This week marks one month since the COVID-19 pandemic began to gain a foothold in Maryland. One month ago, we sent as much of our workforce as possible to work from home, ramped up telemedicine appointments and did our best to abide by the Governor’s order to stay at home and away from others. One month ago, we admitted our first COVID-19 patient to the Bioncontainment Unit. Remarkably, and due to outstanding and dedicated care, this person is now breathing without mechanical support, and is likely to leave the hospital in good condition in the near future. I am very grateful for the generosity, hard work and creativity of all members of our department.

Our efforts have paid off—we do see some “flattening of the curve,” consistent with the goals of social/physical distancing. However, there could be growth of cases in the neighborhoods surrounding The Johns Hopkins Hospital and the Johns Hopkins Bayview Medical Center. These populations are enriched for comorbidities predisposing to worse COVID-19 illness, including diabetes and asthma.

While I cannot pretend to know how this pandemic will unwind, I do believe we are at the end of the beginning, and possibly in the middle. As such, we need to collectively consider and prepare for the reawakening of our non-COVID-19 related clinical services. Profound and rapid changes have transpired during this time, and some of them are likely to inform us about making a better future. One example is the explosion of telemedicine in ambulatory practice. While many questions remain (e.g. Will payors continue to pay? Will state licenses retain a permissive and inclusive mandate? What types of visits do and do not fit into this paradigm? How will we incorporate telemedicine into education, training and research?), it seems clear we will do far more telemedicine visits after the pandemic than we ever did before. This transition could have major implications for our department. For example, we may be able to reduce overhead costs and provide specialty care at a distance, without requiring commutes or complex sustaining business models.

In any event, we need the formidable brain trust that is at the core of our department to consider the opportunities of this unsettling natural experiment, and to devise new, better and more efficient means of delivering care going forward. I am excited by this prospect, and confident our department will contribute important new ideas and practices to reformulate our operations in the post-COVID-19 world.

Collectively, we now have the experience of weeks of successful telemedicine visits - thanks to the flexibility and efforts of our clinical providers, scheduling staff, ambulatory leadership and more. I think our entire workforce has adapted to the changes we have made over the past month gracefully, which is a large part of the reason I am so confident in our ability as a department respond to the opportunities and new challenges the future will bring. Thank you for your consideration and continued patience as we navigate this pandemic together.

-Mark

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