J-LSMS 2021 | Spring

J-LSMS 2021 | Spring

CONTENTS

JOURNAL EDITORIAL STAFF

EXCEEDING EXPECTATIONS Family medicine physician Dr. Stephen Jones operates an urgent care clinic and nine school- based clinics. He trusts LAMMICO to provide his medical malpractice insurance.

EDITOR D. Luke Glancy, MD

ASSOCIATE EDITOR L.W. Johnson, MD

VOL 173 | ISSUE 1 | SPRING 2021

CHIEF EXECUTIVE OFFICER JeffWilliams

6 COMMUNICATING IN A CRISIS The Louisiana State Medical Society knew that communication would be key when dealing with COVID-19. Read more about howwe have kept our membership informed throughout the pandemic. 10 UNCHARTED WATERS State Health Officer, Joseph Kanter, MD, transitioned into his role in the midst of a global health crisis. Read the exclusive interview here. 16 AN EXAMPLE OF RESILIENCE Internationally recognized infectious disease expert and editor of the Spring 2021 issue of the Journal of the Louisiana State Medical Society , Fred Lopez, MD, gives an update on COVID-19. 18 COVID TIMELINE From the first case of COVID to the approval of three vaccines, join us as we look back at 2020 and COVID-19. 20 SARS-COV-2 AND INFECTIVE ENDOCARDITIS: A CAUSE OF NON-ISCHEMIC ST-SEGMENT ELEVATION A case study of the pathophysiology of SARS-CoV-2 and the infective endocarditis as a cause of cardiac injury along with mimickers of an acute myocardial infarction. 22 PANDEMIC PRACTICING: HOW PHYSICIANS MET THE CHARGE AND WORKED TO KEEP OUR STATE SAFE We asked; you answered. In August 2020, the Louisiana State Medical Society partnered with the Louisiana Board of Medical Examiners to send a statewide survey to all licensed physicians. Here are the results. 24 COVID-19 VACCINE PHOTOS Physicians were among the first in Louisiana to receive the COVID-19 vaccine. Join us as we recognize our members for being part of the historical moment. 26 LESSONS FROM LAMMICO Labeledas essential due to their support of healthcareproviders, LAMMICO learned to adapt and continued to provide service to their insureds. 28 LEADERSHIP IN THE TIME OF COVID Charles Sanders, MD, Department of Medicine Chair for LSU Health Sciences Center – New Orleans School of Medicine, details his time in medical leadership when the pandemic started and the lessons we can learn from a crisis such as COVID-19.

MANAGING EDITOR/ ADVERTISING & SALES Gina Garner

JOURNAL EDITORIAL BOARD Vice Chair, K. Barton Farris, MD Secretary/Treasurer, Richard Paddock, MD

Anthony Blalock, MD D. Luke Glancy, MD L.W. Johnson, MD Fred A. Lopez, MD

LSMS 2021 BOARD OF GOVERNORS OFFICERS

President, Katherine Williams, MD Past President, Lee Stevens, MD

President-Elect, William Freeman, MD Vice President, R. Reece Newsome, MD Speaker of the House, T. Steen Trawick, MD Vice Speaker, William“Beau” Clark, MD Secretary/Treasurer, Richard Paddock, MD Chair, COL, David Broussard, MD COUNCILORS District 1 Member, George Ellis, Jr., MD District 1 Alternate, Anne Borreson, MD District 2 Member, Robert Chugden, MD District 2 Alternate, Gabriel Rivera-Rodriguez, MD District 3 Member, Allen Vander, MD District 3 Alternate, Mark Hebert, MD District 4 Member, F. JeffWhite, MD District 4 Alternate, Susan Veillon, MD District 5 Member, Adrienne Williams, MD District 5 Alternate, Gwenn Jackson, MD District 6 Member, Michael Roppolo, MD District 6 Alternate, Azeen Sadeghian, MD District 7 Member, Brian Gamborg, MD District 7 Alternate, Donald Higgins, MD District 8 Member, Lance Templeton, MD District 8 Alternate, Michael Dole, MD District 9 Member, Andy Blalock, MD District 9 Alternate, Vacant District 10 Member, Nicholas Viviano, MD District 10 Alternate, Jeremy Henderson, MD Senior Physician Member, Robert McCord, MD Senior Physician Alternate, Greg Lord, MD Young Physician Member, Amberly Nunez, MD YoungPhysicianAlternate, Randall G.White, Jr.,MD Resident/Fellow Member, Omar Leonards, MD Resident/Fellow Alternate, Ken Ehrhardt, Jr., MD Medical Student Member, Jacob Boudreaux, MD Medical Student Alternate, Dan Frechtling

