No crying in the command center
Carla reflects back on what it felt like to open the command center in response to the arrival of the first community transmitted COVID-19 patient and how ready yet terrified she felt for this moment.
I would say a lot of that felt like that. And reflecting back on the day that we had evidence of our first community transmission COVID-19 patient I think that UC Davis ... I came to UC Davis after the Ebola days. Right? I was doing infection prevention in hospital epidemiology in another community hospital healthcare system across town, and we all looked to UC Davis as that leader for infectious disease and leading the way. Right? You guys had put so much in place around Ebola, and we would all flock to hear Dr. Cohen talk about all the things that you all did, and all the Ebola things.
When we started getting word mid-January that we were going to likely be receiving some folks who were being evacuated out of mainland China, who were right in the heart of this outbreak, ground zero if you will, I was privileged to be here now at this time, and we dusted off our Ebola teams, our Ebola units, all the things that you guys had put into place so well during the Ebola days. So that was a great platform to be able to begin at, and so I'm so thankful for all the work that UC Davis did because I was a beneficiary of that already being in place.
So preparing for patients that were coming from a COVID-19 ground zero, if you will, as part of that initial evacuation was really a no-brainer for us. People rolled up their sleeves. The nurses were like, "We've got this. We've done this before. We know what to do," and it was really amazing to see the nurses jump in like that. It was like, "Okay. We got this. This is not a problem." Right? We were prepared, and I think UC Davis is always prepared. Whether they realize it or not UC Davis staff and nurses are always prepared, and so here comes our patient from Solano County.
Like I said, we were prepared for the patients that were known, and at the time I thought we weren't prepared for the unknown. But actually, now that I have the privilege of looking back over the course of these last several weeks and months, how things have developed, again, the nurses, the staff, the physicians here at UC Davis just head and shoulders above. That patient did not wind up at UC Davis out of happenstance. It happened for a reason, and that's because we were the place that was well able to care for that patient and able to navigate the unknown chartered waters that came with that patient unbeknownst to us. Right?
From the time that we came in on Sunday, February 23rd, and began to test that patient, the staff were calm. They were like, "Okay. What do we do? Let's move the patient. Let's get their specimens. Let's get them off to the CDC, and let's start preparing." The day that we got the word that the patient was positive, again, our ICU managers, everybody got around the nursing staff, supporting them, trying to figure out with the criteria, the CDC criteria, trying to make heads or tails out of the CDC criteria. I call it CDC speak. People in infection prevention will laugh, but it's basically you write off to them, and they just repeat back what you said in a little bit more scientific language, and you really never get an answer.
It's kind of, comes back to you a way of like, "What do you think is the best thing?" That day that we got the notice that this patient was positive I was AOD that week, and again, the command center thing fell in my lap. Also what fell in my lap was, the gravity with Dr. Cohen, I believe, of having to navigate through the CDC guidance. Right before you guys came in here I was getting ready. I was just going through that because we're writing a paper and doing some scientific stuff with that, and I was looking at that guidance. It is jargon. It's absolutely, "If this, and if that, do this."
So we were like, "Our patient doesn't fit any of that criteria, so how do we as a team figure out who's high-risk, who's low-risk, who's medium- risk. Who do we send home? Who do we keep?" You know, all of that. All of that. The gravity of that was horrifying, and the fact that I felt like the safety, the trust of our nurses, was squarely on my shoulders and Dr. Cohen's shoulders to make sure that we got it right, because the guidance was really not there. We were, again, navigating unchartered waters. The nice part of that is, I feel like we got it right. The CDC agreed with us when they came and visited us on the 28th, and on March the 4th they updated the guidance based on our recommendations.
So that guidance, and I have the pictures to prove it-
... so I thank Elizabeth Partridge for that because she was like, "I just need to see this in a simple way," and she went to the whiteboard with the CDC folks and she drew out our algorithm. They took photos. They sent it back to CDC, and lo and behold, on 3/4 guess what came out? Updated simplified guidance around source control/not source control.
I don't think a lot of times the nurses who are doing that work really realize what they're doing every day is actually blazing a path for others to follow. I have had people reach out all over the country wanting to hear what we've done here at UC Davis, and our nurses are really carrying that torch. I think we've done it extremely well, and we continue to do it extremely well, so I'm really grateful for the people that are around us every day. But yeah, it was horrifying those first days. I'm not even going to lie about that. It was horrifying.
The other thing that's really ... I was thinking about this because I'm going to write an article. The article's going to be called, "No Crying in the Command Center". Kristina Spurgeon looked at me the first day, and I was just ... Like I said, the magnitude and the horror of what if we get this wrong? What if we have this novel virus that's really horrible, and we don't find the right people, and we don't take them off work, and we don't give them the right PPE, and what if, what if, what if? Right? So by the end of the third day you're so fatigued, and you've been here for hours and hours, and I was just like, "What if we get this wrong? I don't think I can do it anymore."
I started to cry, and she looked at me and she's like, "Carla, rule number one, no crying in the command center, so you just stop that right now, and you just get back to work and figure it all out." I was like, "Okay." It was funny that this was a fitting day to have this reporting because we officially stood down the command center today, and again I wanted to tear up. These were tears of joy, and I remembered the rule, no crying in the command center again, but I wanted to. I was like tears of joy. I'm so happy. I feel like we're starting to move into some kind of normal operations again.