SGU professor looks back on one year combating COVID-19

Dr. Sylvie de Souza (front) and the emergency medicine team at The Brooklyn Hospital Center in New York. Photos provided by Sylvie de Souza

Dr. Sylvie de Souza, director of emergency medicine at The Brooklyn Hospital Center (TBHC), and a clinical assistant professor for St. George’s University, was on the front lines when it all began. The day was March 1, 2020, when the first COVID-19 case was reported in New York City.

As the coronavirus spread throughout the city, putting pressure on the people and the mechanisms to treat ill patients, she remembers as much about what happened as the way it made her and her colleagues feel. It reminded her another catastrophic event—September 11, 2001.

“We immediately went into preparedness mode while the memory of 9/11 lurked in the back of our minds,” Dr. de Souza said. “Although the nature of the event was different, we all sensed that something major and perhaps terrible was about to happen. The anxiety of the unknown heading our way was palpable.”

A year later, Dr. de Souza reflected on the entire experience, how she and her team weathered the storm, and the hope she has for—and sees in—future SGU medical students who she trains for the fast-paced world of emergency medicine.

St. George’s University: How would you describe the past year in the emergency department at TBHC?

Dr. Sylvie de Souza: In September 2001, many of us remember standing by and watching New York’s bravest selflessly run into the burning building when everyone was running out, running toward the danger, into the fire, to save as many as they could. Sadly, when the unthinkable happened, we were the ones who went to the firehouses, like most New Yorkers, to praise the bravery and console the unimaginable loss. As emergency workers, there was not much else we could do other than what we had been trained to do: treat the walking wounded and the first responders. And we did, for weeks to come. Our lives were never directly endangered on 9/11.

This all changed in March of 2020 when the danger came directly at us. The fire came to us, and it grew uncontrollably with each day that passed. We stood in it, day after day, for hours on end, with little sleep, food, or drink, hardly recognizable in our plastic gear, trying to help as many as we could, with our own fear in the pit of our stomach, watching some of us fall, victims of the vicious enemy we were fighting. Many came to help in every way they could, but everybody knew, as we did, that this time around, it was as though we were the ones standing in the burning building, right there among the victims we were trying to save.

What an amazing twist of fate it was that, this time around, it was us New York’s bravest who came to clap for every evening. If anyone knew what we were feeling, I thought, it would be them. They clapped with the rest of the bystanders, a daily incantation of sorts, to harness the courage they knew we needed to keep going.

SGU: How did 2020 change you as a physician?

Dr. de Souza: I once read this sentence in a French publication. I do not recall who the author is, but it stayed with me: “Courage does not consist of doing the work that is expected of you; that is competence. Real courage is to conquer one’s fear and see the duty before the effort.”

I cannot recall a time in my entire career when this sentence rang truer or when I was, along with my colleagues, tested to honor the oath we had taken to come to the aid of others. It took all we had to overcome our own fears. We worked endless days and nights, not knowing what the fate of our patients would be, or our own, instead trusting that we were doing exactly what we were supposed to do—to follow our calling and answer the call of duty.

Many lessons were learned in the face of such adversity and uncertainty: 2020 was a year of great loss, but also a year filled with a sense of community, resilience, and hope. I face 2021 with a renewed sense of purpose and the knowledge that preparedness and togetherness are likely the most important tools we possess to confront adversity.

SGU: In what way has your role changed the most during the pandemic?

Dr. de Souza: With the restrictions imposed by NYC Department of Health at the beginning of the pandemic, no visitors were allowed in the hospital. Those measures were in place to protect those who were not yet infected.

As a result, we were no longer simply caregivers to the growing number of critically ill patients. We suddenly became their only “visitors,” their only connection to the outside world and their loved ones, their consolers, their prayer partners, their only and sometimes last human interaction, and most poignantly, the last ones to hold their hands as they slipped into unconsciousness or died. No amount of training could have prepared us to take on a responsibility of that scale. Watching patients die deprived of their loved ones or making their hastened last goodbyes on a video monitor was almost too much to bear.

