Efforts to Prevent Further Resurgence of COVID-19, An Update from Galveston, Texas - Stephen Williams

July 29, 2020

Recorded Date: July 25, 2020

Stephen Williams, MD, discusses the state of the COVID-19 pandemic in Galveston, TX, and its continued impact on urologic care in conversation with Alicia Morgans, MD, MPH. Dr. Williams details the precautions that remain in place at the hospital including extensive personal protective equipment, temperature checks, and the increased use of telemedicine, as well as how the hospital's procedures have changed in recent months. Dr. Morgans and Dr. Williams reflect on some bright spots including how some are raising money in his area for COVID-19 relief.


Stephen B. Williams, MD, MS, FACS, Chief, Division of Urology, Professor of Urology and Radiology (Tenured), Robert Earl Cone Professorship, Director of Urologic Oncology, Director of Urologic Research, Co-Director Department of Surgery Clinical Outcomes Research Program, Medical Director for High Value Care, UTMB Health System, Galveston, Texas

Alicia Morgans, MD, MPH Associate Professor of Medicine in the Division of Hematology/Oncology at the Northwestern University Feinberg School of Medicine in Chicago, Illinois.

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Alicia Morgans: Hi, this is Alicia Morgans, GU medical oncologist and Associate Professor of Medicine at Northwestern University in Chicago. I am so, so excited to have here with me today Dr. Stephen Williams, who's the Chief of the Division of Urology and the Medical Director for High Value Care at the University of Texas Medical Branch at Galveston, where he's also a tenured professor. We are so pleased to have you here to speak with us today about how COVID has evolved where you are, especially with your perspective as a member of the COVID taskforce. Thanks so much for being here.

Stephen Williams: Well, thank you for the very kind invitation.

Alicia Morgans: Wonderful. So you have really been on the front lines in Galveston, so close to Houston where things have been challenging for many people in Texas. What do you see as the current situation or how would you describe what you're dealing with as a urologist in Texas?

Stephen Williams: Certainly. Well, as you know, we are one of the first states to have an early reopening, if you will, and at present, as across the nation, we're seeing a resurgence or continuum of what others have seen before, particularly in New York, is basically going back, if you will, to not necessarily a lockdown, but regressing in regards to our governor abandoning the elective surgeries that we're currently doing.

What is very interesting, however, is we're in close proximity to Houston, which is having a significantly increased number of COVID-positive cases at roughly one in four, so about a quarter percent, whereas in Galveston, we're not seeing the increased number of positive cases. So with our epidemiology team, particularly, and infectious disease, and being a part of the employee COVID taskforce, we're analyzing our data and making the necessary adjustments internally, trying really now at this stage is to understand the disease and locally what things we need to be aware of, so that we can decrease the number of positive cases. Gratefully, at least our institution hasn't had the increased number of deaths that others have been seeing, but I think a large part is the team effort. University of Texas Medical Branch has a longstanding history with the Galveston Laboratory to really have some of the world's leaders in infectious disease, who are very critical, you know, in this movement as well.

Particularly for urology, we're very fortunate to have such personnel to help guide us both as a subspecialty, but then also to the overarching institution. As you know, within urology, we have had a number of publications that have come out particularly to help identify which cases are elective, non-elective, and in my field particularly, urologic oncology, to help guide cancer care during this pandemic.

Alicia Morgans: Well, sort of to build on that, when we're now facing the increases in some parts of the country and we expect to have potentially more challenges in the fall and through the winter, what are some of the lessons learned from your initial experiences with COVID-19 as a team and as a urologic group that you think are going to be the most important as you prepare for this ongoing situation?

Stephen Williams: 
Well, that's an excellent point because we really want to learn so that we can prevent further resurgence if you will. I really have hats off to the leadership, that's the institution, and really involving personnel from a variety of disciplines, including myself, although I'm involved with leadership in the high-value care spectrum. But even being a urologist and being in a room with some of the leading experts that certainly know a lot more granularity in regards to the epidemiology and infectious disease standpoint, is coalescing and really putting the necessary preventative measures, I think, as most institutions have started to do, or may continue to be doing, temperatures of all individuals entering any of our facilities at the front door, screening badge checks.

We've somewhat relaxed some of the temperature checks particularly at our institution because we noticed and followed the data objectively. What were we able to identify by doing these? What are the positives, false positives, negatives? Then also too, that runs into our testing, so really having point-of-care testing and then also too, to follow up the data objectively to understand what we're doing. I think we took a very aggressive stance, but appropriate, and now we are slowly peeling back, if you will, an onion effect, to then distill it so that we're able to prevent an increased number of cases that others have been seeing, particularly like in Houston.

