Browse by topic or read the transcript of our interview below.
[0:55] University COVID-19 response and stay-at-home measures
[5:05] The future of medical education
[6:43] Conversations on coronavirus in the medical field
[8:02] Nationwide polarization and the effectiveness of Ohio’s social-distancing response
[11:29] Health care workers’ perspective during the U.S. pandemic
[15:25] Streamlining the global response to pandemics
[17:56] COVID-19 comorbidities statistics and preventative health measures
[20:33] Health care physician-patient relationships and underlying conditions
Angela Williams: 98.8% of their patients that died from COVID-19 had at least one comorbidity, so one underlying health problem and it wasn’t necessarily a huge health problem. It was hypertension. It was diabetes. It was heart problems. It was obesity. And these are things that are not unfamiliar to the United States population.
Logan Sander: I’m so happy to introduce our next guest who is the first of a two-part installment featuring perspectives from medical students looking forward to their future in medicine amidst COVID-19. Angela Williams is a Connecticut native, but a longtime Ohioan. She’s currently pursuing her medical degree at the University of Toledo’s College of Medicine. Thank you so much for being here, Angela. I’m really excited to have you on.
AW: Thanks for the opportunity.
LS: Yeah, of course. So as we know, COVID-19 really has altered so much of our world and I would argue potentially none so much as the medical field. I mean, as a medical student from your perspective, when did you have a moment where you were like, “Wow, this is a big deal. How is this going to impact my life?”
AW: Sure. So, at first, back in January or so, when you started hearing ripples about COVID-19 over in Wuhan. We saw the fear and the SARS relation that they would make. So that kind of made me wide-eyed. And I always realized, being in the medical field, that we would be the first people that a person that’s ill would come to see. So it’s kind of like watching a storm roll in from the distance as more and more cases came up in the U.S. So I guess we would have always known that, as medical students, we would have possibly come into contact with this, being in a hospital setting and being considered on the frontlines. But, there were really only a few days between when things really started mobilizing in the hospital setting to where the school was kind of like, “Okay, I think it’s time for non-essential personnel, including students, to be out of the clinical environment, away from this risk, as we try to figure out how to best tackle this. So, when I realized it could really impact my life was probably about March.
LS: Wow. Yeah. And so you’re a third-year medical student right?
LS: So had you started clinicals at that point?
AW: Yeah, actually our curriculum has changed, so my class is the first class with a curriculum overhaul, so we’re not on traditional semesters, if you will. We still have fall and spring, but we were actually supposed to be fourth year medical students at the beginning of May of this year. So I’m coming up on the tail end of third year, so we pretty much had finished rotations just in the last block or two.
LS: And how has the virus impacted your education? How has the college responded to what’s going on?
AW: Yeah, I think [the University of Toledo (UT)] did a really good job. I think they worked really quickly and well with the ever-changing and evolving situation. They really were open with communicating with us and saying, “Just be on standby. We don’t know what the next steps are at this point, but as soon as we do we’ll let you know.” They expressed that their concern was our safety, as well as our continuing education. So they’re really working both angles for us.
I don’t think we got abandoned; I think they’ve really kept in close contact with us. They’re really receptive to our feedback, to ways that we can make this kind of interim and non-clinical time more beneficial, to continue to move forward and not get behind in our schoolwork. So we’ve been out of the clinical arena since mid-March, which—most med students loved being in that. That’s something that we’ve worked hard for. It’s the latter half of our medical education before we graduate. So selfishly, we’re kind of sad to be out of it, but of course, the medical student has to take on multiple roles—supportive roles—and this is one of our roles is to stay home and abide by those policies as well.
In the interim, we’ve been able to engage in online platforms, complete some case studies with our professors and continue education that way so we’re not losing touch with our clinical decision making skills, which I think has been really good. We’ve had a number of other online modules and online education. So they’re really working hard to make this as seamless a transition as possible so we can, like I said, keep moving forward.
