School of Medicine, Tufts Medical Center swing into action in response to COVID-19

The Tufts University School of Medicine (TUSM) and the Tufts Medical Center (TMC) have been preparing to tackle COVID-19 in recent weeks, according to Gabriela Andujar Vazquez, an attending physician at TMC specializing in infectious diseases and an assistant professor at TUSM.

While not formally affiliated with the university, TMC is the main teaching hospital affiliated with TUSM and employs many TUSM faculty members.

TUSM has transitioned to online learning for the majority of its classes, but third- and fourth-year students are continuing their rotations at several health clinics, according to Patrick Collins, Tufts' executive director of media relations.

“We are using guidance from the Association of American Medical Colleges (AAMC) that students should not be directly caring for patients with suspected or confirmed COVID-19 and we have also restricted their access to patients on precautions of any type,” Collins told the Daily in an email. “Our third and fourth year students are still engaged in patient care as they are important members of the healthcare team.”

In a March 11 email to the TUSM community, Interim Dean Peter Bates said that school offices and facilities would remain functional for the time being, all university-related travel is banned and face-to-face meetings should be avoided as much as possible.

“In an effort to reduce the potential spread of the virus, it is important to limit the density of gatherings, and whenever possible alternatives to in-person gatherings should be pursued,” Bates wrote. “If necessary, an upper limit of 25 attendees is recommended.”

TUSM Professor Helen Boucher, who leads TMC's Division of Geographic Medicine and Infectious Diseases, explained that TUSM is well-equipped to handle the transition to online learning.

“The online learning is very advanced in our medical school. We have a lot of so-called ‘flip classrooms’ where the teaching is done on video and then there are small group discussions,” Boucher said. “I think it was actually pretty easy and quite amenable to the switch because all the software platforms and everything already existed.”

Boucher said that many of her colleagues are making efforts to better understand the virus and are working in conjunction with groups across Boston.

“Fortunately, we’ve been preparing literally for months,” Boucher said. “We have a great team across the Medical Center, and we’re collaborating well with our partners.”

Andujar Vazquez echoed Boucher’s statements, explaining that over 15,000 healthcare workers at TMC have received updated training on the use of personal protective equipment since January.

“We’ve been tidying up all the components of what an influx of patients would look like,” she said. “We’ve identified different areas in the hospital where we can scale up if we need to to take care of patients.”

TMC is also working to create a fast-track illness clinic, through which patients can quickly be evaluated for the severity of their symptoms and treated accordingly, according to Andujar Vazquez. She estimated that TMC has asked for about 20 coronavirus test kits in the last week.

“If the flu is negative, and we’re highly suspicious that they might have COVID based on epidemiological risk factors, then we would go ahead and talk to the [Massachusetts] Department of Public Health, who right now are the only ones who have the test available in Massachusetts,” she said.

Two professors of public health and community medicine at TUSM, Jeffrey Griffiths and Ramnath Subbaraman, both of whom also serve as attending physicians at TMC, spoke to the spread of viruses and the response to such events. 

Griffiths emphasized the importance of the basic reproductive number, known as "R nought" — a measure of the spread of a disease based on contact between an infected person and others. He said that communities are now seeing a situation that is often only simulated in laboratories, in which many of people with no immunity and no vaccinations are exposed to a virus.

“If we were able to come up with a vaccine and get it to enough people and get the number R below 1, then this infection would die out over time because for every 100 people that were infected, less than 100 would be infected in the next wave,” Griffiths said. “At the current time, essentially no one’s got any immunity to this and there’s no vaccine. The R number is well above 1.”

Griffiths emphasized the importance of social distancing to slow the spread of COVID-19, noting that this practice is crucial to reducing the risk of transmission, and cited the Ebola outbreak in West Africa as an example of successful social distancing.

Slowing down the spread of COVID-19 will be largely dependent on trusting people to act responsibly, according to Griffiths. Many healthcare workers are already overworked, but by taking measures such as social distancing, communities can slow the spread of the virus and lighten the burden on the U.S. healthcare system.

“People are having to work incredibly long days because there’s a lot of demand, people are frightened and there’s more illness,” Griffiths said. “The expectation is that at its worst, we could face something that looks like what happened in China or what is happening in Italy, where you overwhelm the medical system.”

Subbaraman cited Singapore and Taiwan as cases in which the government worked quickly and effectively to contain the virus by conducting extensive testing and tracing of patients' contact with people.

“The U.S. has been behind on rolling out testing, which has really hindered our COVID response and will hopefully be rectified in the next 10 days,” Subbaraman said.