Life on the Strike Team
We caught up with Zöe Warczak, who has been working on a Monroe County Health Department "Strike Team" while finishing up her M.S.Ed. in Health Professions Education.
What have you been up to these days?
I’ve been designing an online mini-course for COVID that draws on some of the skills that I’m learning from the health professions education program that I’ve been in. The idea is to teach students basic skills in how to design an organized response to a disaster, and also how to use personal protective equipment (PPE) properly.
What’s your vision for a course like that?
If the situation were to keep getting worse and if medical students were needed to be involved, medical students would have some of the baseline skills that would make them more confident and able to contribute. Plus giving them the sense of some emergency management skills or disaster response-type things would be good for them to know in their future careers, especially if they become hospital administrators at some point.
Tell us about the Strike Team work you’ve been doing.
I’m on a Strike Team for the Monroe County Department of Public Health. Mine is part of the Isolation Unit, which is responsible for all the patients in the county who are either confirmed positive for COVID-19 or presumed to be positive based on symptoms and contact tracing.
So it’s for people who are sick?
Yes. It’s separate from the Quarantine Unit, which is for people who definitely had an exposure but are currently asymptomatic.
What do you do on the Strike Team?
Go out into the field with one or two other strike team members to do nasopharyngeal swab testing for COVID while wearing full PPE. Contact patients via telephone to educate them on isolation guidelines, check for adherence, and whether they have access to needed supplies.
What kind of supplies?
Stuff for COVID, such as surgical face masks, hand sanitizer, and gloves, especially if they’re in a household or apartment with other people who aren’t infected yet, and also any supplies that they need but can’t get access to. So for example, because of the hoarding that took place early on, alcohol wipes were sold out in a lot of places. So people who have diabetes and need alcohol wipes in order to use their glucometer safely weren’t able to get them.
Who pays for that?
Those are things that Monroe County has and can just donate to the people who need it. The hand sanitizer that we include in the packet - or what we call the goodie bag - is the one that was made by the state prisons.
How do those people in isolation get food and stuff?
People in the Health Department told me they’re surprised this seems to be affecting people of all socioeconomic classes, unlike other health problems that tend to disproportionately affect people of lower socioeconomic class. Many of the people who have greater means are isolating in second homes and have no problem ordering in food and stuff like that. But other people might rely on people to drop off food at their house once a day or so.
I’ve been reading about the people who were jailed - I think in the Brighton jail - for not complying with isolation guidelines. Is your team involved in that?
Typically what happens is that we contact people by telephone when we’re educating them on isolation, and also we’re checking on the supplies they need, and whether they can adhere to the isolation protocols. And then we send them paperwork explaining that the person is placed on isolation, and what that means. But if people were to refuse to adhere to the guidelines after multiple attempts were made to obtain adherence, that’s when the isolation order can be served involuntarily with the judge’s order. If people refuse isolation, that also often means they are refusing diagnostic tests for COVID, which would also typically be done in the field.
How does that work if the tests are limited and they’re not testing everybody?
The first person in the household who has symptoms is tested. Other people who are in the same household who are ill don’t need to be tested. They are presumed positive.
Who is somebody who’s refusing a test?
I don’t believe anyone has refused a test by itself. When people refuse, they’re usually refusing everything, including the isolation order.
How do you find out about these people who should be served an isolation order?
There’s a process called contact tracing that a different unit at the Health Department does. It’s something that’s done for a variety of different diseases, like sexually transmitted infections, where you would notify previous partners of the affected individuals so they could go get tested or treated themselves. COVID is similar to this, but it’s a little more complicated now because you have to find out what day someone went to a grocery store, and what time it was, and who else might have been there.
Let’s say someone is identified by the contact tracers. How do they get referred to your team?
Only people with symptoms. Anyone else would be on quarantine.
How have people been responding to your team?
Everyone has been nice and supportive for the most part. I personally haven’t had bad experiences with the people I’ve been contacting.
Do you feel safe?
So something that is a challenge with the Isolation Strike Teams is being in direct contact with people who are confirmed positive or presumed positive for COVID, especially when we’re doing the nasopharyngeal swabs. It’s people who are early on in the illness, and coughing pretty frequently. There are multiple layers of protection, in terms of both systems and actual equipment. For example, we’re able to have the patient put on a surgical mask that we can provide if needed before we enter the household. That way secretions would not go at us directly when we’re giving the test and talking to the person. We’re also wearing the full CDC-recommended PPE, including an N95 respirator, eye protection, gown, and gloves. It’s all disposable and there’s enough where we can use new PPE for every patient and we don’t have to reuse it like some hospitals are doing.
What have you learned?
The PPE works! I can say that, it being a week now since I first came into contact with someone with COVID. Also, it’s important to communicate. If there are communication issues in your team or health department, that can make things challenging, especially if the information you provide is no longer accurate and you’re interfacing with the public. It’s also important to follow NIMS/ICS protocols for any type of disaster response, and when there are problems with communications, it’s usually due to people not adhering fully to NIMS/ICS, such as skipping operational briefings. But I’ve also just gained a good realization of how important public health work is, including contact tracing and quarantine/isolation. These are extremely important for a pandemic and also for individual diseases/infections as well.