Surrounded by all this despair and grief, we became closer as a team; we suddenly felt responsible for one another and supported each other through each day. As emergency workers, we had always known the importance of functioning as a team. This time, however, there was a whole new twist. We were now a team who had to operate in constant danger, facing mortality, that of those we cared for … and our own. We shared the same fears about our own unpredictable fate, fighting this vicious invisible enemy, not unlike a platoon sent to combat.

The Brooklyn Hospital Center. The oldest hospital in Brooklyn was one of many in New York City to combat the emerging COVID-19 crisis.

SGU: What can St. George’s University students rotating with the TBHC EM department expect to learn?

Dr. de Souza: Several faculty, myself included, partake in the weekly didactic conferences for EM residents and medical students. Our program has a dedicated clerkship director who organizes a series of didactic sessions and workshops where students receive direct feedback from the faculty. Aside from some exposure to a series of common complaints, medical students rotating through our department will leave the clerkship with a basic knowledge on the approach to the undifferentiated patient and introductory skills for the rapid recognition of the critically ill patient. We also place a lot of emphasis on the ability to communicate and function effectively in a team.

 

“As emergency workers, we had always known the importance of functioning as a team. This time, however, there was a whole new twist.”

SGU: Is there a personality trait that you find to be common among SGU medical students?

Dr. de Souza: I have had the pleasure of working many SGU students who rotated through our department over the years. Several of them became some of our most stellar residents. I have found them to be driven, focused, and resilient. Most salient is their overall ability to adapt and make the best out of any situation.

SGU: What is one piece of advice that you would give to a student who was considering a career in emergency medicine?

Dr. de Souza: During your ED rotations, immerse yourself in the ED life and culture. Merge with the ED team. It’s not about anyone of us and it’s not about you; it’s about the patient. When the team wins, and you participated, you won. Don’t worry so much about having all the answers. Be perceived as a vibrant, passionate, and compassionate member of the team—someone who anyone would want by their side in the trenches.

– Brett Mauser

Get to Know Dr. Sylvie de Souza

YouTube video

Video produced by The Brooklyn Hospital Center

Under the Microscope: COVID-19 Vaccines in Grenada

Dr. G. Richard Olds, president of St. George’s University, has committed his life to studying tropical and infectious diseases. All over the world, he has seen how viruses—these microscopic parasites that are invisible to the naked eye—can spread through a community, leaving damage in their wake.

One of the best methods to combat the virus is the use of vaccines. A version of the SARS-CoV-2 vaccine began being administered in Grenada last week, and a full program is currently being rolled out that places essential workers, elderly and Grenadian residents with pre-existing conditions on the priority list. Having long studied vaccines and their positive effect on healthcare, Dr. Olds is an ardent supporter of their implementation.

I got my first COVID vaccine today,” he said.

Dr. Olds shed light on the vaccine that is currently being distributed in Grenada, what citizens can expect when receiving it, and the long-term outlook for COVID-19 in the country.

St. George’s University: What vaccine does Grenada currently have in stock? Is it being administered elsewhere in the world and how does it compare to other versions?

Dr. G. Richard Olds: Grenada is currently using the AstraZeneca vaccine, which is currently being used extensively in England. It was developed in partnership with Oxford University. In contrast to the two vaccines being used in the US, it is a chimpanzee adenovirus that has had the message for the spike protein placed within it. This vaccine can’t make humans sick, but it induces a high level of protection against COVID-2. Just like the mRNA vaccines used in the US, this vaccine requires two doses but has the advantage of being stored in cold but not freezing environments.

SGU: How exactly does this vaccine provide protection against SARS-CoV-2?

Dr. Olds: The COVID-2 virus attaches to human cells through a molecule on its surface called a spike protein. All current COVID vaccines target this molecule. Vaccinated people develop antibodies that block the binding of the spike protein to human cells. Unable to bind, the virus is unable to infect cells.

SGU: How long is the protection expected to last?

Dr. Olds: How long the vaccine will protect those who receive it is currently unknown, but it looks like all vaccines provide protection for at least a year and probably longer.

 

“If everyone doesn’t take the vaccine, we run the risk that COVID will circulate for a very long time.”

 

SGU: Is the vaccine available in one shot or does it require multiple shots over a period of time?

Dr. Olds: Most of the seven COVID vaccines require two shots, but the Johnson and Johnson vaccine only needs one shot. This is not currently available in Grenada. The interval between the two shots varies, but about a month is the most common. There are experiments in England now with the AstraZeneca vaccine with longer periods between the shots.

