Editor's Note: The coronavirus disease 2019 (COVID-19) pandemic has taken a huge toll on the health and well-being of not only the world population but also medical personnel. As physicians, we see the clinician and patient struggles in addition to the stress and fatigue that occurs among non-physician health care professionals. We have thus far focused on the experiences of clinicians and their observations; now it's time to hear the stories of our procedure laboratory personnel. To that goal, Lodovico "Vico" Marziale, Director of the Cardiology Service Line, Cath-Lab/EP Lab at Ochsner Health in New Orleans, LA, agreed to a digital interview to discuss laboratory issues at the outset of COVID-19 last spring, intervening "recovery," and now a resurgence. It is important to note that experiences of institutions across the United States and globally vary significantly based on many factors, including the numbers of and severity of risk for vulnerable populations. The Ochsner Health system in particular dealt with many challenges during the first wave of COVID-19 because its service area includes a vulnerable African-American population. The hospital system's unique situation and stresses offer an ideal backdrop for this discussion.

George W. Vetrovec, MD, MACC: Mr. Marziale, could you briefly tell us the scope of your work in terms of laboratories and hospitals that you manage?

Lodovico Marziale, RN: I am the Service Line Director of the Interventional Cardiology laboratories and Electrophysiology laboratories. Ochsner Health is currently a 10-hospital system. My primary responsibility is over Interventional Cardiology and Electrophysiology at the main campus, which consists of 6 dedicated catheterization laboratories and 4 dedicated electrophysiology laboratories. We perform complex ablations, lead extractions, device implants, and structural heart, complex vascular, and pediatric interventions. We also have a robust cardiology research program, and we are a teaching facility with fellowships in electrophysiology and interventional cardiology. I have additional responsibility from a service line perspective over the other 9 hospitals in the Ochsner Health system that have catheterization laboratories.

Vetrovec: Can you give us a summary of special issues that you and the staff experienced during the first wave of COVID-19? Were there issues of sufficient personal protective equipment (PPE)?

Marziale: The first wave caught everyone off guard, and it required "all hands on deck."  Initially, it put staff in uncomfortable situations and unfamiliar surroundings, but this uncertainty diminished over time and with experience, which is a testament to the flexibility and resilience of our staff. We had the same PPE issues as the rest of the world did with concerns with conservation of resources, but we never were in a position of putting our staff at risk. Our supply chain partners did an incredible job with ramping up inventory of PPE, and we have an adequate stockpile on hand.

Vetrovec: Could you please comment on staff morale during this time?

Marziale: Staff morale was a mixed bag of emotions based on personality and depending on if and where you were redeployed and how that was managed. We learned a lot during that first surge, and we are much better prepared now. But even with those who struggled at first, morale improved with better communication and improved processes. Ochsner did an incredible job with insuring that there would be no layoffs or furloughs. This removed that additional burden of the fear of not having a job out of the already tenuous situation.

Vetrovec: A number of studies have suggested that routine patient arrivals were delayed, or that some didn't even go to hospitals for fear of being infected, and ultimately arrived with more severe presentations. Did you observe that phenomenon?

Marziale: We did. Our ST-segment elevation myocardial infarction and acute coronary syndrome admission volumes decreased across the system. We suspect that the fear of coming to a hospital and the chance of contracting COVID-19 kept people from coming in to seek care. The fear will be the late effects of increased heart failure cases and poor outcomes for those who did not seek immediate attention.

Vetrovec: Did catheterization laboratory activities and volumes return to normal as the first wave declined? Were the staff able to relax at all?

Marziale: Volumes started to ramp up in July once the restrictions for out-patient procedures were lifted and patients started to feel more comfortable coming into the hospital setting. Ochsner has done an extraordinary job with making their facilities "COVID Safe" for patients seeking care. There is still some residual impact with a few patients still being uncertain about coming to the hospital, but for the most part we are about 90-95% back to pre-COVID-19 volumes. The catheterization laboratory and electrophysiology laboratory staff are amazing! They are back to normal except for all the COVID-19 restrictions. Living in New Orleans, resiliency is a requirement.

Vetrovec: So now the second wave! Can you compare current issues to the earlier experience? Particularly, are staff adapting better or are is greater fatigue and burnout?

Marziale: The second wave has not been anywhere near the impact of the initial surge so far. Currently, for at least the catheterization and electrophysiology laboratories, it is business as usual. Communication is the key! We keep our staff updated on hospital census and informed on what the plan is in case we need to redeploy. As I said before, we learned a lot the first time the hard way. But now we are prepared and mentally ready for whatever comes.

Vetrovec: What other comments or thoughts would you like to share?

Marziale: I am proud to work at Ochsner Health and very appreciative of what they have done for their employees during these very trying times. Stressful times like this bring out the best in people whether they are front-line staff or the CEO. We will get through this, and we will all be stronger for it.

Vetrovec: Mr. Marziale, thank you so much for your comments. We remain indebted to our staff and their significant efforts during this stressful time. Your comments representing your staff are greatly appreciated.

References

1. Price-Haywood EG, Burton J, Fort D, Seoane L. Hospitalization and Mortality among Black Patients and White Patients with Covid-19. N Engl J Med 2020;382:2534-43.
2. Wood DA, Mahmud E, Thourani VH, et al. Safe Reintroduction of Cardiovascular Services During the COVID-19 Pandemic: From the North American Society Leadership. J Am Coll Cardiol 2020;75:3177-83.
3. Mahmud E, Dauerman HL, Welt FGP, et al. Management of Acute Myocardial Infarction During the COVID-19 Pandemic: A Position Statement From the Society for Cardiovascular Angiography and Interventions (SCAI), the American College of Cardiology (ACC), and the American College of Emergency Physicians (ACEP). J Am Coll Cardiol 2020;76:1375-84.

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Cardiovascular Care Team, COVID-19 Hub, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Stable Ischemic Heart Disease, Vascular Medicine, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Interventions and ACS, Interventions and Imaging, Interventions and Vascular Medicine, Angiography, Nuclear Imaging, Stress, Chronic Angina

Keywords: Angiography, Coronary Angiography, Laboratories, ST Elevation Myocardial Infarction, Fellowships and Scholarships, Acute Coronary Syndrome, Acute Coronary Syndrome, African Americans, COVID-19, Personal Protective Equipment, Personality, Morale, Burnout, Professional, Cardiology, Heart Failure, Hospitals, Catheterization, Fatigue, Electrophysiology, Cardiac Electrophysiology

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