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  

Officials from the Los Angeles County Department of Public Health reported that several cats tested positive for the bird flu, also called H5N1, after drinking raw milk. Shortly after, the officials reported the first confirmed local case of the illness in a human.

But how much of a threat does the bird flu actually pose to humans?

“This is not yet a threat to everyday people who are not in close contact with affected animals, such as dairy cattle, poultry and wild birds, and we have not seen any human-to-human transmission of the virus,” said Jonathan Grein, MD, director of Hospital Epidemiology at Cedars-Sinai and head of the medical center’s Special Pathogens Response Team, which can test for bird flu and treat the most severe cases.

Though most human cases of H5N1 in the U.S. have been mild since the virus first appeared in 1997, Grein cautioned that the bird flu can be severe and is still evolving.

“We’re concerned that this virus now spreads more readily across mammals—cattle in particular—and as this virus mutates and adapts, it has the potential to spread even more easily,” he said. “We must remain vigilant.”

The Cedars-Sinai Newsroom asked Grein what everyone should know about bird flu, including how to treat it and how to avoid getting sick.

How is bird flu different from seasonal flu?

They’re both from the same family of influenza viruses, but H5N1 binds to different cell receptors. They both cause similar symptoms—fever, sore throat, cough, muscle aches—but conjunctivitis appears to be more common with H5N1 patients who have had close contact with dairy cattle. Both viruses can cause mild illness or more severe forms like pneumonia, but these viruses behave differently. The flu generally follows more established seasonal patterns, whereas H5N1 is more unpredictable. We largely use the same antiviral—Tamiflu—to treat H5N1 as we do to treat seasonal influenza.

How can I know which type of flu I have?

There is no way to determine which virus you’ve contracted unless you get tested. As seasonal flu activity picks up, it will be really important to understand which virus you have. From a public health perspective, we need to understand what’s happening in the community. On a personal level, you’ll want to keep those around you safe, especially if you’ve contracted something beyond the typical seasonal flu.

Will my flu shot also protect me from H5N1?

The flu shot is our most powerful tool to protect yourself and those around you from seasonal influenza. But it likely does not confer protection against bird flu. Vaccines have been developed for H5N1, but they’re not widely available at this time, although some have been stored in a strategic national stockpile to be deployed in an emergency. Drugmakers are developing additional vaccines, and their development process would likely pick up if we began seeing H5N1 spread between humans.

How can I avoid bird flu?

Nearly all cases in humans have been in people who had close contact with dairy cattle, poultry or wild birds. Individuals who must be in contact with these animals should avoid cattle and birds if they appear sick. Also avoid drinking raw milk, which the virus can easily infect.

Read more from the Cedars-Sinai Blog: Flu and RSV—How to Protect Yourself Now

The exercise is part of the Cedars-Sinai Special Pathogens Response Team’s efforts to bring its expertise in treating dangerous infectious diseases outside the walls of the medical center and into the broader community.

During the emergency drill, front desk staff, nurses, physicians and Environmental Services staff members will work together to diagnose the pretend patient, isolate them and don protective gear to keep themselves and other employees, visitors and patients safe. The care team will transfer the patient to a specialized ambulance, driven by first responders trained to handle highly infectious diseases. In a real-world scenario, the ambulance would swiftly transport an actual patient across town to Cedars-Sinai Medical Center.  

“We’re a community hospital, but we’re also the closest one to Los Angeles International Airport. We frequently see patients who acquire different kinds of infections while traveling abroad,” said Joseph Botros, who oversees Infection Control, Emergency Management and Environmental Health and Safety at Marina del Rey Hospital. “Working with the Special Pathogens Response Team is a top priority because we want to provide the highest quality of care to our patients while keeping our staff, visitors and other patients safe.” 

Botros said Marina del Rey Hospital employees are excited to participate in one of the special pathogens drills, which in the past have taken place only at the medical center’s Beverly Grove campus. He credited the COVID-19 pandemic with making staff members more engaged in planning for a public health crisis.

“COVID-19 was a huge turning point where everyone felt the importance of emergency management and how to work safely around infectious diseases. Our team members are eager to be a part of the solution,” Botros said.

In addition to collaborating with Marina del Rey Hospital, the Special Pathogens Response Team practices caring for patients in the community. In early June, the team members—dressed in their protective suits and respirators—left the medical center in an ambulance and rehearsed entering a resident’s home, staged inside the hospital’s Simulation Center. A mobile unit nurse and physician evaluated and tested a pretend patient who developed mild Ebola symptoms after traveling abroad.

The team practiced drawing blood from a manikin’s arm in a dining room while navigating the challenges of a normal house call—treating a patient in a nonclinical setting and dealing with a distracting pet.

“Unannounced, we simulated a dog barking,” said Jonathan D. Grein, MD, director of Hospital Epidemiology at Cedars-Sinai, who helped establish the team in 2016 as one of a dozen federally funded Regional Ebola Treatment Centers. “If a family had a pet dog, our protocol is to keep them in a different room and close the door because you don’t want a barking dog scratching at your personal protective equipment. It might seem trivial, but it’s important to practice navigating challenges we don’t normally encounter in the hospital.”

After gathering the blood sample, team members packaged it in a series of secure containers and handed it off to Los Angeles County Public Health professionals before sanitizing the pretend dining room.

“The team is always practicing new skills so that we’re better prepared to care for our community in any situation,” Grein said.

 Read more on Discoveries: Recipe for Disaster