Neurologists Dust Off Their Stethoscopes, Join COVID Frontlines

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MAY 01, 2020 --Daniella Sisniega, MD, a neurology resident at Mt. Sinai Medical Center in New York City, recently dusted off her stethoscope and headed for the frontlines of the COVID-19 pandemic.

She announced her intentions on twitter, saying she is happy to do her part.

Sisniega joins other neurology attendings, fellows, and residents across the globe who are joining the ranks of their critical care and emergency medicine colleagues to provide them with much-needed back up.

Sisniega had always planned to volunteer in some way. Then she learned from her program director that the ED at Elmhurst Hospital in Queens, New York, was understaffed and needed extra hands. She signed up.

"I am currently working on the side of the emergency department that sees the COVID patients that do not require NIPPV [nasal intermittent positive pressure ventilation] or intubation," she told Medscape Medical News.

"As a resident, I see and staff new patients, but if needed I also check all patient oxygen saturations, make sure to titrate oxygen supplementation, refill oxygen tanks or whatever else is needed. It's all-hands-on-deck."

Emergency care differs from neurology in multiple ways, Sisniega said. COVID-19 patients require acute treatment, a contrast to the long-term, follow-up care required by neurology patients.

"To say the least, working in the ED in the middle of a pandemic is very different from a normal day in neurology, but it makes me appreciate what my ED colleagues do."

Sisniega also worked with an ophthalmologist and two volunteer physician assistants to come up with an innovative solution when the hospital temporarily ran out of a type of essential mask, a success she also shared on Twitter:

A Global Effort

Sisniega is not the only one redeploying during the pandemic. Physicians from across the globe are stepping up to help. Tim Wilkinson, MD, a neurology resident in Edinburgh, Scotland, also saw the need and acted:

"It's still early days, but I've been enjoying the switch. It was daunting at first, but the respiratory team were very welcoming, and it didn't take me long to find my feet. I'd like to think they have accepted me as one of their own," Wilkinson told Medscape Medical News.

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Wilkinson recommends that neurologists looking to join multidisciplinary COVID-19 efforts should review the acute patient management and best practices for prescribing palliative care. "These are the two main aspects of working on a COVID-19 ward," he said.

Neurologists in northern Italy, the epicenter of the COVID-19 outbreak in Europe, have also left their usual posts to help during the pandemic.

Anna Bersano, MD, PhD, at the cerebrovascular unit at Fondazione Istituto Neurologico Carlo Besta in Milan, told Medscape Medical News that many of her colleagues have redeployed to teams at other facilities, especially in Bergamo and Brescia.

"Other neurologists at bigger hospitals were reallocated to emergency wards or internal medicine wards," she said.

Although Bersano was willing to help out, she contracted the virus at the end of February. "I was not redeployed. I was fortunate enough only to have a long fever, muscle pain, and ageusia. Now I'm recovering," she said.

Neurosurgeons have also answered the call to help, especially those who find they have more time on their hands because of the large volume of canceled elective surgeries at their institutions.

"We are supporting the frontlines as we can, deploying to emergency room and ICU where we can be helpful," Martina Stippler, MD, a neurosurgeon at Beth Israel Deaconess Medical Center, Boston, Massachusetts, told Medscape Medical News

Waiting in the Wings

The intensity of COVID-19 outbreaks in different regions varies widely, but neurologists are ready and willing to switch specialties should the local infection rate and caseload spike.

"There has definitely been an effect of COVID. While we have not experienced a surge, the hospital has a steady influx of COVID patients," said Shyam Prabhakaran, MD, professor and chair of neurology at the University of Chicago Biological Sciences, Illinois.

Neurologists remain ready to redeploy as needed. Not content to wait, some neurology faculty are volunteering for shifts in the ED to help triage patients for admission, he added.

"The ED faces staff shortages in dealing with the increase in patients with ILI [influenza-like illness]."

The pandemic has also changed the number of people coming to his institution for stroke care, Prabhakaran added.

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"Stroke admissions and EMS transports are down compared to pre-COVID," he lamented. "This indirect public health aspect of the pandemic is a major concern as we fear stroke patients are delaying care or staying home altogether."

The faculty and trainees in the neurology department at the University of Miami School of Medicine have not yet had to redeploy either, Ralph Sacco, MD, chief of neurology, told Medscape Medical News. "We may be faced with this when we see a Florida surge in the future."

It's the same scenario in Seattle. David Tirschwell, MD, professor of neurology and medical director of Comprehensive Stroke Care, University of Washington, said his hospital, Harborview Medical Center, "did incredible planning" for COVID-19 but, so far, there's been no surge in cases.

He praised King County in Washington State for "a remarkable job at flattening the curve."

For this reason, he and other neurologists have not had to redeploy.

"We're right about at our peak hospital usage, and we have not filled our ICU beds with these patients," he noted. "We had a multistep plan we never had to fully implement because the massive surge like we're hearing about in NYC just hasn't materialized here."

"Be Kind"

Back in NYC, Sisniega said the diverse backgrounds and expertise of her new team members surprised her.

"We have volunteers from all specialties including dermatology, psychiatry, ophthalmology, and of course from all areas of the country," she said.

"No matter what their previous roles were — attending, RN, resident — everyone is ready to contribute in whatever way is necessary," she added. "Just today I met an ophthalmology attending whose role was to keep stock of the number of ventilators in the building."

Sisniega's neurology skills have come in handy. "As neurology residents we often respond to stroke codes and we're comfortable with sick patients whose medical history we're not familiar with," she said.

Neurologists are accustomed to acting quickly when patients suddenly decompensate. "Unfortunately, COVID patients can also decompensate unexpectedly," Sisniega said.

Her words of advice for other neurologists considering redeployment to help with COVID-19: "The patients are very scared and anxious. Be kind. You may be the only conversation they had that day."

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