One year of COVID-19: Providence infectious disease expert shares lessons learned from the front lines

A COVID-19 patient is pushed in a wheelchair by a Providence clinician after recovering from the virus
The past year has brought tragedies and victories. Los Angeles Police Department Officer Chang (center) was one of the first critically ill COVID-19 patients at Providence Saint John's hospital in Santa Monica, California. In mid-April, Chang was discharged from the hospital after recovering from the virus, what Providence calls a "Code Victory." (Providence)

Rebecca Bartles got the call late in the day on Jan. 20, 2020: One of the first novel coronavirus cases to arrive in the U.S. had shown up at Providence health system in Washington.

Bartles, who leads infection prevention efforts for the entire 51-hospital Providence health system, believed Providence was ready to respond after exercises based on previous outbreaks of Ebola and H1N1.

What caught her completely off-guard? The breakdown in the hospital supply chain across the U.S. that left doctors and nurses dangerously exposed to the virus.

As local hospitals began to run out of critical supplies needed to treat coronavirus patients, doctors and nurses at Providence last spring geared up with the Hundred Million Masks campaign to make their own face shields and surgical masks.

“Making and disinfecting personal protective equipment for our healthcare workers and creating production lines at furniture manufacturing plants to have enough masks to keep doctors and nurses safe … not in a million years did I ever dream I’d be spending time doing that. We had no other choice. It did not feel good,” she told Fierce Healthcare. She then paused and repeated, “It did not feel good.”

RELATED: Portraits in Healthcare: Providence ED doc says 'I want people to know it’s safe to come to the hospital'

In the year since COVID-19 arrived in the U.S., healthcare workers on the front lines have been waging a war against a pandemic that has killed 429,000 Americans and sickened more than 25 million. Despite the bumpy vaccination rollout, Bartles said she is “cautiously optimistic” that the country has hit a tipping point.

“While the emergence of more contagious variants could put that in jeopardy, we are rapidly vaccinating healthcare workers and are beginning to vaccinate critical populations, such as the elderly and long-term care residents. It’s still a little too soon to see the impact of vaccinations but I think if we can hold out a little bit longer, with social distancing and wearing masks, things could look a lot better in a few months,” she said.

Rebecca Bartles (Providence)

Bartles, an epidemiologist who has devoted her entire career to combating the spread of life-threatening infectious diseases, spoke with Fierce Healthcare recently about the lessons learned since COVID-19 arrived a year ago, the biggest surprises from her experience battling the pandemic and what she most looks forward to doing when the virus has been defeated.

Fierce Healthcare: How does this pandemic compare to addressing other disease outbreaks?

Rebecca Bartles:  It doesn’t compare. The first month in, I was exhausted and my husband jokes, ‘This is your Ebola,’ and I said, ‘This is so much worse than Ebola.’ In the infection prevention field, if we’re doing a good job, then you don’t know we’re there spending time protecting you. Our profession is now front and center, and people now know what infection specialists and epidemiologists do. We’re doing it day and night, often 18-hour days.

FH: Along with the PPE shortages, what were the biggest challenges you faced as you responded to this pandemic?

RB: The value of infection prevention is that we have historical knowledge of infectious disease as a reservoir. It’s very uncommon that we’re asked questions that we don’t have something to go back and reference in order to answer. This time, it was hard to find another case to cite to help guide our decisions. Every scenario was a new scenario as it relates to personal protective equipment, testing and isolation. Literally, every new decision requires that level of discernment, and it’s exhausting not to be able to fall back on default knowledge. You have to question and think through everything as a new and different idea.

RELATED: Providence's Amy Compton-Phillips led the early charge against COVID-19

FH: What are some of the biggest lessons learned from 2020?

RB: I feel that our skills at thinking outside of the box have improved. I have been really impressed at how quickly an organization this size could rapidly change from thinking that we’re steering the Titanic to instead working as nimbly as a startup, and in the space of a few days. That’s a huge lesson—that we can do things quickly and efficiently and maintain the same level of quality. That’s not always the expectation in healthcare.

I’m also struck by, prior to COVID, infection prevention was my job and now it’s literally a part of what every member of every team does every day. It’s now integrated into conversations and galvanized in a way that it wasn’t prior to COVID. And in the public, in places like restaurants and grocery stores, there is a greater appreciation for how diseases spread.

FH: What have been some major surprises in fighting COVID-19?

RB: If you had told me that there would be a time when we would be questioning whether we’re capable of doing what the (Centers for Disease Control and Prevention) is asking us to do and seeing disjointed recommendations from state health departments and local health jurisdictions that did not match with the CDC, or directly conflicted with what the CDC and (World Health Organization) asked us to do, I would have laughed. That wasn’t a reality before. The scale and size of this has stretched our system and showed a lot of failure points.

And I'm surprised at how effectively Facebook has stopped us from believing in science.

RELATED: COVID-19 Special Report: Healthcare lessons from a pandemic

FH: What changes did you see in 2020 that you think will become permanent?

RB: Many healthcare systems screened patients for infectious disease prior to COVID, but it wasn’t hardwired. That will be a process that we will maintain in healthcare after COVID to protect our healthcare workers and patients.

Infection prevention partnerships with groups like the Association for Health Care Resource & Materials Management have always been important but were critical in the earlier parts of 2020 to help us procure PPE. That’s been a real win and one thing I’m glad to take away from this. That has helped us to improve our processes as well. I also think the collaboration amongst healthcare systems has increased substantially as we broke down barriers and shared best practices without hesitation.

FH: What are you looking forward to doing when the pandemic is under control?

RB: I really miss standing in line at the grocery store behind a cute baby and being able to smile at them and the baby can see my smile and then smile back. I hate that I can’t smile at children because they don’t see it with the mask on. There’s a pretty big disconnect when we can’t actively use our smiles and body language to show people we are friendly and have care and concern.

I also want to say, our doctors, nurses, respiratory therapists and essential workers have gotten a lot of much-deserved feedback and props for the work that they do. I think it’s important to call out infection prevention specialists working behind the scenes to empower other people to do their jobs as safely as possible. I’d encourage people to … well, don’t hug your friendly infection prevention specialist, as they might not appreciate that … but at least acknowledge the work they are doing.

Send us your stories: We can't believe it's been a year since COVID-19 came to the U.S. and began to change everything. Fierce Healthcare invites you to share your stories one year after COVID-19. What are the biggest changes—bad and good—you've seen in healthcare because of the pandemic? Email Heather Landi at [email protected].