LS: Yeah, absolutely. And I love that you talked about how, in this case, staying home is actually a part of your education, it’s a part of your duty, you know, because this really is a public health issue. I’ve seen a lot of news articles that are talking about medical students and some residents who feel like they’re being “sidelined” in this case, but I love that perspective that, you know, staying home is a big part of it, as well.
LS: Is there any aspect of your education that you feel like has been delayed or is there gonna be any impact on the future of what your education looks like?
AW: Yeah, I hadn’t really thought about that. In a sense, we’re kind of switching things around so we’re able to do things that we might have been able to do fourth-year during this time and then we’ll catch back up later. So it is shifting around the timeline a little bit. Since, like I said, we would have been fourth-year medical students beginning of May, we’re kind of at this transition point anyways in our career where we are lining up to take our second part of medical licensing exams. So a lot of us are taking time to study for that right now using online resources and book work. So a couple of us would have taken probably a couple weeks off anyways during this time to focus on performing well on those exams. So, in that sense, it’s still kind of staying on track and things are just being shifted around, but, like I said, being out of the clinical environment for a month or so, it’s disappointing for us, because that’s where, you know, every second of the day we’re learning something, we’re seeing something, we’re reading charts and learning up on patient conditions and it’s just an extremely, extremely fruitful learning environment to be in the clinical setting. So, it’s very different. So, maybe a delay in that sense, but otherwise, we’re trying to keep up with it.
LS: And what have your… I’m sure you and your cohort and your instructors have been talking about the coronavirus. I mean, I’m sure this has become a topic of discussion, as well as how hospitals are responding, how healthcare systems are responding, you know, what your role in that will look like as aspiring doctors, as the people who will be the next generation of healthcare workers taking care of our population. I mean, what are those conversations like for you guys now?
AW: So our instructors have told us to remain calm and patient and flexible with all these changes to our curriculum, as well as with the uncertainty that it brings: following CDC guidelines, taking care and being safe. I haven’t really seen much discussion so much centered on the pandemic itself with the students. It’s more, right now, we’re focusing on “What does this mean for the next steps for our medical education in terms of moving forward with licensing requirements and all of that?” So I know that there are a couple electives being designed at the school in order to center around, kind of, crisis communication, pandemic response, things like that, but those are yet to come.
LS: Yeah. And I know that you have been an Ohio resident for a while. You lived in a couple of other places before that, but what’s been your perspective as someone studying in the medical field on how our government and our health care systems have responded? I guess not just in Ohio, but potentially nationwide as well. Obviously, there’s a ton of debate and conversation around how different governments are handling things, what public health representatives should be doing, or shouldn’t be doing, even questions on should we wear masks, should we not wear masks, who are the masks for, should we be wearing gloves in the grocery store, how many times a week should we be going out? I mean, what’s been your perspective on all these conversations?
AW: It’s pretty polarized, [and] Ohio’s response seems extreme, but they have been commented time and time again to be leading the nation in response to this pandemic. So when you look at this success of social distancing, when people actually follow the recommendations, when its integrity is upheld, [it] decreases transmission of COVID-19 and therefore will decrease cases. So I know it’s hard to do the right thing, especially when that right thing is unpopular and may seem unfavorable in short sight, but this is for the good health of all.
I was looking at the Ohio Department of Health website which shows a forecast graph of estimated cases per day if we didn’t have the social distancing and stay-at-home recommendations implemented versus having them implemented and it shows something astronomical. Like, a nice bell-shaped curve that’s humongous and it shows like 60,000 cases per day estimated if we didn’t have these regulations implemented and then it shows a smaller graph that shows the effect of the social distancing and the stay-at-home orders. And it’s just to see that image, it’s just kind of difficult to say that the extreme measures that we’re going to wouldn’t be positively impacting this situation. So I know social media and the news are showing overwhelmed health care workers and hospital systems, but it’s hard to imagine what it would be if we weren’t taking all these precautions. If we weren’t wearing masks or weren’t washing our hands as much and weren’t, you know, wiping down grocery carts, things like that. So I know it’s a lot to talk about, but I think limiting social interaction has probably been a good thing.