When I came to LAMMICO for medical malpractice insurance, they helped me identify ways to minimize risks in my practices. I didn’t want to be reactive if there were problems, so LAMMICO helped me be proactive in preventing risks. The Risk Management team has an amazing level of knowledge for risk mitigation. LAMMICO is a leader in this space. They

maintain a solid knowledge base and provide important communications, especially during crises like COVID-19. The LAMMICO team provides me with an abundance of valuable resources to ensure my needs as a physician are continuously met. I trust LAMMICO. As a LAMMICO insured, you know someone has your back. – Stephen Jones, M.D., family medicine physician

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The COVID-19 pandemic has disrupted virtually all aspects of human activity worldwide more than any other catastrophe in the past 100 years, with the possible exception of the two world wars. COVID-19 is a viral disease that is highly contagious and often lethal, especially to elderly persons with underlying disease. Because little is known about many aspects of the disease, JeffWilliams and I decided to devote an entire issue of the Journal of the Louisiana State Medical Society to COVID-19. Fortunately, Fred Lopez, MD of the LSU Health Sciences Center in New Orleans, an internationally recognized expert in infectious diseases, agreed to be the editor of this issue, and he has assembled other experts to contribute. LETTER FROM THE EDITOR

PRESIDENT’S MESSAGE

It is hard to believe that it has been nearly a year – one year of fear, one year of loss, one year of change and one year of COVID. Who would have thought that the last time LSMS met on January 24, 2020, the House of Delegates would be the last large gathering for many of us without restrictions? And then a virus blankets our nation and our world, and we were called to battle to fight this terrible enemy. Life as we know it came to a halt. Although we continued emergency care at personal risk, many clinics were closed and access to protective gear became limited. All other healthcare needs were put on hold as we focused all of our efforts on controlling the spread of COVID. Many of our peers were the only personal contact in the hospital for many patients dying alone without the embrace of family and friends. We relied on each other for professional and moral support as many of us had to also isolate from friends and family for their protection. It was never a question of if we should fight. The question was how? So, the health care community worked together pooling resources and time to prevail. Not only were we anxious about the risk of COVID to our vulnerable patients but also equally concerned about the lack of attention to other serious health care conditions. On April 26, 2020, after consulting with the LSMS and other health care leaders, Louisiana Department of Health allowed us to resume necessary health care services. For some providers, telemedicine was a welcomed alternative in health care delivery with minimal risk. But not all issues could be addressed virtually, so in-person visits became more challenging for the doctor and patient. Patients were often seen alone without the help of family. The additional screening and the need for supplies were overwhelming at times for providers and staff in an already complicated health care environment. By mid-summer, it was status quo, and we had a new normal with no relief in sight. Many physicians lost a sense of balance, which contributed to further physician burnout. We were dealing with COVID in and out of the office, with little or no opportunity to decompress. Our staff, partners,

