Q&A on COVID-19 with infectious diseases specialist Todd Vento, MD, MPH

“This will last for several months...and we’ll need to be even more aggressive moving forward…”

toddvento


Dr. Scott Stevens says he got up one morning about a week into the COVID-19 pandemic and felt grateful Dr. Todd Vento works here.

“I woke up thinking of Todd,” said Dr. Stevens, who is senior medical director of the Medical Specialties Clinical Program. “The early weeks of Intermountain’s response to COVID-19 have been built on his shoulders. His deep knowledge of infectious diseases, his experience with crisis management in the U.S. military, and his work ethic are major reasons why Intermountain is rising to the challenges of the pandemic.”

Todd Vento, MD, MPH, is one of Intermountain’s leading experts on infectious diseases and public health. He serves as medical director of Infectious Diseases TeleHealth and associate medical director of TeleHealth (Specialty Services), is a retired colonel in the U.S. Army, and is an adjunct associate professor of infectious diseases at the University of Utah School of Medicine, the University of Texas Health Sciences Center-San Antonio and the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

Dr. Vento is also featured in Forbes magazine in a story titled “15 Heroic First-Hand Stories from the Coronavirus Front Lines.”

Here's a Q&A about COVID-19 with Dr. Vento

How would you summarize the threat of COVID-19 in Utah? Just the word ‘pandemic’ sums up the threat. If you compare it with ebola, which was concentrated in West Africa, the difference now is that not only are multiple countries affected throughout the world, but there’s widespread transmission within these countries. You don’t often see that in infectious diseases. COVID-19 also has the capability of being even more severe than epidemics we’ve seen before due to how easily it can be spread and the severity of disease among older individuals and those with weakened immune systems or underlying conditions. The threat is very real. Everyone should take it very seriously.

What are the most important things for Intermountain’s clinicians to know?

First you should be aware that any patient who comes in could have the COVID-19 infection. Second, take the well-documented steps regarding your use of personal protective equipment.

What’s most important for the community to know?

They should know they can take steps to prevent further spread in the community. That means adhering to social distancing measures and minimizing close contact with others. What you hear from the Utah Department of Health and national infectious diseases authorities is spot-on.

We see other states going to more aggressive measures — either shelter in place or stay at home. Our current measures might require even more aggressive actions to prevent community transmission to decrease the threat to high-risk patients and our healthcare system. Given the marked increase in the number of cases in Utah over the past week, everyone needs to do their part to help slow the pace of the epidemic.

What are the top things we’re doing to protect our caregivers and the community, and how effective have they been?

Internally, we’re screening patients, we’re using PPE, and we’re making changes as needed to our clinical protocols. So far I think it’s working well. The organization’s incident command structure helps disseminate information to all healthcare workers and staff, along with other communication on new policies and practices. That’s important too.

Externally, I’d say Intermountain leadership has been very openly communicating and collaborating with government authorities, health departments, and other healthcare organizations in the state to support sound public health messages. That guidance helps all our population limit the spread of disease.

Can you estimate how long the COVID pandemic will last?

One of the ways we try to predict what will happen is, first, through the use of modeling programs, and second, by looking at the experience of other states and areas that are going through the next phases of their outbreaks. We need to learn quickly from their experiences.

Based on initial estimates, I’d say this will last for several months. The final course of the epidemic will depend on the overall integrated responses of our public health and healthcare systems. Our experience might not be identical to other areas, based on differences in our population density, adherence to preventive measures, and other public health factors. That sounds like something a politician would say, but it’s true.

What’s helping you cope personally with the crisis?

First, watching the number of people in our organization who’ve stepped up and brought so much energy and enthusiasm and desire to help solve problems. We’ve had people volunteer to work on teams who’ve worked all day and into the early morning to create solutions to countless number of challenges. And they’ve shown up every day for almost four weeks. And then, honestly, watching everyone’s selfless actions has been very heartwarming and inspiring. That’s given me and I think so many others a huge morale lift.

What advice do you have to help Intermountain’s people cope?

I would say: Dedicate time when you have the ability to not focus on the pandemic experience. That may come in the form of quiet time with family, physical activity, or reading something completely unrelated to the pandemic and infectious diseases. I wish we could watch sports too. You may have to be creative. Just take the opportunity to clear your mind. But I may not be the right one to answer this question. I haven’t done a great job of stepping back since the situation began, but my wife is great at recognizing that and kindly encourages me to take my own advice.

Do you see anything that’s hopeful up ahead?

Yes. For one, we’re learning about the potential effectiveness of clinical treatment responses as well as measures to help protect our healthcare workers as cases increase in our facilities. We’ve already had a tremendous opportunity to learn from other infectious diseases experts and public health colleagues. We’ve had direct contact with pandemic response leaders from the University of Washington, for example. We’ve also benefited from having an established network of colleagues from throughout the country and the world.

We’re also seeing some reports of potential benefits from specific medications that we’ll have the opportunity to study in clinical trials at Intermountain very early in the course of Utah’s epidemic.

Are you optimistic or pessimistic as the pandemic continues?

I think I’m a realist about the epidemic curve and what others have experienced. That’s why I think we’re being smart to focus on measures that will hopefully limit the spread of the disease, knowing we can’t completely prevent it. That’s particularly important within our healthcare facilities to keep our healthcare workers protected.

I think we’ll need to be even more aggressive moving forward. It’s important in our facilities to plan for the possible cohorting of infected patients and reallocate resources to areas where providers might be at more risk for exposure.

How do you think we’ll describe this 20 years from now?

I think we’ll describe it as something that was overwhelming, that taught us valuable lessons about how important early actions are during a pandemic. Hopefully we’ll learn so we can be even more aggressive, earlier, in the face of subsequent epidemics.

We’re also seeing history being made — history that’s happened in the past few days and weeks. We must learn from it and adjust our solutions accordingly. I think we’ll remember the amount of commitment and coordination that happened, not only within Intermountain but with other health and public health agencies across the state. That’s the biggest thing. I’ll remember how inspiring it was to work with people who care and want to solve problems and make a difference.

Why did you go into infectious diseases, anyway — and lately are you regretting that choice?

For me, infectious diseases and public health are specialties that encompass so many factors that affect the health of individuals and populations. In a single patient encounter, there may be social, political, religious, and cultural or familial factors that play a role in their infection and their likelihood of transmitting it to others. That makes it very challenging to diagnose and treat, but also very stimulating to try to figure out what interventions will most likely benefit that patient and prevent the spread to others.

And no, I haven’t regretted it. As a former Army and international infectious diseases and public health officer, I’ve had experiences I never would’ve had in any other specialty. I’ve worked on five continents, I’ve helped the militaries of other countries prepare for pandemics, and I’ve personally been able to help coordinate large-scale efforts to control disease spread during outbreaks. That’s been very fulfilling.