New York.- By Vicki James Yiannas
“Doctors on the Frontline During the Covid-19 Pandemic,” the May 23 webinar organized by the Hellenic Medical Society (HMSNY) featured 6 Greek American doctors of various specialties talking about what they have experienced on the frontlines of the battle against COVID-19 in New York and New Jersey.
Following Hellenic Medical Society (HMSNY) President Dr. Panagiotis Manolas’s directive of “ladies first”, Dr. Lorraine Chrisomalis-Valasiadis, 2nd Vice President of the HMSNY and MC of the webinar introduced Dr. Helen Gouzoulis-Koutsos MD, Dr. Marianna Karounos DO, and Dr. IoannaKatsa MD, who talked about the nature of their work and experiences in the ongoing COVID-19 pandemic. A report on their talks was presented here last week.
Dr. Apostolos K. Tassiopoulos, MD|Professor of Surgery, Director of the Division of Vascular Surgery, Program Director of the Vascular Surgery Residency and the Surgical Skills Simulation Center in the Stony Brook School of Medicine; Dr. George Coritsidis MD|Professor of Medicine and Surgery, Chief of Nephrology and Director of the Surgical Trauma ICU at Elmhurst Hospital; and Dr. Panagiotis ManolasMD|Currently a General Surgeon, in Astoria, NY, spoke in that order.
Dr. Chrisomalis-Valasiadis asked Dr. Apostolos Tassiopoulos, who was participating in the webinar despite being on call, a two-part question, to tell about his experience during this pandemic as the Director of Vascular Surgery at Stony Brook, and what it has been like in Suffolk County, and second, about his current research with anti-coagulation protocol that has just been published in the April issue of the American College of Surgeons Bulletin.
For Dr. Tassiopoulos the crisis began on March 11, when returning from the American Village Forum in Florida he found “the hospital getting ready to embrace this new situation.” Suffolk County lagged about 4-5 days behind NYC in terms of first patients admitted/first patients admitted into the ICUs, and also peaked about 5-6 days after NYC.
The index patient at Stony Brook was a physician, the Chief of the Surgical ICU at Stony Brook (whose family also got sick), said Dr. Tassiopoulos, and though sick he was trying to manage the department from where he was. “In mid-March, two of his faculty came to me and alerted me to the fact that there were a couple of sick patients in the surgical part of the ICU units who caught the virus off their dialysis cathetters… one particular patient caught it off their dialysis catheters three times within 24 hours…”
Explaining his current research with anti-coagulation protocol, Dr. Tassiopoulos said, “We were all looking at the literature at the time, and there was one small paper that had come out of China that was talking about elevated D-dimer levels—an index of thrombose load inside the body— in some patients, how they were doing much worse than the patients who did not have elevated D-dimer levels.”
The D-dimer level is relevant, as many times it is used to make decisions about continuation of anti-coagulation on patients with dvt [deep vein thrombosis]. Dr. Tassiopoulos suggested routine testing of D-dimer levels, then quickly decided that a D-dimer protocol was necessary, as D-dimer levels were going up in a lot of patients.”
The anti-coagulation protocol which was implemented institution-wide on April 20, initally wasn’t accepted by the medical department, who were afraid of bleeding complications. But when it was implemented in the surgical ICUs the differences in mortalities were tremendous: about 15% in surgical ICU compared to about 50% in the medical ICUs. “Throughout the course of the pandemic we only operated on two patients with arterial thrombosis, and both patients were transferred from outside institutions. The number of thrombotic complications at Stony Brook has been very limited compared to that of other institutions,” said Dr. Tassiopoulos.
“A lot of things have changed from the beginning of March but we do believe that the implementation of that particular protocol played a significant role in preventing emergency thrombotic complications, but also in terms of preventing mortailty in these patients.
The 7 vascular attendants and 7 vascular trainees (none of whom contracted COVID-19) that comprising the Vascular Division at Stony Brook have created an emergency line service.
In conclusion, Dr. Tassiopoulos said, “At times like this, when you have to deal with mass casualties, not only are you being asked to do things that you have not done before, but it’s the time that you have to be creative. It’s the time that you have tio be able to collect whatever information is out there and to see how it will best apply to an environment like this.”
Asked by Dr. Chrisomalis-Valasiadis to talk about “holding everyhing together” during the effects of the pandemic at Elmhurst Hospital, which she noted as being more overwhelmed by COVID-19 patients than any other in the city, Dr. George Coritsidis related what happened chronologically, citing many parallels with Stony Brook, the first being returning from an overseas conference to “find things were hitting the fan, as they say,” at Elmhurst Hospital. “Five patients had died; all were infected with the virus in the first week, as far as we can tell, and not survived ARDS and/or renal failure.
“The good news is the amount of positivity that came along as COVID decreased over time in the sense that even though many of the first responders in the ED ended up becoming positive, the next wave of ED physicians and ICU physicians have not been positive to anywhere the same extent, which suggests that the PPE is working, and that’s probably one of the nicest news. I’ve been in the ICU literally continuously in the last 9 weeks-plus, and as of 10 days ago I was
antibody-negative, which I think is a comment on how well the PPE is working.
“Early on, we were jumping into various data that was coming out of China, and afterwards, Italy. We knew that there was going to be alot of acute renal failure, as well as ARDS, and we started recording that. There were issues of clotting with the catheters. We set up a line service. With Mt. Sinai we put together an early anti-coagulation system.” And like Dr. Tassiopoulos,
Dr. Coritsides saw an enormous difference in mortalities when D-dime levels were monitored.
Before the middle of March the dialysis unit was spread out into different dialysis units throughout New York City, and “in the chaos of having some ICUs doing some things, and other areas doing others, regular floors became ICUs: the recovery room became an ICU. The ED was an ICU very early, obviously. You had an entire institution that was essentially a COVID-positive ICU. Very quickly, Elmhurst Hospital became a 24/7 ICU. For the first 6 weeks Dr. Coritsidis was covering 2 nights and six days in the ICU.
Asked by Dr. Chrisomalis-Valasiadis.to. talk about how he and his practice have been affected by the pandemic, what he foresees, “and hopefully we’ll end up with a little bit of a positive note,” Dr. Panagiotis Manolas said, “FIrst of all, I want to say that I am very proud to be a physician. The opportunity given to me in this life is remarkable in that I feel proud and maybe am what is called ‘a hero’ in situations like this becasue being over 60 I’m in the high risk age group.
Dr. Manolas has continued going to his office everyday to see patients, primarily cancer patients, or emergencies, and to the hospital, taking the emergency room call once every 7 or 8 days and participating in surgery on COVID-positive patients in spit of being “very scared, as all of us were,” especially in the first 2- 3 weeks, when there were no level 3 operating rooms and they were operating without any protection on COVID-positive patients. “I saw the same with Apostoli and George, that only one person who works in the ICUs tested positive, or actually became ill, remarkable for a hospital our size, and it shows that PPEs work.”
He thanked all the speakers, saying he is “very proud to be the president of this wonderful
Society because the peak attendance today was 58 people, an all-time record for our society, and it shows how close we are, and we do like each other in society, and we do unite to pursue our philanthropic goals.
“To summarize my personal experience, which probably is the experience of everyone here, although our preparedness was not the best—either nationally or locally— the organizational abilities of the health system, the country, and even our homeland, Greece, were remarkable. I think we averted the death of millions of people because the heroes in the front lines managed to fight a war that was very, very unfair to us; we were fighting an enemy we couldn’t see but grew to recognize very rapidly.
To view this webinar go to: