antifungal Susceptibility Testing of Yeasts. 1st ed. CLSI supplement M60. Wayne, PA: CLSI; 2017.
Bongomin F, et al. A systematic review of fluconazole resistance in clinical isolates of Cryptococcus species. Mycoses. 2018;61(5):290-297.
Chesdachai S, et al., Minimum Inhibitory Concentration Distribution of Fluconazole Against CryptococcusSpecies and the Fluconazole Exposure Prediction Model, Open Forum Infectious Diseases, Volume 6, Issue 10, October 2019.
Sai Cheon JW, McCormack J. Fluconazole resistance in cryptococcal disease: emerging or intrinsic?, Medical Mycology, Volume 51, Issue 3, April 2013, Pages 261–269.
Diflucan (fluconazole) [package insert] New York, NY: Pfizer Inc; September 2020.
A few weeks ago, we introduced three great new additions to the UNMC ID team. Among them, was Dr. Carlos Gomez, who recently joined UNMC ID as an associate professor on the Solid Organ Transplant service line. Read on to get to know more about Dr. Gomez’s background, interests, and love of soccer!
Dr. Carlos Gomez, infectious disease physician and new addition to UNMC ID faculty
Tell us a little about your background.
I was born and raised in Colombia, where I attended Medical School. Following a short tenure as a general practitioner in my own country, I came to the US for training in Internal Medicine and then a fellowship in Infectious Diseases (ID) and Medical Microbiology. I was always curious about the intersection of host, environment, and pathogens, which triggered my interest in ID. Lately, I have specialized in infectious complications that pertain to the immunocompromised population, that is, solid organ transplants and patients with cancer and hematological malignancy. I have always wanted to pursue a sustainable career in academic medicine. I like every aspect of the academic clinician world: teaching in the classroom or at the patient bedside, engaging in clinical research, and of course, the clinical practice where I interact with patients and their caregivers.
Why did you choose UNMC?
I chose UNMC because of its commitment to faculty development, compassionate patient care, and support for clinical research. As a clinician-investigator, I cherish all the dedication from UNMC to advancing science while educating the next generation of healthcare leaders. As a leader in Transplant and Cancer care in the country, UNMC is a reference center for a vast population in the Midwest. Besides its excellent faculty and house staff, the above makes it a thriving place to foster a career in academic medicine.
What about ID makes you excited?
At this point, it’s evident that ID is intrinsically an exciting field with many challenges and opportunities (think about a particular pandemic!). We are in the dawn of breakthroughs and innovations that will bring us closer to more advanced diagnostics and sophisticated antimicrobial interventions. I like to be at the epicenter of that disruption, the patient bedside and the clinical trials bringing those breakthroughs to the field.
Tell us something interesting about yourself unrelated to medicine.
I enjoy playing soccer and watching Premier League, and UEFA Champions League matches. I like to read books about soccer tactics and biographies of Managers (the word for soccer coaches in the UK).
Blood stream infections are one of the most feared type of infections in the infectious disease world. And for good reason- if left untreated they can quickly develop into serious complications such as septic shock. Luckily, researchers are constantly exploring the risk factors and treatments for this infection, including many UNMC ID faculty. Read on for a digest of 3 recent articles authored by UNMC faculty exploring the diagnosis and treatment of sepsis.
Dr. ZimmerDr. StohsAuthors of a recent article on blood stream infection in cancer patients.
Sepsis is of particularly high concern for cancer patients, as various cancers as well as their treatments can interfere with the immune system’s ability to fight off infection. Unfortunately, there is a shortage of up-to-date data about the epidemiology of sepsis and antibiotic resistance in this population, making adjusting best practice guidelines difficult. In a new article, our own Dr. Andrea Zimmer and Dr. Erica Stohs led a cross-sectional study assessing these very variables in hundreds of high-risk febrile neutropenic patients with blood stream infections. They found that the current standard of care, cefepime or piperacillin-tazobactam, remains effective in this population and has excellent results. Read on for the details, including resistance rates to many common antibiotics. Study here.
Dr. Cortés-Penfield, co-author of a recent article exploring the use of imaging in sepsis diagnosis.
Treatment of sepsis first relies on an accurate diagnosis. Bettering our ability to do that is the focus of this next article. Staphylococcus aureus bacteremia is a serious type of blood stream infection which requires heightened clinical attention, as this pathogen is capable of infecting visually any tissue in the body. The use of newer imaging modalities to better detect infection is a promising idea, but the implementation remains controversial. This paper presents a metanalysis examining the efficacy of using 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG-PET/CT) to identify this infection. Combining the analysis of 7 studies, Dr. Nicolás Cortés-Penfield co-authored the analysis showing there is promising evidence that this imaging technique could help detect infection and prevent mortality at evidence levels comparable to those currently used as standard practice. Read the study here for the full analysis and conclusions.