and colleagues were becoming infected with COVID which required us to work longer and harder hours. Patients that avoided or neglected other health care needs were presenting in worse conditions, requiring more intense care. And the delay in screening services has resulted in more advanced disease diagnosis of cancer and heart disease, a problem we will all be addressing for years to come. Finally, hope arrived as the vaccine became available in Louisiana on December 18, 2020. We have seen a decline in cases and hospitalizations and are hopeful for a return to normal in the near future. Although this has been a challenging year, I do believe that with every hardship we have an opportunity to learn and grow. Many have implemented telehealth into their clinics, and I believe, will continue to do so long after COVID to improve access and efficiency. We have realized the importance of family and close friends as we relied on each other for support through these difficult times. And we have gotten closer to our patients, as we were the familiar face helping them through their hospital stay or visit without the benefit of other family members present. And I believe we grew stronger as an organization. I was blessed with the opportunity to connect with physicians across the state as we worked together to overcome the crisis. “In the midst of winter, I found there was, within me, an invincible summer. And that makes me happy. For it says that no matter how hard the world pushes against me, within me, there is something stronger-something better pushing right back.” - Albert Camus

All of us, regardless of our medical specialty, need to know more about COVID-19, and this issue of the Journal provides a good starting point in this endeavor. ■

D. Luke Glancy, MD Editor-in-Chief

CAMS-ad-pdf.pdf 2 2/24/21 10:54 AM

Thank you TO OUR MEMBERS.

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My fellow physicians enjoy your summer. ■

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Sincerely,

Katherine Williams, MD

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COMMUNICATING IN A CRISIS

The LSMS used social media channels to not only express our gratitude for our members, but also provide patient resources to share and help prevent the spread of COVID-19.

Since thefirst caseof COVIDwas reported inLouisiana, the LSMS has kept in contact with our membership. Through email alerts, social media, and video calls, our efforts were aimed at providing physicians with a consolidated source for information being released through federal and state authorities, as well as regulatory agencies. Being that the pandemic is far from over, please know that LSMS stands behind you and will continue to work on your behalf to facilitate our members’ needs, allowing you to better care for your patients. Thank you for your dedication to the practice of medicine for the past year.

Announcing the publication of

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24 COVID-19 email bulletins

60+ COVID resources on the LSMS website

3 other COVID related emails

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The LSMS understood how imperative it was for the state of Louisiana to support each other during this time of crisis. We shared resources fromhospitals, state and federal agencies, and local news outlets to assist our members in providing the best care. Wemourned each case and death, and we celebrate each milestone with our members as we near the light at the end of the tunnel. ■

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UNCHARTED WATERS Joseph Kanter, MD

ON COMING TO NEW ORLEANS AND TULANE I came down to interview and just really fell in love with New Orleans. I’m a musician. I love seeing music and playing music, and the city really spoke to me. I liked the Tulane program because they have a great Ethos with a focus on community service and providing care to marginalized communities. I was also in the class that began four or five weeks before Hurricane Katrina hit, so my medical school experience was the experience of New Orleans recovering from Katrina—physically and spiritually rebuilding, as well as rebuilding the healthcare infrastructure. Through that experience, I got very, very attached to New Orleans and Louisiana, and I can’t really see myself ever leaving.

Bottom line, I really liked the school and the city. It wasn’t much of a decision at that point.

• Raised in Chicago and South Florida • Undergraduate degree from Northwestern University in Chicago • Medical degree from Tulane University School of Medicine • Emergency Room Physician • Currently serves as State Health Officer

I CAME DOWN TO INTERVIEW AND JUST REALLY FELL IN LOVE WITH NEWORLEANS.