SGU: How safe is the vaccine that is available in Grenada? Are there any side effects?

Dr. Olds: All the COVID vaccines appear very safe. In blinded control studies, no difference was seen between vaccinated people and those that got sugar water in terms of long-term side effects. In the short run, vaccinated people will likely feel soreness in their arm, feel poorly for a few days, and may have a low-grade fever. None of these responses are serious, and they often respond to over-the-counter medicine.

The AstraZeneca vaccine currently in Grenada does not seem to cause severe allergic reactions. All minor reactions to the vaccine appear more commonly in reaction to the second vaccine, and are a sign that they are working.

SGU: Are there any pre-existing conditions that would prevent someone from getting it?

Dr. Olds: If a person is severely immune compromised—such as being infected with the AIDS virus, on high-dose steroids, getting chemotherapy, or having an organ transplant—they should consult a doctor before getting the vaccine.

SGU: Once an individual receives the vaccine, how will restrictions change for them?

Dr. Olds: Even after you get fully vaccinated, people will still need to wear a mask and socially distance until everyone on the island is vaccinated. That’s because vaccinated people are protected from dying from COVID, but they could still transmit the virus to others. Once everyone is vaccinated, life should return to normal.

SGU: Do you believe that all eligible individuals should receive the vaccine?

Dr. Olds: Everyone over 18 years of age should get the vaccine. Soon we will know if children over 12 should get the vaccine. The vaccine is very safe, and COVID can lead to serious illness or fatalities. In addition, COVID can cause long-term health issues for people. By now, millions of people in England have already received the vaccine currently available in Grenada without a problem.

If everyone doesn’t take the vaccine, we run the risk that COVID will circulate for a very long time, and the more the virus circulates, the greater the chance that a new variant will develop that the vaccine will not protect people from. It’s a race, and I hope this time humans win.

1,000 Residency Slots Approved by Congress: What it Means for Medical Students

Congress recently passed a measure to fund 1,000 postgraduate residency positions over five years as part of the Medicare-supported program—the first increase in nearly 25 years according to the American Association of Medical Colleges (AAMC). St. George’s University President Dr. G. Richard Olds explained to SGU News what the increase means for our medical students. In addition, Dr. Olds also recently appeared on Action News Jax (Jacksonville, FL) to discuss the new medical residency funding in the stimulus package.

St. George’s University: St. George's University President G. Richard OldsWhat does this mean for SGU medical students, especially those applying for residency?

Dr. Olds: This new legislation should help our students in the Match no matter what specialty they decide to go into. Also, these new slots are permanent in contrast to the teaching health center funds that have to be renewed by Congress every few years.

SGU: What specialties will be included?

Dr. Olds: Potentially all specialties are included, but an institution can’t just expand specialty slots. Half must be for primary care, which includes OB/GYN.

SGU: Residency positions in rural and underserved communities were highlighted as a particular focus in the legislation. Why is that important?

Dr. Olds: The population is both growing and aging. The real problem, however, is a maldistribution of doctors geographically and a maldistribution of doctors by specialty. The first issue points out that affluent urban and suburban areas of the US often have a surplus of doctors, while underserved rural and urban areas have severe shortages. In big states, for example, the surpluses in affluent areas often mask the severity of shortages in rural and poor urban areas.

The second problem of maldistribution by specialty is created by the fact that 70 percent of US medical students specialize. The country needs over half to go into primary care fields. To make this issue worse, primary care doctors as a group are older, and age and COVID-19 are driving them into retirement faster than specialists.

SGU: How and why did these positions become available?

Dr. Olds: The issue that is causing problems in the physician pipeline are residency slots—not medical schools and students. Although there are far too few US medical schools for the current need, 25 percent of all residents in US residencies are international medical school graduates (such as SGU grads), and there are far more doctors who want to train in the US than we have residency slots to accommodate them. The shortage of graduate medical education (GME) slots is driven by a decision made in 1997 to cap GME funding by Medicare. Pressure has been growing to increase GME slots because of the growing doctor shortage. This is the first time in over 20 years that Medicare has increased the GME caps on most teaching hospitals.