Dr. Cawcutt, co-author of an article exploring sepsis in the VV-ECMO population.
Sepsis is also a big concern for the patient population utilizing venous-venous extracorporeal membrane oxygenation (VV-ECMO), including right ventricular assist devices. But, just as in cancer patients, current data surrounding this problem is sparse. This study also aimed to investigate the rate of infection in these patients to better understand the risks involved. The article, co-authored by Dr. Kelly Cawcutt, confirmed that infection rate in this population is moderately low, sitting at 2.7%. The authors suggest that this low rate of infection may be owed to the use of preoperative antimicrobial medication as most cannulations occur in the OR. Read the full details here.
Fellowship application season is well underway and our fellowship directors can’t wait to review applications. We have recently posted about the benefits of a UNMC ID fellowship (see here) and on how to thrive in interviews (link here). But today, we wanted to highlight the words of current and past fellows as they explain why they wanted to train at UNMC.
Dr. Zelus…with a bagel she baked herself…that is as big as her face!
Interestingly, I ended up coming to UNMC because they have a phenomenal Emergency Medicine Residency! My significant other enjoyed his away rotation in UNMC’s ED so much we ended up couples matching into their IM and ED residencies. Initially I thought I would pursue Rheumatology, but abruptly changed my mind after a phenomenal ID rotation my intern year. I subsequently rotated on ID two more times during residency and enjoyed working with the UNMC ID family so much I wanted to stay for fellowship.
Dr. Bryan Walker
After researching the program for infectious diseases fellowship, I was especially struck at how both comprehensive and well-organized the training program appeared to be. Having dedicated clinical experiences in orthopedics, oncology, and transplant, for example, caught my eye. After my interview day, I learned that the program’s strongpoints were largely the result of a dedicated program leadership and faculty. There is a sincere interest at UNMC in helping me become the clinician I hope to be.
I chose UNMC for Internal Medicine residency in part because of the strong Infectious Diseases fellowship program. During residency, I was able to form strong mentorship bonds that truly made leaving the program incredibly hard. Working with the incredible faculty throughout my three years made staying at UNMC the right decision for my career. My interest in ID is antimicrobial stewardship. Our stewardship team is one of the best in the country (maybe I’m biased?), and I look forward to training under them throughout my fellowship. Furthermore, having access to the biocontainment unit and leaders in the field of emerging pathogens is an experience I don’t know I would be able to get anywhere else. Our training here is well balanced between general ID, immunocompromised services, and antimicrobial stewardship so I know that when I come out of fellowship I will be prepared for whatever position I decide to take. – Dr. Mackenzie Keintz
Dr. Nabil Al-Kourainy
UNMC has a rich tradition for being a center of clinical and scholarly excellence while promoting education through mentorship and fostering initiative and collaboration. The Medical Center is also committed to providing empathetic, evidenced-based, and patient-centered care while serving a diverse and often medically underrepresented population. I look forward to experiencing this collegial and supportive atmosphere during fellowship training. The HEAL track also represents an amazing opportunity to further advance my knowledge and skills in medical education and leadership!
Dr. Catherine Cichon and her dog Loki.
(1) The infectious disease training here is highly regarded, and I wanted to train at a location where I could learn from all branches of ID – from emerging infectious diseases (check this out) to antimicrobial stewardship to transplant ID…even pediatrics ID!
(2) I have family here in Omaha, and Omaha is much closer to my family in Colorado. It’s great to be close to your support system!
(3) Omaha itself is a great city! There is so much to eat, do, and see here. The affordable cost-of-living adds to the attraction.
Dr. Timothy Jang
Before the COVID pandemic began, I had visited UNMC and Omaha for internal medicine residency interviews, and I was considerably impressed by the medical facilities, the strength of the educational program, and the tranquility of the city. One of the faculty that I had interviewed with for residency interviews was Dr. Mark Rupp, the chief of the ID division, and I had promised him that regardless of where I ended up for residency, I would apply to UNMC for ID fellowship. So when I matched to UNMC for ID fellowship, I knew I had matched to the right place!
