Since the launch of the COVID Confirmed (COCO) Clinic in early April, over 4,700 patients with COVID-19 have been given virtual follow-up services after being discharged from the hospital. Not only has this virtual outpatient clinic helped patients on their road to full recovery and often kept them from being readmitted to the hospital, it also provided resident physicians and senior medical, nurse practitioner, physician assistant, PharmD, social work and behavioral health students, with a place to complete their clinical rotations. In mid-March, the Association of American Medical Colleges (AAMC) issued new guidance for medical student clinical rotations during the coronavirus which stated that it, “strongly supports medical schools pausing all student clinical rotations, effective immediately, until at least March 31,” due to concerns about the availability of personal protective equipment (PPE) and to give time for appropriate educational strategies and alternative clinical experiences to be developed and implemented.

Volunteers and trainees played vital roles within the clinic which included conducting regular welfare checks, offering support and discussing any symptoms that haven’t been resolved. Social work and behavioral health students were not originally part of the COCO Clinic when it first launched, but the team quickly realized that COVID-19 and quarantine could severely impact a patient’s mental health and so the interprofessional team expanded. The medical, social, and mental health assessments screened for depression, anxiety and substance abuse, and if a patient answered “yes” to any of the questions, they were offered resources or referrals to support. According to Asa Oxner, MD, FACP, COCO Clinic operations director, one patient agreed to being referred to the mental health team of COCO and a real suicide attempt was mitigated.

In addition to regular follow-up assessments, nurse practitioner students were in charge of monitoring the dashboard that displays the oxygen levels and heart rates of high-risk patients who were wearing a special device on their wrist.

A patient wearing one of the COCO Clinic’s monitors. Photo by CBS affiliate, 10 Tampa Bay, from their, “COVID-19 Telehealth Clinic Getting Overloaded with Tampa Bay Patients” video.

“Volunteering with the clinic has been a unique educational experience. The clinic administrators do a great job of turning every opportunity into a teaching moment,” said Joshua Mizels, Morsani College of Medicine fourth-year medical student and past clinic volunteer. “My classmates who all volunteer have had the opportunity to keep interacting with patients, giving us the opportunity to learn more about what they are going through during this pandemic.  The experience from this opportunity has been invaluable toward my medical education. ”

Lucy Guerra, MD, MPH, FACP, and Asa Oxner, MD, FACP, co-coordinators of the COCO Clinic, along with Elimarys Perez-Colon, MD, medical director, Christine Jennings, RN, nurse manager, and Rachelle Idziak, MD, data manager, led the effort to get the clinic up and running and play a pivotal role in helping the community. For their dedicated efforts, the doctors received a USF Health Culture Coin from Chief Medical Officer, Dr. Mark Mosely.

Dr. Asa Oxner (left) and Lucy Guerra (right), COCO Clinic co-coordinators, were presented with USF Health culture coins by Dr. Mark Moseley, USF Health chief medical officer, for leading efforts to get the virtual clinic up and running.

“We have been successful in offering close follow up to patients keeping them out of the hospital when able, monitor patient’s vital signs remotely to identify patients at higher risk, safely linking patients to care and offering education and reassurance to patients with COVID19 in the Hillsborough county,” said Dr. Elimarys Perez-Colon, assistant professor of medicine, vice chief of medicine at Tampa General Hospital, and medical director of the COVID-19 Confirmed Clinic. “The data collected will assist our department of health to better understand the distribution and epidemiology of COVID19 in our county. This effort wouldn’t have been successful without the assistance and compassionate care offered by our trainees.” In the first three months, over 150 trainees played a part in the care of patients.

The COCO Clinic has been the talk of the town, featured in news stories by ABC Action News, Baynews 9, 10 Tampa Bay, among others.

After the success of the virtual clinic for COVID-19 patients, clinic leaders began working with partners at Tampa General Hospital and the Florida Department of Health to make the clinic a permanent resource for the community. As of November 12th, the COCO Clinic transitioned management of the clinic to TGH and became the TGH Transitional Care Center. “This transition will allow the clinic to continue operating and provide excellent care to our patients impacted by COVID-19, while allowing USF Quality and Clinical Operations Department staff who have been assisting the COCO clinic to return to their normal non-COVID duties,” said Dr. Moseley. “The clinic will continue to provide hours to our medical, pharmacy, and nurse practitioner students and our teaching attendings will continue to support the clinic. TGH has also been able to hire several RNs and Mas, who have been training in the current clinic and will be able to facilitate a smooth transition.” An emphasis will be put on taking care of COVID-19 ‘long haulers,’ virus survivors who continue to have side effects weeks, or months, after surviving the coronavirus. Caring for these patients will also help conduct research into the little known long term effects of COVID-19. Beyond COVID-19, the clinic can continue to help patients using the same monitoring and staffing model, but for serious chronic diseases such as heart failure or chronic obstructive pulmonary disease (COPD).

