Don’t follow where the path may lead. Go instead where there is no path and leave a trail! - Ralph Waldo Emerson

During this past month as a patient-facing, frontlines “soldier” during the apex of the coronavirus disease 2019 (COVID-19) crisis at a tertiary academic medical center in New York City, New York, I learned a lot about leadership. As physicians, we find ourselves in leadership roles every day irrespective of seniority or proximity to medical school graduation. Whether it is leading a goals-of-care discussion as a freshly minted intern, leading a large clinical team as an experienced attending physician, or developing administrative strategies as a department chairperson, a substantial component of what we do every day involves leadership.

But the compelling necessity of strong leadership is heightened during a pandemic and a conscious awareness of leadership roles is magnified. This form of advanced deliberate leadership throughout our hospital during the surge made a monumental difference in the tangibles, including patient outcomes and staff safety, and intangibles, such as overall staff and physician morale.

Almost overnight I went from relying heavily on my knowledge and technical skills as an interventional cardiologist to assuming a leadership role on a COVID-19 infectious disease service, attempting to treat a new and devastating viral illness. I was at a crossroads, wondering how I could lead my team with quiet confidence while treating a lethal disease completely unknown to me, but I was also a silent benefactor of the leadership examples surrounding me within my own division, department, and university. Applying the qualities of those leading me to my new role became my survival mechanism.

As I recall the last month of death, loss, and isolation, it is clear that with excellent colleagues who exhibit key crisis mode leadership qualities that can be emulated, it is possible to see the light at the end of the tunnel and begin to feel whole again. I watched my institution’s housestaff and my senior colleagues learn to adopt the following 5 essential qualities as they each fulfilled their specific leadership roles.

1. Availability: Perhaps the most important quality a leader adopts during a time of crisis is availability, both physical and emotional. My institution’s senior attending physicians were available to support me at any time, and I in turn tried to do the same for the housestaff. I quickly realized that it was the emotional availability and vulnerability of those leading me that especially struck a chord, such as not being afraid to shed a tear when expressing grief and candidly discussing the overwhelming challenges that lied ahead. Witnessing this human side of leadership among my senior colleagues helped me overcome my internal struggles and subconsciously transition from the standard cerebral and calculated clinical approach to one that incorporated more emotion and empathy.

2. Communication: The constant communication through various platforms was not only productive to disseminate valued information, but also served to expose individual concerns and create a sense of community when many team members were isolated working under the cloak of personal protective equipment (PPE), fear, exhaustion, and anxiety. Not all communication was clinically driven but rather also addressed our bruised and battered emotional well-being. Video chats with colleagues allowed us to keep alive the tradition of supporting each other and laughing together, perhaps when we needed it more than ever.

3. Adaptability: We are all comfortable with structured activities in our daily schedules. But the norm is antithetical to a crisis-driven environment in which being amenable to and embracing constant change must become the new norm. With increasing numbers of physicians and staff becoming sick and new pop-up intensive care units opening almost daily, the housestaff were the foot soldiers subject to constant reassignment to different services and hospitals within our network. This meant instantly adapting to a new system, attending physicians, and service of patients, and required accepting these changes with a sense of confidence and grace. Part of this adaptability meant instantaneous integration of housestaff and attending physicians from markedly different subspecialties and creating a cohesive, highly functional unit caring for patients with severe illness with optimal efficiency. The ability of the housestaff to adapt to newness and the attending leadership to organize and mentor eliminated the standard territorial behavior and instilled a sense of unity, purpose, and a common goal: the “we’re all in this together” mentality. Moreover, despite the waxing and waning availability of adequate PPE, a concept previously foreign to many of us, housestaff and attending physicians alike worked together to revise previous rounding structures and efficiently use available resources. Those in senior leadership roles also adapted to the growing list of issues, devising creative solutions to obtain necessary supplies and even making personal deliveries of PPE to the floors and units. From my standpoint, adaptability to optimize teamwork has been a key aspect enabling us to achieve small successes during this pandemic.