In addition to world-class patient care, UNMC ID faculty are leading the charge in the use of social media in medicine and infectious disease. Recently, members of our department contributed heavily to a social media supplement published in the journal Clinical Infectious Diseases. This supplement is a fascinating and actionable exploration of social media’s role in medical education. Read on for a brief synopsis of these great articles! (Link to Full Supplement)
Dr. Jasmine Marcelin, co-author and guest editor of this issue.
This introductory article covers the impact, both potential and realized, of social media on ID education and practice. As the authors explain, social media use has the promise of enabling “improved clinical care and advocacy, data analysis, broad reach to diverse patient populations, educational access, best practices in medical education, peer review, digital strategy for individuals and institutions, and combating misinformation.” For a self-contained explanation of the benefits of social media in ID, look no further than this article!
A good mentor is one of the most impactful accelerators of success. In this article, the authors note that social media platforms can and have been used successfully to connect mentors and sponsors in medicine, especially in the case of marginalized and under-represented groups. Due to a lack of representation of women and, Black, Indigenous, and People Of Color (BIPOC) in senior leadership positions, finding a mentor can serve as a barrier to professional advancement for many healthcare professionals. Social media can then make it easier to connect with leadership outside of one’s institution.
Dr. Kelly Cawcutt, co-author and contributor to this supplement in Clinical Infectious Diseases.
Social media platforms are ubiquitous throughout society and have revolutionized how we consume information. The same can be said for academic fields, especially in ID. This article outlines the rationale for incorporating social media competency into ID training, equipping the next generation of ID doctors with the skills needed to take full advantage of the benefits of social media in education.
Sold on the benefits of social media in ID but don’t know how to start implementing this tool in education? This article describes how to best use social media in medical education while underscoring the educational theories that support its use. For an operational user-manual for social media in education, read the full article at the link above!
Dr.Nico Cortés-Penfield, co-author of multiple articles in this supplement.
This article discusses the creation of a virtual ID journal club ran on Twitter (#IDJClub). It involved a live 1 hour discussion of a recent publication by tweet. Over the 31 journal clubs held, a median of 42 participants from all stages of ID training/practice participated in this educational experiment, with 95% of them agreeing that the experience provided clinically useful knowledge and 72% agreeing that this journal club was more educational than the traditional forms. For a concrete example of social media being utilized to improve medical education, click the link above!
While most research we highlight focuses on medicine and clinical care of patients, there is just as much value to be gained in researching the workforce and healthcare community at large. Understanding the trends and problems within our own field can lead to profound improvements in the daily lives of healthcare workers everywhere. In this alternative arena of research, UNMC ID has made major strides. Read on for digests of recent articles published by UNMC ID faculty that pertain to matters of personnel.
Dr. Selby, author of a recent paper (along with Drs. Hewlett, Rupp, and Starlin) about COVID-19 spread among healthcare professional
The hospital or clinic is not the only place that healthcare workers can be exposed to SARS-CoV-2. Just like the rest of the public, household exposures are understandably a major risk factor for contracting the virus. As data from the delta variant became available early this year, Drs. Selby, Hewlett, Rupp, and Starlin of UNMC ID conducted a study on vaccinated healthcare professionals with home exposures. They concluded that the delta variant, along with numerous environmental factors, contributed to a sharp increase in the COVID-19 attack rate. This rose from around a 20% chance of contracting the virus from a COVID-19 positive household member before the delta variant, to a ~50% chance of COVID-19 contraction during the delta wave, underscoring the large jump in infectivity possible with a mutating virus. Read the full research brief here.
Dr. Lawler, author on a recent paper outlining the ethics of ‘essential workers’ during a pandemic.
Stepping away from the healthcare workforce, Dr. Lawler and colleagues recently published a paper examining the intersection of ethics, the meat-processing industry, and COVID-19. This paper explores a group of workers who, because of their ‘essential industry’ status and working conditions which facilitated the spread of SARS-CoV-2, were expected to put their health and lives at risk during the pandemic. In the words of the authors: “This paper offers an ethical framework for infection prevention and control recommendations grounded in public health values of health and safety, interdependence and solidarity, and health equity and justice, with particular attention to considerations of reciprocity, equitable burden sharing, harm reduction, and health promotion.” Read more here.
Dr. Cawcutt, author of a recent article on medical burnout.
Lastly, on the topic of healthcare burnout, Dr. Cawcutt recently published an article exploring the relationship between bias, the impostor phenomenon, and burnout. A significant problem in medical fields, burnout afflicts 30% of nurses and greater than 50% of physicians. The paper argues that the interaction of these three concepts, previously considered separate, create a cycle which perpetuates burnout within the medical community. Targeting these components may then help guide interventions in the future. Read on here for more details.
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