The four USF Health physicians who traveled the Bahamas to offer medical help to evacuees from Hurricane Dorian have returned, sharing details about their effort.

Seetha Lakshmi, MD, Andrew Myers, MD, Asa Oxner, MD, and Elimarys Perez-Colon, MD, — all on faculty in the Department of Internal Medicine in the USF Health Morsani College of Medicine – spent several days in Nassau.

Arriving in Nassau to help provide medical care are, from left, Dr. Seetha Lakshmi, Dr. Asa Oxner, Dr. Andrew Myers, and Dr. Elimarys Perez-Colon.

The team evaluated around 50 to 60 pediatric patients for school physicals and acute illnesses.  Patients were about 60 to 70% Haitian living in Abaco and now living in public shelters. Most common ailments were upper respiratory infections, dermatologic diagnoses, asthma, allergies, pneumonia, probable tuberculosis, which was referred to hospital for diagnosis and treatment, and grieving/emotional and psychological trauma.

The trip also included a delivery of 3,000 pounds of medical supplies and medications. This adds to the estimated 50,000 pounds of medical and para-medical humanitarian donations that this group of partners has been able to source and deliver to Rand Memorial Hospital on Grand Bahama over the past two weeks.

Help is still needed to continue the donation effort. Please visit: usf.to/Bahamas

Reactions from the USF Health team:

“We were really surprised by the amount of resiliency we saw because they were evacuee patients, but then they have smiles on their faces and plans for their future,” said Dr. Oxner. “We are also really impressed with how organized the (Bahamas) Ministry of Health is. We’ve participated in other responses in other countries and the Ministry of Health in the Bahamas was much more organized.”

“We offered a lot of help to children who were displaced and trying to get back to school,” said Dr. Lakshmi. “The parents who brought them in just teared up. Another child came in, a four-year-old girl, and she had a rash all over her body and I asked the parent how it started. She said they were in their house when the water started coming up and up. She grabbed her kids and ran up to the hilly area where there was an abandoned truck. She loaded her kids in and she saw the water rise up. They were in chest deep water for 12 hours.”

“In addition to donations, they are going to need more mental health and support,” said Dr. Perez-Colon. “The trauma we witnessed there is very significant. These kids are incredible. They’re resilient. Some were smiling but a lot of them we had a little bit of trouble getting close to them, and some had trouble having eye contact, having nightmares. So they do need more mental health help.”

Dr. Elimarys Perez-Colon with a young girl in Nassau.

Tampa, Fla.  (Oct. 17) — Back from last week’s trip to Puerto Rico, USF Health’s Dr. Asa Oxner discussed her recent experience treating patients and assessing critical medical needs in outlying rural areas of the hurricane-ravaged island.

Dr. Oxner spoke with local news media outside the USF Health Morsani Center for Advanced Healthcare.  She was joined by USF Health Director of Safety and Preparedness Don Mullins, who oversaw the Oct. 11 delivery to Puerto Rico of 1,500 pounds of USF Health-donated medications and supplies aboard a jet chartered by the Tampa Bay Rays for a medical humanitarian mission.

“We saw lots of devastation – power lines cut in half, laying across roads and homes, bridges down and roads full of debris,” Dr. Oxner said.

Dr. Asa Oxner of the USF Health Department of Internal Medicine speaks with local news media about ongoing USF Health disaster relief efforts in Puerto Rico following her return from the island.

Dr. Oxner and Dr. Elimarys Perez-Colon, both assistant professors in the Morsani College of Medicine’s Department of Internal Medicine, spent five days in Puerto Rico working out of hospitals and shelters in devastated rural areas of Puerto Rico.  They also assisted in sorting and delivering supplies and medicine, — including insulin, IV fluids and tubing, and specialized baby formula — donated by USF Health, Tampa General Hospital and other provider partners.

Hospitals in urban areas like San Juan and Ponce where power and water have been restored are rebounding, and most of those critically injured from the hurricane have been treated and are recovering, Dr. Oxner said.

“The long-term health concern is patients with chronic illnesses like heart disease, diabetes and respiratory disorders who cannot access care,” she said.

They live in the central mountainous region of the island hit hardest by the hurricane, and mudslides continue to make many roads difficult to navigate, she added. “They will continue to have shortages in medications for chronic conditions, because the supply chain has been disrupted.”

A dozen cases of leptospirosis, a waterborne bacterial disease, have been reported to the Puerto Rico Department of Health, Dr. Oxner said, adding that the island is also at high risk for diseases like cholera that can emerge after disasters in places with contaminated water.

Dr. Oxner, who spent a year in 2014 helping patients infected with Ebola in Sierra Leone, has always been interested in helping underserved populations impacted by disparities in health care. “Those are the patients I connect with,” she said.