Have there been any moments of humor in this work?
Oh, plenty. Sure. You call on a patient with COVID and you ask if they have a moment to talk. And they burst out laughing and say, “Yeah, I’m not going anywhere for two weeks!” Or a patient saying that they have a new nickname; all their friends are calling them “Corona.”
Talk about the health professions education masters program you’re in.
It’s an MSEd, which is masters in science in education. It’s a mixture of people from a variety of health professions, including primarily physicians, nurses, and dentists. There are so many opportunities in teaching medicine, and learning is something that’s very important both for patients and for professionals. Especially in pediatrics, a lot of what we’re doing is teaching healthy habits and educating about illnesses and so forth.
Tell us what your professional goals are, and how they’ve been influenced by the pandemic.
For my program, my big independent study project was developing an online course on integrated trauma-informed care for sexual assault survivors. And then all this pandemic stuff happened. So I asked my advisor, “Oh, so can I do something with COVID with the work I’m doing with my Health Department?” And he wrote back in three words, “Go for it.” And so now I’m getting credit for my work with COVID.
What’s your perspective on URSMD’s move to computer-based learning at this time?
So there’s a difference between online learning and emergency remote learning. Emergency remote learning is when you’re suddenly turning an in-person experience online when it’s not intended to be online. Online learning is intended to be online, and makes full use of things that can be done only online. Being in a medical school that has historically eschewed the role of technology in learning makes the transition to meaningful digitally rich learning more difficult. I believe that at URSMD, it certainly started out with emergency remote learning, but I think some aspects are turning into online learning, such as the telehealth video encounters for the Comprehensive Assessment, with assistance from subject matter experts in the field, such as the director of the Institute for Innovative Education.
You’re starting your residency soon.
Yes, in pediatrics.
How does it feel going into your residency at this time?
No one really knows what’s going to happen! Massachusetts usually takes 90 days to process medical licenses; now it’s going to be done in two days. Now it’s a two-page document that we are required to e-sign and e-mail back. Currently I’m scheduled to start in the Emergency Department in July, possibly starting sooner either there or here.
Is that normal?
There is a one-month rotation in the ED. I just happen to be the resident assigned to do it first.
How does that affect your housing and all that?
For people who are starting residency early at their home schools, what they’re being told - like people in NYC - they have to quarantine for two weeks before starting residency. I’m planning to do that. I’ll leave Rochester at the start of June to give two weeks for quarantine before starting orientation June 17.
Good luck to you, Zöe, and thanks for all you’re doing in our community!
Thanks for the thoughtful questions!
What have you been up to these days?
I’ve been designing an online mini-course for COVID that draws on some of the skills that I’m learning from the health professions education program that I’ve been in. The idea is to teach students basic skills in how to design an organized response to a disaster, and also how to use personal protective equipment (PPE) properly.
What’s your vision for a course like that?
If the situation were to keep getting worse and if medical students were needed to be involved, medical students would have some of the baseline skills that would make them more confident and able to contribute. Plus giving them the sense of some emergency management skills or disaster response-type things would be good for them to know in their future careers, especially if they become hospital administrators at some point.
Tell us about the Strike Team work you’ve been doing.
I’m on a Strike Team for the Monroe County Department of Public Health. Mine is part of the Isolation Unit, which is responsible for all the patients in the county who are either confirmed positive for COVID-19 or presumed to be positive based on symptoms and contact tracing.
So it’s for people who are sick?
Yes. It’s separate from the Quarantine Unit, which is for people who definitely had an exposure but are currently asymptomatic.
What do you do on the Strike Team?
Go out into the field with one or two other strike team members to do nasopharyngeal swab testing for COVID while wearing full PPE. Contact patients via telephone to educate them on isolation guidelines, check for adherence, and whether they have access to needed supplies.
What kind of supplies?
Stuff for COVID, such as surgical face masks, hand sanitizer, and gloves, especially if they’re in a household or apartment with other people who aren’t infected yet, and also any supplies that they need but can’t get access to. So for example, because of the hoarding that took place early on, alcohol wipes were sold out in a lot of places. So people who have diabetes and need alcohol wipes in order to use their glucometer safely weren’t able to get them.
Who pays for that?
Those are things that Monroe County has and can just donate to the people who need it. The hand sanitizer that we include in the packet - or what we call the goodie bag - is the one that was made by the state prisons.
How do those people in isolation get food and stuff?
People in the Health Department told me they’re surprised this seems to be affecting people of all socioeconomic classes, unlike other health problems that tend to disproportionately affect people of lower socioeconomic class. Many of the people who have greater means are isolating in second homes and have no problem ordering in food and stuff like that. But other people might rely on people to drop off food at their house once a day or so.
I’ve been reading about the people who were jailed - I think in the Brighton jail - for not complying with isolation guidelines. Is your team involved in that?