PREVIOUS ROLES:

• Assistant Health Officer • Office of Public Health Interim Secretary • Office of Public Health, Region I Medical Director • New Orleans Department of Health Director • Healthcare for the Homeless Medical Director • Assistant Professor of Medicine, LSU and Tulane

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ON BECOMING STATE HEALTH OFFICER IN THE MIDDLE OF A PANDEMIC I come on the heels of Dr. Jimmy Guidry, who dedicated about 35 years of service to the state, so I have big shoes to fill. I had been working for the Department of Health for about two years as the Medical Director for Region 1, which includes the New Orleans region, and as the Assistant State Health Officer under Dr. Guidry. So, it was a natural progression. I look around at my colleagues in the Health Department and while it’s a lot of work with COVID, and people are stretched quite thin, I think there is a common sense that this is really what we are trained to do. I think people are finding themselves rewarded in that they are able to provide for the community more now than they ever have, and that’s a pretty powerful sentiment to hold—even though these have been the most challenging 12 months that anyone could ever imagine. ON 12 MONTHS IN We’re exactly 12months in. We had our first case diagnosed in Louisiana on March 9, 2020. We have recently hit the anniversary of that. I think some things have gone as fairly as we expected. Some things certainly have not. That said, I feel that we are in a new phase now, and we can clearly see how the pandemic ends. We can see the goal line, if you will, and now it’s just a matter of holding strong until we get there. Right now, we have about 16% of the population of Louisiana that has at least initiated the vaccine series now. That’s not an insubstantial number. That’s not herd immunity, but it’s a really good base to build on, and the vaccine supply is only going to pick up. It really is exciting to think that in two or three months, we’re going to have substantially more vaccine coverage than now. We’re going to be on much better footing. The challenge is to be able to get there intact and to be able to keep transmission down until we get there, especially with these variants circulating.

ON VACCINES AND VARIANTS It is possible that we will need a booster shot. I don’t think that will happen in the next few months, but I think that’s something that could come at the end of this year, perhaps sometime next year. It’s certainly possible. One of the attributes of these Messenger RNA (mRNA) vaccines is that it is relatively easy to create alterations in the vaccine to accommodate a booster to provide protection against the new variants. Taking a step back from that, if COVID transitions from a pandemic to an endemic, it is something that will be with us but not in a way to significantly alter life the way it is now. If we can keep it minimized by taking a booster every year or every two years, that’s okay. That’s how we do it with the flu and other viruses. It’s much better than living under a pandemic. It’s still a win.

I think it’s very important to remain grounded like that. For me, personally, it’s important to never give up the practice of medicine because it’s something I hold dear and is a privilege. ON BEING IN NEW ORLEANS AS COVID EVOLVED Well, I’m takingmyself back tomid-March and April 2020, in my mind. It was a scary time. Clinically, in a sense, we were flying blind because we didn’t have a great understanding of how to treat COVID patients yet. At that point, we thought it was advantageous to intubate early. That turned out not to be true. All of those things were challenges. You are humbled very quickly when you get thrown something in medicine you have never seen before. That was certainly applicable then. I have never been prouder of my physician colleagues, as well as, nurse colleagues and other support staff than I have throughout COVID. They all stepped up, and their primary goal was to care for patients and save lives, and they did so under risk to their own bodies. The conditions in which clinicians had to work under, particularly during those early days of COVID were austere, to say the least. I have very vivid memories of reusing N-95 masks days and weeks on end; wiping down plastic gowns – which are intended to be single-use and disposable – multiple times throughout a day’s work. My colleagues have really shown what drives them, which is to provide care, no matter how difficult circumstances are. The public did a good job of thanking us, and it was nice that they saw it and said it. I think most clinicians thought so, too, but the real sentiment was… it’s nice to be thanked, but just get us PPE. ON PPE It took some time, but it is there now. It’s humbling and off-putting at the same time to think how a country as rich as the United States can be put in such a situation, to be so ill-prepared and scrounging around for PPE to keep their doctors safe. It really is not something that a lot of people thought would have been possible. This has been a humbling experience, and I hope we can come out of this better prepared for the next time. ON BEING PREPARED NEXT TIME I think we invest. We invest in preparedness. We invest in public health. We listen to physicians and nurses about what vulnerabilities are there. It was no secret that the US was vulnerable to the pandemic. It had been spoken about many times. There was a disconnect that recognized vulnerability and thewillingness of policymakers to directly appropriate resources. But if you talk to the infectious disease colleagues, for example, it was no secret or surprise