4. Humility: The across-the-board humility exhibited by leaders during the COVID-19 pandemic has been notable and set an example for everyone. I am fortunate to be at an institution with many world experts in various disease processes, but I watched as these leaders identified their gaps in knowledge and expeditiously arranged for myriad platforms to learn from physicians across our institution, country, and world. We were humbled by this disease, so humility became a weapon to achieve greater collaborative knowledge as we armed ourselves to become more effective physicians. I learned to emulate those leaders around me as I humbly leaned on coattending physicians and housestaff to fill my own knowledge gaps while treading unfamiliar waters.

5. Gratitude: Lastly, through the last month of clinical service caring for patients with COVID-19, I have learned the importance of explicitly expressing the gratitude we often feel but rarely verbalize. This became especially imperative during crisis situations when people are most vulnerable. I noted senior leaders taking the time to personally call and express their gratitude to their teams, ensuring they felt valued and respected. These actions were very effective in boosting team morale. Words of appreciation from housestaff, nurses, patients, and leadership often kept me going, and I quickly realized the importance of consciously and consistently verbalizing my own gratitude towards the members of my team that were so heroically caring for patients.

Thus, in an era during which leadership has been a controversial topic, it is important to look within our hospital systems and recognize the exemplary leadership exhibited by so many individuals at all levels to fight perhaps the most challenging medical battle of our time. A lot has changed for me in the last month. I went from my biggest worry being optimizing every stent strut and precisely shaping my coronary guide wire so I could efficiently cross a subtotal occlusion to stepping back and gaining perspective as I was reminded that I am a physician first and a specialist second. The last month has allowed me to feel more connected to my fellow physicians as we have come together to take care of these patients under the most adverse of circumstances. I learned, as John F. Kennedy once said, “Leadership and learning are indispensable to each other.” Perhaps most importantly, I now realize that we must not only continue leading each other to heal patients, but also to heal ourselves.

Corresponding Author: Megha Prasad, MD, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY (This email address is being protected from spambots. You need JavaScript enabled to view it.).

Published Online: June 24, 2020. doi:10.1001/jamacardio.2020.2240

Conflict of Interest Disclosures: None reported.

Additional Contributions: I thank my mentors, Marty Leon, MD, and Ajay Kirtane, MD (Columbia University), whose admirable leadership and dedication served as the inspiration for this piece. They were not compensated for their contributions.

Source: https://jamanetwork.com/journals/jamacardiology/fullarticle/2767015?resultClick=1

MANILA -- The Department of Science and Technology (DOST) is considering the local and finish type of manufacturing, should the Philippines be given the opportunity to reproduce vaccines made by other countries, DOST Undersecretary Rowena Cristina Guevara, chair of the Inter-Agency Task Force's sub-technical working group (TWG) on vaccine development, said Wednesday.

"We are looking at the fill and finish type of local manufacturing as a starting point for the Philippines," she told the Philippine News Agency in an interview.

Both Guevara and DOST Secretary Fortunato Fortunato dela Peña said the country does not have the capability to develop and manufacture coronavirus disease 2019 (Covid-19) vaccine as it does not have the facility.

"These are the reasons why (the) DOST has proposed the establishment of the Virology S&T (Science and Technology) Institute of the Philippines (VIP), and why the sub-TWG on vaccine development is looking for potential vaccine collaborations to be pursued that will be favorable to the Philippines and allow local manufacturing, possibly through licensing from a foreign vaccine developer or company," Guevara explained.

In May, dela Peña shared on his Facebook page that he submitted a proposal for possible legislation for the establishment of a virology institute in the country, which he said would be a premier research institute in virology and diseases in humans, animals, and plants.

The establishment of the VIP would also be for the development of vaccines, diagnostics, and therapeutics, he added.

Guevara said that in the fill and finish type, vaccine manufacturing starts with a bioreactor to produce the antigen.

