Dear Medical College of Georgia Friends,

An innovative way to calm the cytokine storm of COVID-19

One of my favorite aspects of each of you is how you rise to any occasion. You see a problem, you try to solve it. You see a need, you try to fill it. The busiest among you are always the first to raise your hands. You see coronavirus and you see both a huge problem and need, and I continue to be very proud of so many of you who have raised your hands. People like Drs. Azeem Mohammed and Sandeep Padala. They are both MCG-trained nephrologists who have known each other about 20 years and are now young faculty members. They were already helping take care of the patients with COVID-19 whose kidneys were failing because of the cytokine storm brewing in their bodies. The storm is an over-the-top response of the immune system to the invasion of the novel coronavirus. But they were thinking what else can we do? How can we use our skills to help prevent patients who are hit hardest by this infection from the body-wide damage and sometimes death that results? So Dr. Mohammed reached out to their contact at Baxter International Inc., which supplies kidney dialysis machines to our intensive care units, to see if they had a filter that could catch excessive cytokines. The company’s Oxiris filter, already in use in Europe and Asia — but not in our country — for problems like sepsis, was their filter for capturing cytokines and more. Baxter quickly sought and obtained emergency use authorization for COVID-19 from the FDA and this week we received and used the first filters.

Drs. Azeem Mohammed, Sandeep Padala working to cleanse blood of excessive cytokines 

It’s a simple enough concept, swapping out this filter for the usual filter in the dialysis machines in our ICUs, where we are taking care of patients with COVID-19. But it’s also very smart because Drs. Mohammed and Padala hope to keep patients, showing early signs of the cytokine storm like difficulty breathing, from deteriorating with these preemptive measures. If they are correct, these patients’ kidneys won’t fail, their lung function won’t deteriorate to ARDS and the myriad of other ravages resulting from COVID-19. The filter, like those used in kidney dialysis, also has a heparin coating which should reduce clot risk in these patients, some of whom also are experiencing strokes at a wide range of ages. Drs. Mohammed and Padala were quick to thank the leadership of Baxter for their swift action to enable this innovative yet logical way to help patients. They also thanked our Health System, particularly Larry Dreiling, director of business operations for nursing, for their and his rapid response. Please let me add my thanks here. When the enemy is tough, this is the kind of team we need to fight and to win. My particular thanks to these two fine physicians who wanted to do more for patients and hope to stop this disease in its tracks. “We wanted to see what we as a division can do to try to help,” Dr. Mohammed says of the Division of Nephrology in the Department of Medicine.  They knew these unusual times called for quick, decisive measures, but they also have plans for formal clinical trials of this approach. Our best thoughts are with you on this.

Ciamillo brothers take on intubation dangers of COVID-19

Here’s another dynamic duo. Dr. Lou Ciamillo Jr. and his brother George Ciamillo grew up knowing how important it is to be precise. Their father Louis was a police officer in Montgomery County, Maryland, a populous county right near Washington DC, who became a captain, a SWAT team member and a competitive shooter. To ensure competitiveness, Louis Ciamillo also began pistol smithing to accurize their aim. Long story short, many years ago these precise molders of metal relocated to Augusta and established over on Mike Padgett Highway MGW Precision, Inc., whose number one selling product today is precise shifters for American muscle cars. George would eventually run the business and his one-year-older brother Lou would come to MCG as a student and complete his training here as an emergency medicine physician. When COVID-19 surfaced and word began to spread about an intubation box designed by a Taiwanese anesthesiologist to protect caregivers, the younger brother asked his doctor brother about it. In the great tradition of their father, they put their heads together to design a better box that includes a stainless port that directly vents airborne contaminates into a hospital’s internal venting system; enables the use of an hyperangulated laryngoscope stylet, which can be better in difficult, emergency intubations for both patient and physician; and sturdy clips that hold in place extra physical barriers — something as simple as a pillowcase could work — to further protect both physician and patient from contaminants. Like those muscle cars, these boxes are built to outlast the coronavirus and to provide ongoing safety whenever intubation is needed. These boxes already are being delivered to our hospital and others, including a half dozen donated to us by the brothers. Thank you both and your father for your commitment to excellence.