While the number of additional residencies will not be enough to solve the doctor shortage in the US, and only a percentage of these slots will go to rural primary care residencies where they are most needed, it’s a start.

SGU: What is the rough number of Medicare-funded residency positions now, and why is adding these residency positions such an important breakthrough?

Dr. Olds: Medicare currently funds about 90,000 GME slots, the US Department of Veterans Affairs funds about 12,000, and children’s hospitals fund about 7,000 each year. Remember that training in internal medicine or pediatrics takes three GME slots spread over three years; general surgery five GME slots, etc., since you need a funded slot each year of your training. If you crunch the numbers, we have the ability to train about 35,000 new residents each year, mostly through the Match.

While the addition of 1,000 slots spans five years, and some of those slots will go to big teaching hospitals that are currently over their cap, it’s the first time in decades the number of Medicare slots have increased. It’s a big deal.

 

– Laurie Chartorynsky

The News Stories that Defined the School of Medicine in 2020

2020 Top News Stories

For a wide range of reasons, 2020 is a year that we won’t soon forget—from the heroism on the front lines of medicine, powerful demonstrations surrounding racial equality, and the change to our day-to-day lives and our perspectives.

It was a monumental year in so many ways for St. George’s University School of Medicine, its faculty, staff, and students. SGU made history when students and graduates secured 1,124 residency positions across the US and Canada in 2020—a 95 percent residency placement rate for eligible 2020 US graduates who applied for US residencies* and a record for the University. Over the summer, approximately 450 of those grads began their residencies in New York-New Jersey area hospitals, some of the hardest-hit hospitals in the nation during the early days of the COVID pandemic.

SGU profiled many alumni across specialties and locales who tirelessly donated their time and services to help those suffering from the disease, some of those who sacrificed seeing their own families to help the sickest of COVID patients.

It was also a year in which diversity and equality was brought to the limelight. The University had frank discussions with its entire community about the importance of listening, learning, and supporting, not only in the current climate but going forward.

These are the stories that underscore the School of Medicine’s strengths and define us as a University as we aim to enhance student success and grow the number of healthcare professionals around the world. Read on to see the top news stories of 2020 on SGU.edu.

*SGU student data as of November 2020

Match Day 2020

Match Day 2020

With the ongoing COVID-19 pandemic, SGU students and graduates were called on to assist in the fight against the virus. On Match Day 2020 in March, they learned of where they would begin their career as physicians. Positions were secured across a wide range of specialties—including anesthesiology, emergency medicine, orthopedic surgery, pathology, and many more—and spanned across the United States.

All told, 1,124 SGU graduates had started residency in the US and Canada in 2020, which equals a 95 percent residency placement rate for eligible 2020 US graduates who applied for US residencies*—a record for the University—including some 450 SGU grads in New York-New Jersey area hospitals. They joined a proud network of 18,000 SGU physicians who have made a difference in healthcare around the world.

*SGU student data as of November 2020

 

A Conversation on Diversity in the Medical Profession: Thoughts from SGU’s Student National Medical Association

With the tragic deaths of people like George Floyd, Breonna Taylor, and many others, and as social justice events were held around the world, SGU News connected with SGU chapter members of the Student National Medical Association (SNMA). The national organization is committed to supporting current and future underrepresented minority medical students by addressing the needs of underserved communities, and increasing the number of “clinically excellent, culturally competent, and socially conscious physicians.” SGU chapter members shared their perspectives on the world around us, the importance of the SNMA’s mission, and how students can get involved.

 

Wyckoff Hospital

SGU Adds New US Clinical Sites for Medical School Student Core Rotations

SGU’s clinical network is growing. This fall, seven US hospitals joined the SGU family, including several in California as well as a new venue into the South that allow third-year medical students to receive core clinical training during a crucial time in healthcare.

These hospitals included:

  • Baton Rouge General Medical Center in Baton Rouge, LA
  • Doctor’s Medical Center in Modesto, CA
  • Hemet Valley Medical Center in Hemet, CA
  • MacNeal Hospital in Maywood, IL
  • Mission Community Hospital in Panorama City, CA
  • Westchester General Hospital in Miami, FL
  • Wyckoff Heights Medical Center in Brooklyn, NY

 

Georgios Mihalopulos, MD '18

True Calling: From the Navy to the OR

Critical problem solving. A wide array of challenges. The operating room was exactly the type of workplace atmosphere that Georgios Mihalopulos, MD ’18, set out to find when he began working toward a career in medicine. It also mirrored his life as an officer in the Canadian Navy, a position that he held before and during medical school.

