In January 2020, before COVID-19 was officially declared a pandemic, Cedars-Sinai treated one of the first COVID-19 patients in the U.S. Although it was a fearful time full of unknowns, physicians and investigators also knew it was an extraordinary moment in history.

“Working with that first patient on an unknown virus was tremendous,” said Jonathan Grein, MD, director of Hospital Epidemiology. “There was so much to learn. I remember wondering when I might develop symptoms and sleeping in the garage to avoid exposing others. When the first COVID-19 vaccine arrived later that year, we all paused to reflect on the effort and science that went into developing it. It was a remarkable time.”

But getting there was months in the making. Early on, a special Cedars-Sinai task force was meeting multiple times every day, strategizing about how to increase the hospital’s critical care capacity.

Michael Nurok, MB, ChB, PhD, now co-chair of the Department of Anesthesiology, was on the task force as director of the Cardiac Surgery Intensive Care Unit.

“We were seeing the news out of Italy about the surge in patients with COVID-19, and we were asked to prepare for 1,000 critically ill patients on ventilators,” Nurok said. “We had to think about how we might use ventilators for multiple patients. Luckily, we never had to do that, but we had to prepare for the worst.”

Standout Memories

There was fear among patients, loved ones and providers alike, physicians said.

“Fear about not being able to manage all our patients, fear of running out of supplies, fear of colleagues getting sick, fear of my family or me getting sick,” said pulmonologist Isabel Pedraza, MD, director of the Medical Intensive Care Unit and a member of the hospital’s Special Pathogens Response Team.

In addition, hospitalized patients were isolated. Rabbi Jason Weiner, PhD, BCC senior rabbi and director of the Spiritual Care Department, said the situation reminded him of the importance of human connection.

“The lockdown happened around Easter and Passover,” Weiner said. “We made signs for the glass doors of the Intensive Care Unit, wishing patients happy holidays. Later they told us it was grounding to know what was happening in the outside world.”

In the beginning, the number of infected patients was overwhelming, said Peachy Hain, MSN, RN, executive director of Nursing, Surgical Services and Clinical Support Programs.

“We were running out of beds and low on supplies,” she said. “But nurses are resilient, adaptable and supportive. We acted quickly to convert recovery rooms into shared spaces. We made sure every mask, gown and piece of equipment lasted. It reinforced how creative and innovative we are, and, in the end, it made nurses closer. We are one team, one family.”

For Sam Torbati, MD, medical director of the Ruth and Harry Roman Emergency Department, the early days were marked by a constant reminder there was no script for how to handle a pandemic.

“We’re prepared for any situation, but COVID-19 didn’t come with a playbook,” Torbati said. “So, every day we were in battle mode and every day, at every level, we came with a strategy, a plan, and strong communication and team support.”

Lessons Learned

Rita Shane, PharmD, vice president and chief pharmacy officer, recalled various lessons learned in the wake of the pandemic; among them, using protocols developed during COVID-19 for other emergency situations. For example, last September, after Hurricane Helene damaged a manufacturing facility and severely limited the national supply of IV bags and fluids, Shane’s team used pandemic learnings to help manage the shortage.

“COVID-19 taught us we can more efficiently respond to any emergency going forward,” Shane said. “Our real-time response time is more accelerated, and our experts can navigate any situation.”

Shane also recalled that Cedars-Sinai was one of the first hospitals to get the COVID-19 vaccine in December 2020—another opportunity to navigate a new situation.

“We needed a specific storage plan, and we needed a rollout plan since we were one of the local sites coordinating public vaccination,” she said.

Pedraza called the rapid development of the vaccine “an incredible breakthrough that likely will be one of the top achievements of our time. Prior to this, it could take as long as a decade for a new vaccine. The COVID vaccine gave us hope that there was an end to the pandemic. I hope we don’t forget the power of vaccines to stop human suffering.”

Equally rapid and transformative was COVID-19 research, said Susan Cheng, MD, MMSc, MPH, the Erika J. Glazer Chair in Women’s Cardiovascular Health and Population Science in the Department of Cardiology in the Smidt Heart Institute.