IT’S HUMBLING AND OFF-PUTTING AT THE SAME TIME TO THINK HOW A COUNTRY AS RICH AS THE UNITED STATES CAN BE PUT IN SUCH A SITUATION....

at all. It was just a matter of when. I hope we take some lessons from this and learn to listen to the medical and public health community about what vulnerabilities exist, and as a community, decide that it’s worth the money to invest ahead of time. ON THE LONG-TERM IMPACT TO THE PRACTICE OF MEDICINE That’s a really great question, and I don’t know the answer. I do think we will be more conscientious about infection- control practices. I think we will be more conscientious about slowing the transmission of whatever the infectious agents may be, but I don’t think we really know yet what all the impacts will be. ON TELEMEDICINE GROWTH AND USE Telemedicine played a huge role and grew more than anyonecouldhaveexpected.Without question, it continues as an adjunct, not as a replacement. Going virtual doesn’t just apply to medicine – I think all types of industries and businesses are now recognizing the potential of virtual work and thinking about how to integrate it into post- COVID life. Medicine should be no different. Telemedicine is a tool that can augment clinical care. It can overcome some of the barriers that exist, such as individuals who are rural, individualswho are homebound, or individualswho require frequent checkups, and it can help clinicians reach patients in a way that they haven’t been able to before. However, it certainly does not and will not ever suffice for the in- person visit. It’s an addition. I’m actually pretty excited about finding new ways to integrate it. It really is going to be a significant tool, so I think people shouldn’t shy away from it. It’s going be with us from here on out, and it’s going to be on us as physicians to figure out how to make it worthwhile. ON HOWWE MANAGE SOCIAL MEDIA There is a great deal of information and misinformation shared through social media. The one part in all of this that gives me comfort is that when people rank the most

ON BEING AN ER PHYSICIAN AND CONTINUING TO WORK IN THE ER

It’s important to me to understand what the challenges are on the ground level. It’s especially important to me to maintain my clinical skills and acumen and to have a first-hand understanding of how policies that are instituted through the Health Department actually pan out in people’s lives. The emergency room is a great laboratory for that because all items that fall through the cracks of society or that don’t get adequately addressed show up in the ER. Whether it is addiction, domestic violence, homelessness, or any other issues that the Department of Health seeks to address, you really see the fallout of that first-hand in the ER from a policy perspective. It helps keep me grounded. It helps give perspective on what’s working, what’s not working, and where the Department of Health needs to focus energy.

IT’S IMPORTANT TO ME TO UNDERSTAND WHAT THE CHALLENGES ARE ON THE GROUND LEVEL.

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trusted sources of information about COVID or the vaccine, the most trusted source of information is consistently their physician. We need to leverage that. There has been so much politicization on COVID. And because of how quickly the vaccines were developed, there are a lot of suspicions out there. Of course, in many communities, this is building on decades of mistrust and marginalization, which are unfortunate realities of the healthcare system. So, we have to be cognizant of that too. But physicians are THE most trusted voice in not only Louisiana but the entire country. We need to make sure our voices are heard. We need to actively quell the myths, and we need to make sure that we rely on the trust people have given us to help get this pandemic over sooner rather than later. I also think we have to champion all vaccines. I think the antivax challenges will only increase from here, but we should not underestimate the power of physician voices in this area. We are the most respected voices on the issue, but we have to show up, and we have to open our mouths. We have to combat the nonsense with facts and anecdotes from the patients and their families that trust us with their care. We have to combat the noise with >Page 1 Page 2-3 Page 4-5 Page 6-7 Page 8-9 Page 10-11 Page 12-13 Page 14-15 Page 16-17 Page 18-19 Page 20-21 Page 22-23 Page 24-25 Page 26-27 Page 28-29 Page 30-31 Page 32

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