“I always say I love stress and I hate sleep, so that’s why surgery is the perfect field for me,” said Mihalopulos, now a third-year surgery resident at Waterbury Hospital in Connecticut. “It just seemed like the most natural thing in the world for me to do.”

 

SGU and Grenada partner to address COVID-19 pandemic

As the coronavirus pandemic spread throughout the world, SGU and the Government of Grenada worked hand in hand, developing and operating a COVID testing facility, and bringing in new devices to treat ill patients.

SGU Vice Chancellor Dr. Richard Liebowitz Featured in KevinMD

An op-ed by SGU Vice Chancellor Dr. Richard Liebowitz about the importance of internationally trained doctors within the U.S. physician workforce was recently featured in KevinMD.

In the article, “We need more doctors. International medical schools can provide them,” Dr. Liebowitz outlines the increasingly competitive nature of U.S. medical schools. He explains that although our country’s doctor shortage is growing rapidly, these institutions have been unable to respond to the increase in demand. U.S. schools received almost 900,000 applications in the 2019-2020 cycle, but enrolled less than 22,000 new students.

“Consequently, thousands of promising U.S. students who would make excellent doctors are victims of a cruel numbers game,” he writes. “According to a 2019 survey from U.S. News and World Report, the average acceptance rate at 122 U.S. medical schools was just 6.7 percent. And the odds of admission could grow even longer, as the pandemic motivates people to consider careers in medicine.”

Dr. Liebowitz outlines how top-tier international medical schools are resolving this educational bottleneck — and producing the doctors of the future.

“Already, thousands of U.S. citizens head abroad for their medical training. And that number has been growing in recent years. Three-quarters of students at the school I lead are U.S. citizens. Most of them return home to the United States to practice; more than 1,000 started residencies in the United States this summer.”

For a full list of the 2020 residency matches, visit our residency archive. More information about SGU’s admissions deadlines and scholarship programs can be found here.

SGU President: What Are Your Chances of Getting Into Medical School?

 

SGU President Dr. G. Richard Olds was recently featured in a US News and World Report article about successful medical school admissions strategies. The article, titled “What are Your Chances of Getting into Medical School?”, includes insights from medical school administrators, faculty, admissions counselors, and other experts.

Dr. Olds explains that school selection is a crucial component of the application process and can make or break a student’s chances of admission to their institution of choice. “The most common mistakes in the med school admissions process are either not applying to a sufficient number of schools or not applying to the most appropriate types of schools. Olds says it’s crucial to apply to a wide range, including reach, match and safety schools.”

 

 

 

 

 

 

 

 

 

 

 

 

 

A Closer Look at Trends in Telemedicine

Shyamal Majithia, MD ’14

The emergence of the novel coronavirus (COVID-19) forced just about every individual, and every organization, to discover new ways to achieve their goals and reach positive outcomes.

Shyamal Majithia, MD ’14, a family medicine physician at Western New York Immediate Care in and around Buffalo, NY, has been accustomed to providing in-person urgent and emergent care for patients of all ages and backgrounds. However, in light of recent events, much of that care has shifted online, including Teladoc Health, for which Dr. Majithia serves as an independent contractor.

He sat down with St. George’s University to describe his experience with administering telemedicine during a crucial time in healthcare.

St. George’s University: What has your experience been like working for Teladoc Health?

Shyamal Majithia: During the current pandemic, the need for access to medical advice and care has grown rapidly. Working with Teladoc was relatively easy to get used to from the obtaining of emergency medical records and ‘seeing patients’ aspect. We provide care via video and/or over the phone. For minor complaints, patients can be seen quickly and efficiently allowing them to get a genuine medical opinion from a licensed professional rather than being left to find their own answers during the pandemic.

SGU: What are some of the trends you are seeing in telemedicine?

