Marshaling the Troops Against COVID

In the sunny hours of a November afternoon, Dr. Bettina Fries,  chief of infectious diseases at Stony Brook University Hospital, joined a Zoom meeting, rubbing her eyes as if she had risen from a nap. 

Fries had just completed two weeks of clinical service at the hospital treating COVID-19 patients as cases spiked right before the holiday season. As a physician-scientist, her job usually revolves around managing a research laboratory and includes only six to eight weeks of in-hospital service a year. But 2020 had been anything but usual and Fries lost count of how many weeks she’d been breaking this record since the summer. 

Fries joined Stony Brook University Hospital in 2014, but had already been in practice for more than 20 years. She originally wanted to become a cancer physician-scientist and in the early 1990s she researched infectious agents that may cause cancer. She soon found herself immersed in the infectious disease realm as HIV was rampant at the time. Almost 30 years later, she’s on the front lines in one of the largest pandemics of all time. 

When the first COVID-19 patients were diagnosed in New York on Feb. 28, 2020, Stony Brook University Hospital activated its hospital incidence command structure – the chain of command that oversees the emergency response and preparedness system used in hospitals throughout the country. Fries joined the group as an advisory member because she had already implemented a clinical trial task force at the hospital to conduct new studies on the novel coronavirus and create guidelines for how patients under investigation would be treated. 

By mid-March, all the hospital’s clinics were closed as new cases increased. Fries recalled her growing concern.

“I was on service at the end of March and once I was on service it was clear that we were going to get too many consults and that we were not going to be able to handle it with our normal consult services.” 

As head of infectious diseases, known as ID in the medical world, Fries reassigned faculty usually attached to research and the veterans and HIV clinics to handle the rapidly rising number of patients. 

“We went from three consult services to essentially six,” Fries said. “We assigned a consultant to a set amount of floors so that every floor had an ID person they could call.”

For four straight weeks, Fries worked “from morning until evening” treating COVID-19 patients and making sure the new hospital procedures were working properly. A typical day started at 8 a.m. with Fries answering emails and tending to administrative tasks. At 10 a.m. she met with her infectious diseases colleagues to review the cases they had for the day before making her rounds. The rest of her day was devoted to treating COVID patients – monitoring their vital signs, supplying oxygen and checking ventilators in certain cases. She then spent hours writing notes about her patients until late at night. 

Fries recalled a case in which an entire household was being treated for COVID-19. Most of the family required oxygen and minimal treatment, but the mother was not as fortunate. She required more intensive care and was intubated. Fries hooked her up to an IV, periodically gave her pain medicine and regularly adjusted the ventilator’s settings. Although she did her best, Fries quickly lost hope for her patient. After a few hard-fought days, the 29-year-old woman became the doctor’s youngest COVID patient to die.   

By the end of March, the hospital had transferred most consult services to electronic systems to limit doctor-patient contact and conserve supplies of personal protective equipment. Fries and her colleagues still had to enter their patients’ rooms, but only when necessary.

By this time, the lack of masks, gloves and gowns known collectively by the acronym PPE was a national news story. “We never really ran out of PPE, but we were short of blue gowns and masks at one point,” Fries said. 

“There were enormous supply chain issues,” she explained, “which our hospital did a really good job trying to anticipate and be proactive about.” 

There was an especially large need for face shields in hospitals across the country. Fries knew this and wanted to help local hospitals. She teamed up with her neighbor, Agjah Libohova, an industrial engineer who specializes in plastic, to produce face shields. They developed a prototype in a few days, which Libohova took to his boss at Clear-Vu Lighting, a Long Island company that produces LED lighting for construction sites and the New York City subway system. Clear-Vu’s CEO, Danny Lax, was a willing partner. 

In seemingly no time, Clear-Vu was producing about 2,000 face shields a day and eventually production reached 100,000 shields a day. The company now sells these to hospitals, including Stony Brook University Hospital. New York State also ordered one million Clear-Vu face shields to distribute to hospitals that needed them.

By the end of the year, the hospital’s safety guidelines and PPE supplies were figured out and the staff was more confident and comfortable handling COVID patients, she said. “We put them in negative air pressure rooms and we just put on PPE.” 

In the midst of it all, Fries took a lead role in a clinical trial for Regeneron’s drug sarilumab, also known by its brand name, Kevzara – a monoclonal antibody that blocks interleukin-6 from binding to its receptor and suppresses the immune system’s overreaction to viral infections. The drug is already approved by the Food and Drug Administration to treat juvenile rheumatoid arthritis as well as the flood of inflammatory proteins called cytokines that accompany the use of CAR T-cell immunotherapy for acute leukemia. Many COVID-19 complications may be the result of this so-called cytokine storm, which can kill tissue and damage organs.

“When you’re not in the hospital you need to get out and clear your head… You need to – in a limited way – try to have some social interaction that’s not related to work and not related to all the disaster and tragedy that you see.”

– Dr. Bettina Fries,  chief of infectious diseases at Stony Brook University Hospital

The ups and downs of the ensuing months were both predictable and unpredictable. “All hospitals will report significant numbers of COVID patients, in the midst of everything else,” Fries predicted in late autumn 2020, explaining that the holiday season and the weeks beyond are traditionally the busiest times of the year for most hospitals.  “Everyone’s going to be incredibly busy.”

She was right as a second wave and then a third buffeted the world. The numbers of COVID cases and deaths locally, nationally, globally climbed and climbed – to a point no one could have contemplated. But vaccines arrived sooner than expected as Fries herself was involved in a study of a protein subunit vaccine made by Novavax.

Working long hours to save lives while being exposed to a deadly disease is mentally and physically demanding. “When you’re not in the hospital you need to get out and clear your head,” Fries said. “You need to – in a limited way – try to have some social interaction that’s not related to work and not related to all the disaster and tragedy that you see.”  

Her worries about the arc of the pandemic still resonate months later, as the Delta variant wrecks hectic across large swaths of the country. “Health care providers need the community to protect us as a resource,” Fries said, adding that the severity of what lies ahead will be determined by the public’s commitment to stopping the spread. Her hope, she said, is that people will remember the chaos of the pandemic’s early days. 

“Everybody is already incredibly burned out,” she said. Which might have explained why she was rubbing her eyes as if she’d woken from a nap right before this interview started.