Dr. Oxner is one of 12 Spanish-speaking USF Health doctors, many with disaster experience, who will travel to Puerto Rico over the next two months. She plans to return to Puerto Rico at the end of October.

You can help with USF Health’s relief efforts in Puerto Rico.  Go to the USF Herd Funder site to contribute.

-Photo by Sandra C. Roa, University Communications and Marketing

1,500 pounds of medications and supplies donated by USF Health were delivered Oct. 11 to hurricane-ravaged Puerto Rico on a jet chartered by Tampa Bay Rays for a humanitarian relief effort.

//www.youtube.com/watch?v=Zt5BLxnsftE

Video courtesy of Tampa Bay Rays

USF physicians are now in Puerto Rico donating medical supplies and treating patients severely impacted by Hurricane Maria.

Asa Oxner, MD, assistant professor of Internal Medicine at the USF Health Morsani Collge of Medicine, works without power in Puerto Rico with only the illumination from a head lamp.

Asa Oxner, MD, and Elimarys Perez-Colon, MD, both from the Department of Internal Medicine in the Morsani College of Medicine, landed in San Juan Saturday, Oct. 7. They brought along donated boxes of medications, IV bags and fluids to various hospitals including the Hospital Menonita de Caguas, which is affiliated with the San Juan Bautista Hospital and Medical School.

Drs. Oxner and Perez-Colon traveled to  rural areas to treat patients with diabetes and high blood pressure. They’ve worked in shelters where most patients had their homes destroyed in the hurricane and don’t have the means to travel to hospitals in larger cities.

Dr. Oxner (far left) and Dr. Elimarys Perez-Colon (second from left), a USF hospitalist in internal medicine and pediatrics, are welcomed by officials at Hospital Menonitas Caguas, affiliated with the San Juan Bautista Hospital and Medical School. That’s where majority of the supplies from USF have been dropped off.

On Wednesday Oct. 11, USF Health Director of Safety and Preparedness Don Mullins escorted more than 1,500 pounds of additional supplies and medications donated by USF Health — including insulin, anti-inflammatory medications, IV supplies and baby formula —  aboard a jet chartered by the Tampa Bay Rays for a humanitarian relief mission to Puerto Rico.   The charter jet took off about 9:30 a.m. Wednesday morning carrying tons of medical supplies, food and water from the Tampa-based Course of Action Foundation as well USF Health’s supplies.

Boxes of donated medications and supplies are unloaded on the tarmac in Ponce, Puerto Rico, from a jet chartered by the Tampa Bay Rays for a humanitarian relief mission. The cargo included 1,500 pounds of medications and supplies contributed by USF Health. | Photo by Don Mullins, USF Health

Don Mullins, director of safety and preparedness at USF Health, carries a case of insulin from the airport runway to vans waiting outside the airport to deliver the supplies to hospitals coordinating their distribution.  Mullins escorted USF Health’s delivery and supervised claiming and sorting the boxes. | Photo by Dr. Asa Oxner, USF Health

Dr. Perez-Colon and Dr. Oxner load a chest of refrigerated insulin into a van in Ponce, Puerto Rico. | Photo by Don Mullins, USF Health

Once the flight landed in Ponce, Puerto Rico, Mullins connected with Drs. Oxner and Perez-Colon, to unload and sort the supplies and medications so they could be allocated to outlying rural areas based on need.  The USF Health group also met with representatives from Hospital Menonitas Caguas and San Cristobal Hospitals in Villalba and Juana Diaz municipalities. The two doctors — who spent the last five days in Puerto Rico caring for patients and assessing items critically needed in the outlying rural communities including pediatric nebulizers, prescription baby formula, disposable IV tubes and sterile saline water  —  accompanied Mullins on the flight back to Tampa at 2:30 p.m. the same day.  They plan to make a return trip with more supplies later this month, joined by other doctor colleagues.

Dr. Perez-Colon sorts through the various types of insulin to be delivered for patients in hospitals, shelters and outlying communities. | Photo by Don Mullins, USF Health

A total of 12 USF physicians will travel to Puerto Rico over the next two months to provide additional medical care.  Many have disaster relief experience helping local physicians and hospitals care for victims of earthquakes and disease outbreaks in other countries.

“These folks are our Navy SEALs; they’ve been in Haiti, they’ve helped with Ebola,” Charles Lockwood, MD, senior vice president for USF Health and dean of the Morsani College of Medicine said in an interview with the Tampa Bay Times.  “They know what they are doing.”

Dr. Oxner packs medications and supplies at USF Health before leaving for San Juan, Puerto Rico on Oct. 14. | Photo by Sandra C. Roa, University Communications and Marketing

You can help too! Go to the USF Herd Funder site to contribute.

-Story by Tina Meketa and Anne DeLotto Baier, University Communications and Marketing