But we're still taking precautionary measures with PPE. Right now I know from our OR leadership and having contact with them, we're taking the precautionary measures in case we in fact do see an increased number of cases. I think that's critical. And also to provide education, not only to the community within the institution, but outside, and really trying to better understand and then help others collaboratively. We're working with other institutions and even not just locally, but across the nation to really understand what others are doing and then how we can apply that locally at our institution. Interestingly enough, they're also asking us how are we able to keep our numbers so low, so that they can also reciprocally do the same in their own environments.

Alicia Morgans: I think those are all such important things and really such a shift in the way that our everyday practice has been, so we're really forging new ground, which is exciting. But as we do that, there are junior people who are coming through the ranks, new residents. It's almost August, so there is a class of brand-new residents who's who is joining your crew, I'm sure, and there are folks who are still in their training. What are you and the folks at UTM be doing as urologists to help support their ongoing education?

Stephen Williams: Certainly. So, as the Chief of the division, one of the first tasks that I did is understanding, and my training in this day and age is you can't do everything on your own. I have an appointed residency program director, as well as a director of operations, clinical operations. Going back to your question regarding the education, Dr. Joseph Sonstein as our residency program director, has really, if you will, taken the lead on creating a lot of virtual learning opportunities, particularly for our own residents instilling on a routine basis, making sure particularly with COVID-positive patients, one resident visiting physically, if needed, if it can't be done virtually, consults or actual contact, and more importantly, having a very low threshold to reach out and get the appropriate testing if anything is in fact, breached.

From incoming such as applicants, we're creating virtual sub-internships, educational programs, things of this nature, very interesting on the social media platform, how urology, I've noticed, more than any other discipline, has really taken the helm in creating a lot of these wonderful educational opportunities, virtual meetings. We just had a virtual visiting professor from Johns Hopkins, Dr. Arthur Burnett, come by. We had Ashish Kamat from MD Anderson as one of our visiting professors. Then we're going to have Dr. Ralph Clayman as one of ours as well, upcoming. So it's really, if you will, alleviated a lot of the travel and sometimes unnecessary travel, and optimized the educational environment.

So we've learned a tremendous amount, I think, through this pandemic, how to optimize the current situation, and in my mind has actually broadened the depth of education by allowing people more to work collaboratively with one another. I think it's actually, in an odd term, has been kind of a beautiful transition, if you will, to where we could be more efficient and effective. But definitely limiting the physical contact, it takes a toll, and being mindful of the mind, body, and spirit and keeping in track that everyone is doing well from that stance as well.

Alicia Morgans: So as you think about that, I know that there have been a lot of challenges, but there are always some bright spots, some things that kind of stand out as positive things. As you mentioned, our transition to being able to be more virtual and inclusive in education is definitely one of them. I heard you have a story about a young lady who has also tried to put a positive spin on some of the challenges that folks at UTMB are dealing with. Can you tell us a little bit about that?

Stephen Williams: Yes. Thank you. You know, as we all... I have three children, and a number of our employees obviously, they have their personal life, professional lives. One of the things, particularly my oldest child, was witnessing on the television as well as it's kind of hard to hide what is in fact going on in the rest of the world, noticed a lot of the healthcare employees, particularly our local institution, we're undergoing hardships both financially as well as either directly impacted the COVID pandemic.

And I think one of the critical things that as being a father is she came to me and said what she could do to help. I kind of left it to her accord what she wanted to do, but it is quite surprising. She's been an artist for the last five years and done some artwork and then basically created some artwork and sold it online to raise funds, which was approximately about $2,000 to donate to the COVID relief fund at our institution, was in our local newspaper. She got to meet the president of UTMB and really inspired, I think, not only myself, but others. We could all participate in this time where people are going through a lot, but working together, keeping being mindful and all of us can play a role in getting us through this. But it was quite an uplifting experience and definitely a proud dad moment for myself.

Alicia Morgans: That's wonderful, and I think it's important, as you said, that we can all feel small sometimes during these kinds of things, and isolated, but even the youngest of us can make a big difference. The small of us can make a big difference and inspire others to have that positivity as well. So, thank you so much for sharing your evolution in terms of dealing with COVID at UTMB and for the encouragement around education and around the small things that we can do that end up actually being quite substantial in making each other have a better time with the challenges of the COVID pandemic. Thank you so much.

Stephen Williams: Well, thank you for having me today, and hopefully everyone stays safe and well.