Students Anabel Liyen Cartelle, Zulqar Islam establish a site to keep us informed on COVID-19

Like our former student Dr. Ciamillo, our current students continue to make us proud. Some of the great work emerging out of our innovative pandemic medicine elective includes our students helping us all stay up-to-date in this too dynamic area of COVID-19 by providing a sort of one-stop weekly literature and twitter update. They give us an easy way to find answers to important questions, like where the research is going and what new complications are arising from this novel virus. Anabel Liyen Cartelle and Zulqar Islam, both third-year students, have the lead on this new site. Thank you.

Athens campus expands free clinic to provide COVID-19 testing

At our Athens campus, the mobile, two-year-old Athens Free Clinic has partnered with Athens-Clarke County, the Georgia Emergency Management Agency and the Northeast Health District to take COVID-19 testing to the people who need it. Dr. Suzanne Lester, site clerkship director for family medicine at the AU/UGA Medical Partnership campus, is medical director of the free clinic, which has taken on these important new duties. Our medical students are making calls to patients to find those who likely need COVID-19 testing and plotting a map that enables the actual visits by the mobile clinic. Faculty and residents are collecting the samples for testing. The clinic team is already out five days a week and collecting 40-50 samples daily. Awesome work.

MCG students taking the lead in contact tracing for viral exposure

You likely also are hearing about stepped up efforts in our state for contact tracing, an effort to find those who may have been exposed to a person who is COVID-19 positive, to make them aware and potentially get them tested. Our fourth-year student Rebecca Decarlo  has helped organize the contact tracing project with the Coastal Health District based in Savannah and has been busy helping train other students for this important job. Our students who already have joined this and other important efforts against coronavirus include Southeast Campus students Leticia Cardoso, Patrick Stallings, Okola Ulrica Tull, Maya Milton and Marshall Waller. In fact to enable even more volunteers for these efforts, on Wednesday of this week Rebecca, along with Mercer School of Medicine student Catherine Waldron, who also has been at the frontline of this effort, taught even more medical students the ins and outs of contact tracing they have learned, including important lessons about how to report what they find, during our Pandemic Medicine Elective. I sat in for this instruction and it was so good maybe even I can figure out how to do this now.Rebecca says it’s an interesting way to help hospitals in this major effort without actually being in the hospital and that it is both fun and rewarding work. She also admits that she doesn’t like not being busy. Not to worry. This North Georgia native will be headed to Charlotte, North Carolina soon for a neurosurgery residency at Carolinas Medical Center.

AU Health System takes the lead in screening for Georgia

I hope you all know by now that the Health System is taking the lead in expanding COVID-19 testing across Georgia and has some great partners in the Georgia Department of Public Health and the Georgia National Guard. This role was announced last week by Governor Kemp. This undertaking includes directing those who screen positive with the health system’s app to swabbing/testing sites closest to them, and these sites have really multiplied. This is a huge frontline effort on the part of a growing number of hard workers but I wanted to thank in particular here Health System CEO Katrina Keefer and CMO (and MCG graduate) Dr. Phillip Coule for their steady leadership in an extremely dynamic situation. I also want to thank Dr. Matt Lyon, vice chair of our Department of Emergency Medicine (and another MCG graduate) for his expertise in both telemedicine and apps that has really enabled the success. Late last week testing through this network was expanded to include asymptomatic critical infrastructure workers who want to be tested. These are people like you, and firefighters, EMS professionals, our military and grocery store workers, who have continued to keep our world moving and to help keep us safe. We’ve also added asymptomatic individuals from particularly hard hit counties in our state like the South Georgia counties of Baker and Early. Good going.

Virtual Hooding set for May 7

Finally today, a reminder that next week is the storied Hooding Ceremony, which, much as we all hate it, the coronavirus has affected just as it has essentially every aspect of our lives. But in the great MCG tradition, we will not let the coronavirus stop us and with some innovative thinking yet again, we will have a virtual event that we hope you also will love. Next week, you will be getting information on how to access the event. But today, I want to thank class of 2020 presidents Miller Singleton and Ben Daniel, fourth-year class associate dean (and MCG graduate) Dr. Jennifer Tucker and her assistant Angela Ham, associate dean of student and multicultural affairs Dr. Kim Loomer, Athens campus dean Dr. Shelley Nuss, my executive assistant Leslie Bedenbaugh, MCG senior project coordinator Nikia Erickson, MCG administrative assistant Laurie LaChance and AU senior video producer extraordinaire Tim Johnson. Without them, there would be no event. Thank you all and stay tuned. Please continue to take good care out there.

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