Friends,

This is going to be a long haul, and each day I become more appreciative of the dedication, resilience, and ingenuity of our people. Which is to say, we can do this.

One piece of good news is the way our fellow Michiganders are social distancing. When “anonymous” cell phone data is analyzed, the good people of Michigan are really staying home. Social distancing is our single best weapon for slowing the spread of the virus, helping our hospitals manage the sick, and keeping our elders safe. (And, some of our not-so-elders.)

It is not lost on me that struggles of society before COVID-19 continue and may be worsened by this virus. The major risk factors, beyond age, for morbidity and mortality from this virus are tightly tied to social determinants of disease. We can easily hypothesize that communities most impacted by these social determinants will also be highly impacted by this epidemic. As we struggle to distribute scarce resources, it has to be that we equitably distribute resources. It is understandable that we worry about those closest to us, but the whole point of living in groups is to provide for each other.

For alumni who are getting this update for the first time: You can find last week’s update here and all of the weekly updates from 2020 and 2019.

Our people have done a lot of good work in the last couple of weeks:

Nigel Paneth is a leader in the national effort to bring convalescent serum to the care of patients with COVID-19. This technology is old and known to be effective in treating viral illnesses, but the dose, duration, and timing of this treatment is unknown, and the goal of this project is to answer those very questions.

Our college was a leader in finding a path to early graduate certification to allow interested students who have completed their education to get an educational license from the state and choose early entry into their residency. We hope this brings more physicians into the care of patients during this crisis.

Following a submission to a CHM suggestion box, the folks in OMERAD have created a set resources for people caring for kids at home.

MSU Health Care has started drive-up testing on campus after an excellent effort.

Jack Lipton and his team have validated a new test for the SARS-CoV2 virus that is causing the pandemic, and they are working on FDA approval to bring the test to the general public. Our colleagues in the Veterinary Diagnostic Lab are working with a lab in the Department of Medicine on viral and antibody testing. And the IQ, a collaboration of the College of Engineering and our college has a viral test as well.

CHM is offering CME for work on the COVID-19 pandemic!

We have heard from alumni who are working on the frontline of this crisis. It is heroic work, and it was great to hear from Miguel Joaquin in Boston and Blake Lopez and Daniel E. Roberts in New York. If you are a part of the CHM diaspora, let us know how you are doing during the pandemic.

As many of you know, we will not have an in-person graduation ceremony this year, but we will have a virtual graduation celebration, and we have invited all of our 2020 graduates to be hooded and walk in a future in-person graduation. As great as we hope our virtual graduation celebration will be, there is no way it will be the same as our usual commencement. To help students return to a future graduation, the college has provided graduating students with a $2,000 scholarship.

The college has had its clinical students out of rotations for a couple of weeks, and it will be a couple of more weeks before they re-enter. We have a special, 2-week COVID-19 elective our students will take before entering the clinics again. Our primary clinical education focus over the last few weeks has been graduating fourth-year students, and our next focus will be preparing our late third years for their fourth year.

I am disappointed that our students are not currently in clinical settings, and I think it is deeply important for students to re-enter clinical rotations soon. The whole point of our curriculum is that students will be useful, because being useful is a powerful educational experience and the key to their future performance. In addition, over the last two decades our profession has systematically removed students from meaningful clinical experiences. Some of this is a result of billing concerns, and some is a result of protecting students from scut work, and some has been a been slow degradation in our expectations.

We, as a profession, pay for this in graduates who need a bootcamp before residency and residency graduates who are not experienced enough to enter practice. COVID-19 challenges us to decide what kind of profession we want to have, and I argue we want our students to be treated like the intelligent, well-educated, highly capable adults they are. They should be safe, to be sure, but they should be a part of the profession.

Getting students back in clinic involves making sure students are safe, that they expand capacity of our health care system, and that we use PPE and other scarce resources efficiently and responsibly.

Here are some principles that can guide our work:

Students need to be safe . They cannot participate in care without the proper training and protective equipment. Students in high risk categories should be at home contributing in ways that do not require in-person activity.

. They cannot participate in care without the proper training and protective equipment. Students in high risk categories should be at home contributing in ways that do not require in-person activity. Students should only participate in ways that add capacity to the health care system . We should only include students in rotations where their usefulness outweighs the risk of their exposure and becoming a vector. So, no dermatology rotation, though students might be on a medicine service.

. We should only include students in rotations where their usefulness outweighs the risk of their exposure and becoming a vector. So, no dermatology rotation, though students might be on a medicine service. Students should only use PPE, and other scare resources, when it increases the capacity of the health system . As examples, we had students screening workers for COVID-19 symptoms as they enter the hospital (as required by our governor) and could have them providing education to patients as they leave emergency department triage to go home. In both cases the students are or should be in PPE, as any caregiver should be in these roles, as they are freeing nurses and physicians to do other work and thereby increasing capacity of the health system. Hospitals need to do their own assessment of this risk-benefit and make the choice to use PPE in this way.

. As examples, we had students screening workers for COVID-19 symptoms as they enter the hospital (as required by our governor) and could have them providing education to patients as they leave emergency department triage to go home. In both cases the students are or should be in PPE, as any caregiver should be in these roles, as they are freeing nurses and physicians to do other work and thereby increasing capacity of the health system. Hospitals need to do their own assessment of this risk-benefit and make the choice to use PPE in this way. During this crisis we are creating the professional spirit of future physicians and laying down the understanding of medical student participation in care for the next generation. We should be clear that students deserve to be engaged as providers under supervision.

We have alumni across the country, and faculty and colleagues in southeast Michigan saving lives in the very harshest circumstances. Be thinking of them… and offer help if you can.

The doubling time for cases in Michigan is increasing, so social distancing is working!

Be well.



Serving the people with you,

Aron

Aron Sousa, MD FACP

Interim Dean