“We pivoted to focus on understanding how the virus affected people differently, as well as mitigation and prevention, and later, vaccine response,” said Cheng, a professor of Cardiology. “People in every corner of Cedars-Sinai helped us in what was the most fast-paced clinical research study I’ve ever been a part of. We learned how quickly research can answer impactful questions, and I hope our findings inform future policy and clinical practice. It was a testament to how people can stretch above and beyond to improve and protect the health of humanity.”

A Medical Landscape Altered

Grein, director of Hospital Epidemiology and head of the medical center’s Special Pathogens Response Team, said the pandemic gave him a glimpse into the future of healthcare.

“Medicine can be very conservative, and it often takes years for new guidelines to come out and change clinical practice,” he said. “COVID taught us how to more quickly respond to emerging science and adapt protocols to benefit patients and staff.”

Torbati, associate professor and co-chair of the Department of Emergency Medicine, agreed.

“We rapidly readjusted safety protocols during the pandemic, determined how to isolate patients, built treatment tents and created safe environments with adequate ventilation,” Torbati said. “We had to figure out how to do things differently while also responding to heart attacks, strokes, car accidents and other common Emergency Department situations. If a similar situation happens again, we’re very prepared.”

COVID-19 changed healthcare in many ways, Hain said, such as an increasing use of telehealth visits.

“We also use home health more effectively now, which frees up beds in the hospital for patients with more immediate needs,” she said. “We also expanded our mental health programs for staff. And we expanded community resources and outreach to improve care among Black, Hispanic and Asian patients, who faced the highest COVID death rates.”

Lasting Takeaways

David Marshall, JD, DNP, RN, senior vice president, chief nursing executive and chair of the Department of Nursing, offered three pandemic takeaways that he still relies upon daily.

“It’s critical to protect health providers so they can take care of the community, and as providers, we must pace ourselves and protect ourselves,” he said.

But heavy emotions still surface when he remembers the distress of COVID-19.

“A patient’s family shared with me that they watched on their iPhone during the lockdown and isolation as their loved one passed away while a nurse held their hand and stroked their brow,” he said. “There were moments of tragedy. There were moments of fear. There were moments of joy. COVID-19 was a moment when our institution shined while we took care of our community … and while we took care of each other.”

Read more on the Cedars-Sinai Blog: New COVID-19 Vaccines Hit the Market  

“Patients with airway diseases, such as pulmonary fibrosis, COPD and asthma, may experience worsening of symptoms due to exposure to poor air quality from wildfire pollutants,” said Isabel F. Pedraza, MD, an assistant professor of Medicine and director of the Medical Intensive Care Unit at Cedars-Sinai. “We want to ensure that our patients have access to care when they most need it.”

Pulmonology patients, Pedraza said, should be sure to take their inhalers as prescribed, as well as any other “controller” medications that contain an inhaled steroid.

“Both inhalers and controller medications can help reduce the airway inflammation brought on by smoke,” Pedraza said.

Pedraza offered several other tips to anyone experiencing smoke and fire debris:

• Stay indoors as much as possible, keeping windows closed.
• Avoid strenuous outdoor activities.
• Use fans to keep cool; if you are using air conditioning, adjust the system to allow for recirculation and prevent intake from outdoor air.
• Wear N95 masks when outdoors, especially in areas with dense smoke.
• Keep car windows rolled up and set vents to recirculate air.
• Ensure you have all necessary respiratory medications on hand. If you have asthma but are not currently on your maintenance steroid inhaler, consider restarting the inhaler.

For those experiencing worsening respiratory symptoms—such as an uncontrolled cough, wheezing or shortness of breath—Pedraza said patients should contact their care provider as soon as possible. Cedars-Sinai Urgent Care is also available to support patients.

To arrange an interview, contact:
Soshea Leibler | 213-215-8000 | soshea.leibler@cshs.org
Cara Martinez | 310-562-7821 | cara.martinez@cshs.org

For the Cedars-Sinai Newsroom team's complete coverage of the Los Angeles County wildfires, please click here.