Dr. Marlene Wüst-Smith is a pediatrician by training who serves as medical director for a small private university in rural western New York. It was supposed to be her “easy job” that would afford her ample time to work on the magazine, Physician Outlook, she had founded. It seemed “easy”... until COVID-19 decided to rear its ugly head six months into her tenure at the helm of the university’s health services.

Doctoring during a pandemic on the front lines of an institution of higher learning has given her lots to write about and a unique perspective on what it’s like to practice medicine in 2020. We are pleased she has shared her insights in this Q&A on how she and her school is dealing with COVID-19:

HO: One of the most challenging groups to monitor and treat is the college student population. As a medical provider at a university, what safety protocols do you employ to see and treat patients?

Wüst-Smith: Most of the visits with the students begin as telemedicine encounters where I evaluate them via “zoom” before bringing them in for testing or for an in-person exam. Telemedicine allows for adequate history taking and overall assessment of the patient’s status while minimizing potential exposure. At our facility, we have locked our doors and only see students by appointment. This has translated into lots of phone calls and communication via secure messaging in the Electronic Health Record.

HO: What protocols do you use to test students for COVID-19 who are exhibiting mild or no symptoms, as well as those who are highly symptomatic?

Wüst-Smith: The University has set up a tent outside of our office for swabbing anyone who has any potential COVID symptoms if they appear well. We perform rapid COVID antigen testing (dressed up head to toe in PPE). If a student has a fever, cough or is VERY symptomatic, we examine them in one of 13 rooms in our “COVID” hallway instead of bringing them indoors to the actual Wellness Center side. Regardless of their test result, they will be housed in one of the “COVID” rooms if they share a dorm room with someone else until they improve. We sometimes send a second (or third COVID swab).

HO: Studies have shown that while classroom activity has not been a major factor in spreading the virus because of precautions taken, strict sanitizing, social distancing and masks. Social gatherings on campus appear to be the major cause for concern in terms of virus spread. Do you find that true at your school?

Wüst-Smith: The university has been very proactive about disciplinary action for those students who break rules (parties on campus, off campus parties that are in violation of the social contract each student signed, etc.). In one incident, the involved students were sent home for two weeks and had to submit a negative molecular test prior to return. We assist the local health department with contact tracing by automatically quarantining the roommate (usually in place as they are now inhabitants of a single room, with meals delivered, and with an excuse to attend classes remotely) as the infected person is put into isolation in our “COVID” hallway.

HO: How else is your school cooperating and working with public health officials? Is there something you might change in the way they interact with you?

Wüst-Smith: At the county’s request, we also help to identify those students/contacts who had more than 15 minutes of unmasked exposure to the positive student (those who may have eaten together, have been passengers in a car together, etc.).  The county also has requested seating charts, which we at the university feel is likely the LEAST likely place where students are exposed to the virus as seats are six feet or more away from each other.  We have provided pictures of auditorium seating when we have felt that the county’s tracers are over-identifying potential contacts.

HO: What has been your biggest challenge in contact tracing those gatherings and impressing students with the importance of good hygiene, masking and social distancing outside the classroom?

Wüst-Smith: We have plenty of signage reminding students about the importance of hand hygiene, social distancing and mask wearing. Impressively, MOST have been compliant, although many are getting weary. We are trying to impress upon them that the end of the in-person semester is drawing near. With 18 deaths in a small county we do not want our students 1) inadvertently blamed for spread of the virus within the county and 2) we don’t want them going home for Thanksgiving and inadvertently infecting their at-risk grandparents, neighbors and other relatives. 

Be sure to check out Dr. Wüst-Smith’s publication, Physician Outlook, at www.physicianoutlook.com