SM: I believe telemedicine will soon become a staple of most healthcare practices. It provides a much wider access to care. Minor injuries are treated with relative ease. Patients now upload their photos or are being evaluated by a physician over video chat. These trends are particularly used as viable tools in specialties such as dermatology and psychiatry.

SGU: How has the telehealth traffic been affected by the COVID-19 pandemic?

SM: There has definitely been an increase in the use of telemedicine in recent months. I remember logging onto Teladoc and seeing the patient queue with a wait time of over three hours at times of patients waiting for callbacks. It was understandable as everyone was trying to shelter in place and help flatten the curve. Now that the country has been reopening, people have continued to seek telemedicine options because they’ve had their issues resolved, resulting in a positive experience.

“I remember logging onto Teladoc and seeing the patient queue with a wait time of over three hours.”

 

SGU: How have hospitals/medical practitioners had to adjust to practicing telemedicine?

SM: There was a learning curve when it came to adjusting to practicing telemedicine. Medicine is such a personal experience, usually practiced face to face with a physician. It was hard to imagine not doing a full physical exam, or having immediate access to a set of vitals. My colleagues and I have definitely had to adjust the way we navigate health problems over the phone. This is where new features such as being able to see uploaded photos or logging on to a video chat can be a big help in aiding in diagnosis.

In preparation for the upcoming possible second wave coupled with flu season, we have also begun integrating telemedicine into our clinics to allow our patients a safe way to seek care.

SGU: Can you share a time when practicing telemedicine was particularly helpful to you? Also, where do you see it going in the future?

SM: With the shelter in place order, volumes dropped in emergency rooms and urgent care practices. Telemedicine allowed me another way to fill my schedule and feel like I was contributing during the pandemic. It allowed me to set my own work hours, and see patients after my urgent care job as well. I see telemedicine here to stay. With today’s access to technology such as phones, tablets, and computers, patients have almost 24-hour access to care from the comfort and safety of wherever they are.

– Ray-Donna Peters

Washington Post: Grad’s Quick Thinking Saves Life of Mother, Newborn Twins

Earlier this month, The Washington Post chronicled what one physician, a 22-year veteran, at Saint Barnabas Medical Center called “the craziest day of [her] career.” That’s when a 40-year-old mother, whose condition quickly worsened due to the coronavirus disease (COVID-19).

Upon being told that the patient’s blood pressure and oxygen level were dropping, Fariborz “Bobby” Rezai, director of critical care and medical/surgical intensive care at Saint Barnabas, made the decision to do an emergent C-section on the mother. In a matter of minutes, the babies were delivered, each at just over two pounds. His team’s attention continued on the mother, and in a span of 48 hours, she was “a new person.”

“I’ve been a critical care physician for over 13 years, and I’ve never seen anything like that,” Dr. Rezai told the Post. “Especially with COVID patients, you know when a patient is going to survive or not, and Ebony was not looking like she was going to survive. The decision to do the C-section really saved her life.”

SGU Grads to Help Physician Shortage in Nevada

Several graduates of St. George’s University who recently started their residencies at hospitals in the state of Nevada were featured in an article by the Las Vegas Review-Journal.

Of the 14 residents who started this July, all but two are in family medicine or internal medicine, both areas where Nevada is in short supply of physicians.

Amid the COVID-19 pandemic, which “really stresses a hospital system, particularly from a manpower standpoint,” having residency training programs is particularly important, said Dr. G. Richard Olds, president of St. George’s University.

More than 40 SGU graduates have matched into Las Vegas-area residencies over the past five years.

Patient of SGU Alum: “I Owe This Doctor Everything”

In a recent edition of the Los Angeles Times, pulmonary and critical care specialist Baljinder Sidhu, MD ’06, was praised for the role that he played in the treatment of a patient who was intubated and on a ventilator at Marian Regional Medical Center due to the coronavirus disease (COVID-19). Even after receiving a plasma infusion, she remained extremely ill and it was recommended that she be moved to another facility to be put on a lung bypass machine.

To facilitate this move and avoid any adverse consequences, Dr. Sidhu accompanied the patient in an ambulance for the three-hour trip to Providence St. John’s Health Center in Santa Monica, CA.

“I owe this doctor everything,” said the patient’s husband. “I’m not kidding you, this guy went above and beyond, riding in the ambulance all the way to make sure she got there safely.”