I was also reading an article published in JAMA, it’s titled, “What Other Countries Can Learn From Italy During the COVID-19 Pandemic,” and the authors suggest that initial push back to the stay-at-home orders in Italy, as well as social distancing early on, contributed to the virus spread, noting attendance to sporting events and you know, dining out at restaurants and bars and things like that. So, they do implicate the push back that they identified through police reports that said there were disturbances, or you know, people not upholding the recommendations that they believe that contributed to the spread. So it’s probably extreme, but probably necessary.
LS: Yeah, absolutely. I’ve been hearing a lot that the success, if you want to call it that, that we’re seeing today is really a result of policy making and decisions and actions that were made yesterday. So, just because we’re seeing maybe not that huge projected curve, doesn’t mean that we can just simply let up on the measures that, you know, we’re doing right now. And I think, you know, something also that might be interesting from your perspective: just because if it had been a year or two or three later, for you, that this has happened, you would be on those front lines. You would be the one working when everyone else is staying at home. From your perspective for this, from the kind of health care professional side of things, what would you want to tell people, the public, right now in terms of, you know, what’s going on, what we should be doing while all of our health care professionals are risking their lives on the front lines now?
AW: Yeah, I think social media does a great job of highlighting some of the social pleas that some of these health care workers are sharing with us to please stay home. You know, stay home for us, the people that are trying to take care of your loved ones and I think the health care workers, they have both sides of this situation. They have families at home and friends at home and those people are not so removed from the things that we’re feeling when we’re just mandated to stay home. They have to stay home, but then they have to go to work and help out these people that have fallen ill with COVID-19. And I think hearing it straight from the health care providers with what’s needed, which is to stay home and protect them by protecting ourselves and others, is probably a good way to go.
LS: I mean, I can’t imagine being an aspiring doctor at this time in our history. I mean, of all times to be looking at what’s happening in the medical field, you know, what doctors are having to do. Doctors, nurses, other health care professionals out there putting their lives on the line. How does this situation change the way you see your future field? Does it make you nervous? Does it make you scared? Does it make you feel, maybe, even more determined to be doing what you’re doing?
AW: Yeah, at this point, just being mandated to stay home and take on that role, it’s more encouraging to me. I think, as a physician, my calling to become a health care professional and physician leader is one that’s rooted in desire to help others that are in their most vulnerable and needy states at a time where they need my help. They need expert help. They need professional opinions and that’s something that eventually I’ll be able to give to them. So this is really an inspiring time for health care providers that are really doing what I think is at the heart of the profession on all levels of health care providers and health care workers. The emotional exhaustion that some of these providers are experiencing is not something I’m familiar with yet, but like I said, it is the inspiring attribute that these health care workers have to persist through that for the good of their patients. So at this point, it’s maybe a little bit nerve-wracking to see because this pandemic is so widespread and it’s so serious that all these lockdowns are occurring and businesses are closing. So I think in that sense, it’s a little nerve-wracking, but also this is the call for help. So when and where you can help, I think that can override any kind of nerves.
LS: I think that something people also are talking about now is this “new normal” that we’re looking at. And I’ve also heard the opposite side. That if we go through something so traumatic as a nation, as the human race, that when we come out the other side of this, that things shouldn’t be normal. We should take from this some sort of dramatic action or a change in the way things are headed. And one of those which is really important now that we’re seeing is in certain states, as well as across the world. We’re seeing a lack in the number of hospital beds and ICU beds, potentially in ventilators and key medical equipment and PPE, so personal protective equipment, as well as in personnel in some places. As I know they’ve been importing doctors into places like New York where they’re seeing such high counts of this virus. I mean, what do you see the impact potentially when we come out on the other side of this? What are some of the potential changes in terms of how our healthcare system works? How the field of medicine works? Will there be dramatic change? Will it be slow? Will it be fast? What do you see in that?