"At the end of the manufacturing process is the filling up of vials, injection, ampules or container for the vaccine, then it is labeled and packaged for transport. This end of the manufacturing process is called 'fill and finish'," she said.

Other countries' vaccines are still welcome

Meanwhile, Guevara confirmed that even if Russia was the first to register a Covid-19 vaccine, the DOST would still welcome clinical trials on vaccines that are being manufactured by other countries, as long as these would get the Food and Drug Administration's (FDA) approval.

"We have already committed to the WHO (World Health Organization) Solidary Trial for Vaccine where the Philippines will undertake the clinical trials Phase 3 for four or five vaccines that are pre-qualified by WHO," she said.

She added that the DOST is also pursuing collaboration with bilateral partners, whereby vaccine companies may undertake clinical trial Phase 3 in the Philippines. "In all cases, the FDA requirements must be complied with," Guevara said.

Among the functions of the DOST as head of sub-TWG on vaccine development is to review the recommendations of vaccine expert panel it has appointed, regarding possible collaborations for Covid-19 vaccine clinical trials.

Any new development on vaccine is being monitored and evaluated by a panel of experts and members of the sub-TWG, Guevara said.

On Tuesday, Russian President Vladimir Putin announced that the first Covid-19 vaccine in the world has been registered in Russia.

According to the Department of Health, the Russian Direct Investment Fund has proposed to establish partnership with the Philippines to conduct clinical trials, supply doses of Covid-19 vaccine, and set-up local manufacturing. (By Ma. Cristina Arayata, PNA)

Source: https://www.pna.gov.ph/articles/1112055

TAGUIG CITY - The Department of Health (DOH) and Department of Science and Technology (DOST) announced their commitment to fund and support the Philippines’ participation in the World Health Organization (WHO) Solidarity Vaccine Trial as part of the country’s efforts to join the global action in developing a vaccine against COVID-19.

The Solidarity Vaccine Trial will ensure prompt, efficient, and reliable evaluation of the safety and efficacy of the many SARS-CoV-2 vaccine candidates currently being developed worldwide. To date, over 100 countries have expressed interest to participate in this large-scale vaccine trial.

The Philippines’ participation in the trial was approved by the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF-EID) as recommended by the sub-Technical Working Group (TWG) on Vaccine Development led by DOST.

“We are in close collaboration with WHO to intensify our preparations for the Solidarity Vaccine Trial, including the identification of trial sites in the country. In addition, we are continuously monitoring several vaccine candidates with the technical help from the Vaccine Expert Panel,” said Usec. Rowena Cristina Guevara, Chair of the Sub-TWG on Vaccine Development and DOST Undersecretary for Research and Development. (Written by: CJ Gonzalez)

Source: http://www.pchrd.dost.gov.ph/index.php/news/6588-dost-doh-commit-funds-for-ph-solidarity-vaccine-trial

In observance of Breastfeeding Awareness Month, the Department of Health (DOH), World Health Organization (WHO), and United Nations Children’s Fund (UNICEF) jointly appeal to the public to protect, promote, and support the practice of exclusive breastfeeding of infants from birth up to six months and continued with complementary feeding onwards with breastfeeding being the most healthy, efficient, and environmentally-sustainable action of mothers for their children.

This year’s theme, “I-BIDA ang Pagpapasuso Tungo sa Wais at Malusog na Pamayanan!”, reinforces the importance of breastfeeding now, more than ever, because of the COVID-19 pandemic which poses a challenge to infant feeding. We enjoin everyone to ensure that Filipino infants will have proper and adequate nutrition to improve their resilience against the disease and minimize the long-term effects of malnutrition, ultimately meeting the country’s commitment to sustainable development.

The COVID-19 pandemic has taken a toll in many Filipino families’ health. Because of this, we cannot stress enough the importance of ensuring that the correct information on health and nutrition—which includes breastfeeding—reach our people. The child and the environment greatly benefit from the efficient, climate-smart practice of breastfeeding that contributes to food security and reduces our carbon and ecological footprints.