Typically what happens is that we contact people by telephone when we’re educating them on isolation, and also we’re checking on the supplies they need, and whether they can adhere to the isolation protocols. And then we send them paperwork explaining that the person is placed on isolation, and what that means. But if people were to refuse to adhere to the guidelines after multiple attempts were made to obtain adherence, that’s when the isolation order can be served involuntarily with the judge’s order. If people refuse isolation, that also often means they are refusing diagnostic tests for COVID, which would also typically be done in the field.
How does that work if the tests are limited and they’re not testing everybody?
The first person in the household who has symptoms is tested. Other people who are in the same household who are ill don’t need to be tested. They are presumed positive.
Who is somebody who’s refusing a test?
I don’t believe anyone has refused a test by itself. When people refuse, they’re usually refusing everything, including the isolation order.
How do you find out about these people who should be served an isolation order?
There’s a process called contact tracing that a different unit at the Health Department does. It’s something that’s done for a variety of different diseases, like sexually transmitted infections, where you would notify previous partners of the affected individuals so they could go get tested or treated themselves. COVID is similar to this, but it’s a little more complicated now because you have to find out what day someone went to a grocery store, and what time it was, and who else might have been there.
Let’s say someone is identified by the contact tracers. How do they get referred to your team?
Only people with symptoms. Anyone else would be on quarantine.
How have people been responding to your team?
Everyone has been nice and supportive for the most part. I personally haven’t had bad experiences with the people I’ve been contacting.
Do you feel safe?
So something that is a challenge with the Isolation Strike Teams is being in direct contact with people who are confirmed positive or presumed positive for COVID, especially when we’re doing the nasopharyngeal swabs. It’s people who are early on in the illness, and coughing pretty frequently. There are multiple layers of protection, in terms of both systems and actual equipment. For example, we’re able to have the patient put on a surgical mask that we can provide if needed before we enter the household. That way secretions would not go at us directly when we’re giving the test and talking to the person. We’re also wearing the full CDC-recommended PPE, including an N95 respirator, eye protection, gown, and gloves. It’s all disposable and there’s enough where we can use new PPE for every patient and we don’t have to reuse it like some hospitals are doing.
What have you learned?
The PPE works! I can say that, it being a week now since I first came into contact with someone with COVID. Also, it’s important to communicate. If there are communication issues in your team or health department, that can make things challenging, especially if the information you provide is no longer accurate and you’re interfacing with the public. It’s also important to follow NIMS/ICS protocols for any type of disaster response, and when there are problems with communications, it’s usually due to people not adhering fully to NIMS/ICS, such as skipping operational briefings. But I’ve also just gained a good realization of how important public health work is, including contact tracing and quarantine/isolation. These are extremely important for a pandemic and also for individual diseases/infections as well.
Have there been any moments of humor in this work?
Oh, plenty. Sure. You call on a patient with COVID and you ask if they have a moment to talk. And they burst out laughing and say, “Yeah, I’m not going anywhere for two weeks!” Or a patient saying that they have a new nickname; all their friends are calling them “Corona.”
Talk about the health professions education masters program you’re in.
It’s an MSEd, which is masters in science in education. It’s a mixture of people from a variety of health professions, including primarily physicians, nurses, and dentists. There are so many opportunities in teaching medicine, and learning is something that’s very important both for patients and for professionals. Especially in pediatrics, a lot of what we’re doing is teaching healthy habits and educating about illnesses and so forth.
Tell us what your professional goals are, and how they’ve been influenced by the pandemic.
For my program, my big independent study project was developing an online course on integrated trauma-informed care for sexual assault survivors. And then all this pandemic stuff happened. So I asked my advisor, “Oh, so can I do something with COVID with the work I’m doing with my Health Department?” And he wrote back in three words, “Go for it.” And so now I’m getting credit for my work with COVID.
What’s your perspective on URSMD’s move to computer-based learning at this time?
So there’s a difference between online learning and emergency remote learning. Emergency remote learning is when you’re suddenly turning an in-person experience online when it’s not intended to be online. Online learning is intended to be online, and makes full use of things that can be done only online. Being in a medical school that has historically eschewed the role of technology in learning makes the transition to meaningful digitally rich learning more difficult. I believe that at URSMD, it certainly started out with emergency remote learning, but I think some aspects are turning into online learning, such as the telehealth video encounters for the Comprehensive Assessment, with assistance from subject matter experts in the field, such as the director of the Institute for Innovative Education.
You’re starting your residency soon.
Yes, in pediatrics.
How does it feel going into your residency at this time?
No one really knows what’s going to happen! Massachusetts usually takes 90 days to process medical licenses; now it’s going to be done in two days. Now it’s a two-page document that we are required to e-sign and e-mail back. Currently I’m scheduled to start in the Emergency Department in July, possibly starting sooner either there or here.
Is that normal?
There is a one-month rotation in the ED. I just happen to be the resident assigned to do it first.
How does that affect your housing and all that?
For people who are starting residency early at their home schools, what they’re being told - like people in NYC - they have to quarantine for two weeks before starting residency. I’m planning to do that. I’ll leave Rochester at the start of June to give two weeks for quarantine before starting orientation June 17.
Good luck to you, Zöe, and thanks for all you’re doing in our community!
Thanks for the thoughtful questions!