March 18, 2021

Looking back at the COVID-19 pandemic — the early days

A multipart series capturing the reflections of Kaiser Permanente employees and physicians on the global pandemic and how it changed their work and lives.

He started seeing a series of posts on online global health sites — tracking something that looked very much like severe acute respiratory syndrome, or SARS. Paul Thottingal, MD, Kaiser Permanente’s national infectious disease leader and chief medical officer of the national command center, took notice. “Infectious disease folks tend to watch the horizon for things like this.”

It was when the World Health Organization reported a cluster of pneumonia cases in Wuhan, China, in early January 2020 that he started making calls to his fellow infectious disease and public health colleagues, asking, “Are you concerned? Because I’m concerned. We need to shift our focus to this.”

“Are you concerned? Because I’m concerned.”

It’s been a year since COVID-19 became a global pandemic and shut down our communities. No one knew then how profoundly it would change nearly all aspects of our lives. In early 2020, Kaiser Permanente employees and physicians in many different roles within the organization were following news of a fast-spreading novel coronavirus.

The early days of the outbreak

Senior medical director for quality at The Permanente Federation, and executive director for Kaiser Permanente’s Care Management Institute, Scott Young, MD, was struck by early reports of outbreaks in early February. “Knowing the experience countries in the Western Pacific had with SARS years before, when we saw authorities in Wuhan build hospitals and move tens of thousands of health care workers into that city, I thought, okay, this is big.”

In late February Craig Robbins, MD, was at a conference on precision medicine attended by medical professionals from across the country. A family medicine doctor in Colorado and medical director for the Care Management Institute’s Center for Clinical Information Services and Education, he recalled the energy in the room that day. “There were about 16 to 20 people, and during that whole meeting, half of them kept getting up and going out to have calls,” said Robbins. “It was all about what was going on with this new virus and whether we were prepared and talking about hospital readiness. That was the last time I traveled for work for quite some time.”

Quick responses to a quickly changing situation

By early March 2020, Kaiser Permanente was treating people with confirmed COVID-19 cases in several of its facilities. The organization’s 24/7 national command center had been activated weeks earlier to focus on providing the right care to patients, ensuring the safety of employees and physicians, and preparing for the predicted large surge in cases.

“We had to not just plan for a surge and manage through that surge,” said Skip Skivington, vice president of health care continuity and support services, “but then keep looking farther out over the horizon to see how high and how demanding that surge was going to be before it would begin to slow down.” But as Skivington and the command center team quickly realized, even the best forecasting models couldn’t accurately predict that far in advance. “We learned how to pivot from one set of realities and facts quickly to new realities and facts, almost on a dime.”

We learned how to pivot from one set of realities and facts quickly to new realities and facts, almost on a dime.

An early emerging reality was the fragility of the global supply chain — the ability for organizations to locate, buy, and take delivery of equipment crucial to patient care.

“Kaiser Permanente was fortunate to have a reserve of personal protective equipment items as a result of our readiness work for Ebola,” explained Mary Beth Lang, vice president, chief supply chain and procurement officer. “We were able to use that reserve as we started to work on how to increase the supply of PPE.”

Multiple teams formed to look at how to source specific items. Other teams worked to identify every possible purchasing channel domestically and from outside the United States. A quality team was formed to validate authenticity and compliance to regulatory standards and certification to ensure items coming into the environment were acceptable. “The big driver for us is how do we keep our front-line workers safe,” said Lang, “and how do we ensure the products we have are appropriate?”

The early hope of a vaccine

On March 16, 2020, just days after the World Health Organization officially declared the novel coronavirus outbreak a pandemic, the Kaiser Permanente Washington Health Research Institute gave the first-ever injection of an investigational vaccine for COVID-19 to volunteers participating in a phase 1 federally sponsored clinical trial.

“We were selected for the first COVID-19 vaccine trial at the end of January 2020,” said Lisa Jackson, MD, senior investigator at KPWHRI and lead researcher for the study. The research institute immediately started hiring and training more staff, developing the protocols and processes, and recruiting volunteers.

“There were innumerable issues that had to be dealt with rapidly, and we ended up starting our enrollment about 6 weeks after that,” said Dr. Jackson. “It was a pretty intense 6 weeks and it’s not really let up since that time.”

The promise of a possible vaccine offered hope, but the virus continued to spread, and some of the darkest days of the pandemic were still ahead.


Part 2: Looking back at the pandemic — care during the surges
Part 3: Looking back at the pandemic — lessons learned