AW: Yeah, that’s a tough question. I don’t know what the outcome is gonna be, but I do hope that it will be a collaborative and global learning effort [so] the things that worked and the things that didn’t work in various places can be drawn upon by all [to] then develop a better way to predict a pandemic like this, better ways to streamline the process of developing tests or providing more PPE, more personal protective equipment, ways that we can all just pitch in and help each other out.
I don’t think that globalization will slow down. I don’t think people will slow down their travel for business or for pleasure, so I think that the avenues for another situation like this will probably just continue with people migrating and moving from one place to another. So collaborative efforts from all nations to really figure out how to have a generic template to deal with the next pandemic would be a really good thing to do, to get all hands on deck, so there’s no scrambling needed.
LS: Yeah, this is absolutely something that will leave a mark on national memory, on global memory, but I think it’s also something that, on a very individual level, leaves a mark on all of our memories and how we move forward after this. I think a lot of us are looking at a change in our mindset and how we live our lives day to day. For you, as a potential doctor, as someone going into the medical field, do you think there’ll be any change in your generation of doctors, the ones who are coming up next to handle our public health and in the medical field? Do you see any practical changes or even just changes in mindset? I mean, how do you go about your day? How do you treat patients? What does your schedule look like? What kind of doctor do you want to be?
AW: Sure, I think a lot of people will be motivated to probably work in infectious disease, vaccine development, supportive care treatment [and] critical care because of this, but I think that our generation of doctors could probably focus on preventative health measures. At this point, it doesn’t have to just be primary care physicians. It could be specialists of any kind that are able to bring to the attention of patients high blood pressure that they have when they’re coming in for their office visit. So that same article from Italy that I read in JAMA, it said that 98.8% of their patients that died from COVID-19 had at least one comorbidity, so one underlying health problem. And it wasn’t necessarily a huge health problem. It was hypertension. It was diabetes. It was heart problems. It was obesity. And these are things that are not unfamiliar to the United States population.
So when we’re thinking about preventing the severity of some of these diseases, we can start by doing annual visits, checking up on high blood pressure, checking on our weight, checking up on our diet. Simple things, small things at the beginning that we can make a difference to reduce the impact of a pandemic so that the next one isn’t as serious. The next one doesn’t overwhelm hospital systems as much. So I hope people also engage in building a good physician-patient relationship so that they’re able to chat with their physician about any changes that might be going on. So hopefully that’s the change that our generation can make, focusing on preventive care to reduce the severity of something like this happening again.
LS: And you’ve just hit on two of the major points. I think that people really are criticizing the way our health care system works today, which is one, not having enough preventative care, so thinking about holistic health, health hopefully before the problems come along. And also the relationship between physician and patient. Nowadays things are so quick. Doctors are so busy. You go in, you go out. There’s not a ton of time in some cases especially depending on the insurance you have or the availability of good healthcare for certain populations. That’s not always an option. And I think those two issues are really key now. You are seeing that those with underlying health issues are the most vulnerable to this disease and they’re the first one who are susceptible. So I think that’s really great to hear from you and hopefully that’s the case when we come out on the other side of this that we begin to address those problems.
Well, I really appreciate you sitting down with us today. It’s great to hear from your perspective. I know so many things are in flux, not just for you, but for the whole world right now. And it’s really inspiring to hear from someone who is still looking forward to making an impact in this field. So I really appreciate it.
AW: Absolutely. Thank you for the opportunity.
LS: Thank you all for joining us today on this episode of the Midpoint. Angela gave us some perspective on how this virus is impacting medical students and residents and how it’s also shaping the future of their profession. If you enjoyed this conversation, like, comment and share to support Midstory at a time when we need information, interpretation and inspiration most. As always, stay safe, stay healthy and stay human. See you next time.