“Breastfeeding is the most complete and sustainable nutrition for the first 6 months of life, with continued benefits when done with complementary feeding for older infants and children. In this pandemic, mothers should not be worried about breastfeeding, as long as proper infection prevention and control (IPC) measures are observed,” Health Secretary Francisco T. Duque, III said.

Duque added that mothers with suspected and/or confirmed COVID-19 should continue breastfeeding, following proper wearing of masks, and frequent, proper handwashing before and after contact with the child. Among the few cases of confirmed COVID-19 infection in children, most have experienced only mild or asymptomatic illness—and this must be supported with the immunological benefits of breastfeeding in infants and young children.

To date, COVID-19 has not been detected in the breastmilk of any mother with confirmed or suspected COVID-19. While researchers continue to conduct tests, it appears unlikely that COVID-19 would be transmitted through breastfeeding or by giving breastmilk that has been expressed by a mother who is confirmed or suspected to have COVID-19. Babies who receive their mothers’ breastmilk receive antibodies that protect them from potentially deadly infections like pneumonia, diarrhea, and sepsis. This is a call for mothers to breastfeed without any additional food or fluids, not even water, for the first six months—and continue breastfeeding with safe, nourishing, and diverse complementary food. Appropriate complementary feeding should be introduced at six months with continuous breastfeeding up to 2 years and beyond.

Following delivery, medical practitioners and midwives are also advised to facilitate immediate and continued skin-to-skin care, including Kangaroo Mother Care, to improve thermal regulation

of newborns and several other physiological outcomes. Aside from the association with reduced neonatal mortality, placing the newborn close to the mother also enables early initiation of breastfeeding which also reduces neonatal mortality.

“Exclusive breastfeeding protects against childhood diseases and death in infancy and childhood, while improving the nutritional status of babies. The protective effect of breastmilk is particularly strong against infectious diseases that are prevented through both direct transfer of antibodies and other anti-infective factors.” said Dr. Rabi Abeyasinghe, WHO Representative in the Philippines “Therefore, it is important to ensure all babies enjoy exclusive breastfeeding during the first six months of their life even during the COVID-19 pandemic,  following standard infant feeding guidelines but with appropriate precautions for infection prevention and control, such as wearing a mask, practicing hand hygiene and cough etiquette.

In all socio-economic settings, breastfeeding improves survival and provides lifelong health and development advantages to newborns and infants. Breastfeeding also improves the health of mothers. According to the 2018 Expanded National Nutrition Survey, however, the percentage of 0-5 months old children who are exclusively breastfed remains to be low at 29.0 percent.

“Exclusive breastfeeding is the first step towards achieving optimum nutrition for children. Aside from improving lifelong health and development, it paves the way for addressing nutrition gaps that prevent children from achieving their full potential,” said Oyunsaikhan Dendevnorov, UNICEF Philippines Representative. “We call on mothers to take this necessary first step as we remain committed in working towards sustainable health and nutrition services for every child and mother in the country.”

Several legislations have been enacted by the Philippine Congress to support better nutrition, especially during the first 1000 days of a child’s life, including Republic Act (RA) 11148 or the Kalusugan at Nutrisyon ng Mag-Nanay Act, RA 11210 or the Expanded Maternity Leave Act, RA 10028 or the Expanded Breastfeeding Promotion Act, RA10821 or the Children’s Emergency Relief and Protection Act, and the Executive Order 51 or the Philippine Milk Code.

DOH, WHO, and UNICEF call for the firm and continuous enforcement of these legislations, particularly the Philippine Milk Code, the strict regulation of milk donation, and the implementation of Essential Infant and Newborn Care (EINC) or “Unang Yakap” during the time of COVID-19.

Source: https://www.who.int/philippines/news/detail/05-08-2020-breastfeeding-must-continue-amidst-covid-19