By: Abby Schwartz
To passersby, it simply looked like a group of workers enjoying treats from an ice cream truck on a beautiful spring day. To employees of the Hospital of the University of Pennsylvania (HUP), May 11 was a celebration of extraordinary achievements. On the day the federal Public Health Emergency for COVID-19 ended, Penn Medicine hosted events to recognize the contributions of employees across the health system, from Lancaster County to Philadelphia to the Jersey Shore.
In many ways, Penn Medicine is now stronger and better prepared for the future thanks to the lessons, alliances, and workflows developed in response to the pandemic.
Central to these efforts was the team of 11 hospital epidemiologists, led by Judith O’Donnell, MD, director, Infection Prevention & Control and chief of Infectious Diseases, Penn Presbyterian Medical Center, who were responsible for establishing COVID-19 protocols for the University of Pennsylvania Health System (UPHS).
“The pandemic allowed the emergence of a team of experts who helped keep things as steady as possible, while providing some level of reassurance for everyone in our health system,” O’Donnell said.
Today, as COVID-19 transitions from a pandemic threat to an endemic disease, that team is carrying forward plenty of lessons to be ready if they need to mobilize again using the strengths of a unified system.
What Do Hospital Epidemiologists Do?
The team of Penn Medicine hospital epidemiologists who began meeting virtually early in the COVID-19 pandemic.
Hospital epidemiologists are physicians specializing in infectious diseases, with additional training within health care settings. They lead the Infection Prevention & Control departments at each hospital, working with a team of infection preventionists. Infection control is essential to the safe functioning of a hospital — from making sure the environment is properly cleaned and certain patients are isolated, to physicians, nurses, and staff taking precautions to prevent infection.
“We also investigate clusters or outbreaks of infection. For example, if a case of tuberculosis comes in, we determine if anybody was exposed and make sure they are evaluated and isolated to limit further exposure,” O’Donnell said.
“I’ve often said we’re like the tunnel system beneath Disney World. No one knows what goes on down there, but it makes the Magic Kingdom the experience that it is,” she added.
Prior to the pandemic, each Penn Medicine health care epidemiologist was responsible for infection control at their own hospital entity, though efforts had begun to build an alliance for standardizing practices across Penn Medicine. That changed in March 2020, when the epidemiologists began calling one another to check in and compare notes. Real-time guidance was needed: by anesthesiologists wondering how to safely intubate patients, clinicians working at the bedside, staff tasked with cleaning rooms and transporting patients, and many others.
“I thought: we have to get together and speak with one voice or there’s going to be a Tower of Babel — mass confusion for everybody,” O’Donnell said.
The team held its first virtual meeting on March 23, 2020, and continues to meet weekly to this day. They were an instrumental part of the effort that collectively cared for more than 27,650 inpatients with COVID, administered nearly 390,000 COVID vaccines, stood up more than 500 COVID-related clinical trials and other research studies, and conducted more than 2.3 million outpatient telehealth visits.
New Testing Strategies Activated
Testing for COVID-19 was among the most critical and complex issues to navigate during the pandemic, essential for informing and preventing the spread of disease among Penn Medicine’s patients and staff, and in the wider community. As a result of this experience, clinical testing has become an area of strength looking forward.
Penn Medicine activated a cross-system team, the COVID-19 Clinical Testing Oversight Committee, composed of medical and operational leaders throughout the system. The team was charged not only with policy governance, but reviewing and interpreting a ‘tidal wave of information’ pouring in from myriad local, state, and federal sources.
“The Epi team helped coalesce that data to better inform our testing strategies,” said Robert Challender, FACHE, chief operating officer (COO) of HUP (formerly COO of Pathology & Laboratory Medicine at UPHS).
David Pegues, MD, medical director of Healthcare Epidemiology, Infection Prevention and Control for HUP, said Penn Medicine’s capacity for testing has expanded dramatically, including the high throughput testing laboratory at HUP and the sequencing facility at Children’s Hospital of Philadelphia, available through a partnership with Penn.
“We’ve purchased a variety of molecular testing platforms that could be sourced for other clinical diagnostics, but then could be rapidly used if we had a new, emerging pathogen that we needed to be tested for,” Pegues said.
Prepared for the Future as One Penn Medicine
The epidemiologists who once made siloed decisions now consult as a group — and not just on COVID-19. They’ve become a nimble team, responding quickly at the first sign of infectious disease to assess the situation, review data, and establish standards for every staff member, patient and visitor. One example is last summer’s Mpox (formerly known as monkeypox) outbreak in the U.S. Within a week, the team had written and shared a new policy — an efficiency O’Donnell called “unprecedented.”
After COVID-19, the team feels better prepared for the next pandemic, if and when it strikes. This preparedness includes stockpiling personal protective equipment (PPE) such as masks and powered air purifying respirators, standardizing treatment protocols and incorporating them into the electronic health record, and knowing how to manage capacity and safely expand each hospital’s footprint — working with Facilities teams, for example, to change the direction of air flow in order to minimize the risk of infection.
“We’ve learned to be much more flexible about where and how we deliver care, which will help us in the event of any kind of future pandemic, with respect to infection control,” Pegues said.
Danielle Werner, MHA, FACHE, chief operating officer for Clinical Practices of the University of Pennsylvania (CPUP), worked closely with O’Donnell and her team to address pandemic protocols and infection control in the system’s outpatient facilities. She said that Penn Medicine is strengthened by having hospitals and ambulatory services under one umbrella, as demonstrated during the pandemic.
“We know how to operationalize testing sites and vaccine distribution, because they’re really like outpatient clinics. We're also able to quickly shift resources to where they are needed, when one area of our community is impacted — just as we redeployed ambulatory staff to support hospital services,” she said.
In addition, the ambulatory team recently appointed Kathleen Murphy, MD, an associate hospital epidemiologist for HUP, to a newly created leadership position: medical director of Infection Prevention in CPUP, overseeing infectious disease readiness in outpatient settings.
“There’s nothing we have learned during the pandemic that isn’t translatable to our day-to-day activities,” Werner said. “It made us a stronger health system and stronger collaborators.”
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Hear from Penn Medicine doctors, nurses, and staff from across the health system as they reflect on their experiences during the COVID-19 pandemic.