Top Doctors Special Report: Pivoting in a Pandemic

To battle COVID-19 effectively, doctors in Minnesota need to respond swiftly and strategically to adapt to changes in protocol and care. Despite high patient volume, shortages of equipment, and a disease that’s not wholly understood, these health care workers are innovating process and practice with unprecedented collaboration between systems. Learn how these professionals improve best practices, research new treatments and vaccines, and elevate care strategies to improve patient outcomes regionally and globally. Then read on to discover more than 800 local top doctors from 46 specialties who have been selected through a process involving extensive research and peer review.

See the complete list of doctors selected to this year's Top Doctors.

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Sharing Critical Knowledge 

Back in January, before the terms “social distancing” and “PPE” (personal protective equipment) peppered conversations, before COVID-19 even had a name, Michael Osterholm, director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota, met with technical staff at 3M’s headquarters in Maplewood and urged the company to ramp up production of N95 respirators. The company responded by quadrupling production and airlifting the masks—crucial to protecting health care workers from the virus—to hotspots in New York City and Seattle.

“That saved thousands of lives,” says Osterholm.

It proved to be one of the few examples of preparing ahead in the United States. It also may have been the first meeting of what’s turned into an unprecedented collaboration among hospitals, public health experts, and government and industry leaders to combat the COVID-19 pandemic in Minnesota.

The degree to which we are working together during COVID-19 is remarkable. 

Dr. Mark Sannes

Elsewhere, while early debates waged about potential influx and impact of the disease, the crisis was quietly escalating, threatening to throw the health care system into chaos. Much was unknown: What kind of PPE would protect health care workers, and where would it come from? Would doctors and nurses get too sick to work? Would national guidance be helpful? Would testing work? What would a quarantine look like?

When the virus hit Seattle and New York, the importance of prep work became clear: In order to prepare for a surge of unknown size, nature, and arrival date, states would need to make room for more sick people to receive high-level hospital care. University of Minnesota researchers helped model those needs for Minnesota, the state started counting beds and PPE, and hospitals started discharging patients, eliminating non-urgent procedures, and buying real estate to house an overflow of patients. 

By mid-March, as hospitals scrambled to set up drive-up testing sites, different health care systems started doing something rare in the industry: calling competitors to share best practices. “I remember Fairview giving us some hints on what worked well for their drive-up sites, which were first,” says Dr. Mark Sannes, an infectious disease physician with HealthPartners with expertise managing HIV and HPV infection. “I remember a call the same day with two other large systems in the metro about how we might try to leverage all of our sources to get more testing supplies for the Twin Cities.”

Several weeks later, on April 22, Gov. Tim Walz announced a $36 million initiative that he hoped would allow Minnesota to test 20,000 people per day, more than any other state—and possibly more than anywhere else in the world.

“This is not a state that’s just going to get through COVID-19. This is a state that’s going to lead this nation and the world out of this,” Walz said at the press conference that day. The plan involved the Minnesota Department of Health, the Mayo Clinic, and the University of Minnesota operating a central lab, working with the state’s health care systems.

“Today in particular it’s a proud moment for health care systems to be part of this collaboration,” Sannes said that afternoon. “While we remain separate [health care] systems, the degree to which we are working together during COVID-19 is remarkable. We’re collaborating on a scale that no other state is. On a scale of public health interventions, we haven’t done this before in Minnesota, and it might put us at a completely different level. I’m excited about that potential.”

As the pandemic continued to rage through May, such collaborations started to pay off. Sharing equipment helped ensure that patients had access to treatments such as ECMO, a therapy that adds oxygen to blood and pumps it through the body. ECMO machines are limited, so transfers between hospital systems became common, said Dr. Seth Baker, a pulmonologist and intensive care doctor at Allina.

Sannes hopes that type of cooperation will become a new norm, even after the current pandemic is over. 

Until then, it’s a safe bet that doctors will continue to face COVID-19 challenges. The latest predictions on the pandemic’s path from Osterholm’s team aren’t exactly rosy: In the best case scenario, we’re still quite far from any sort of normal. To reap the benefits of early social distancing efforts, Osterholm says, will require continued vigilance and compliance with social distancing guidance. Much will depend on the continued willingness of Minnesotans to adjust lives and businesses around public health.

“Minnesota’s Department of Health and the governor have done a terrific job of delivering clear messaging, and trusting the officials leading this work is the most important thing,” he says.

Says Sannes: “Minnesota may blaze a trail for others on this, and it’s fun to be part of that, even in this unprecedented, difficult time.” 

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Innovating New Care Strategies 

Fortunately, only about 1 percent of people with COVID-19 need to go to the hospital. While many of us may fear going to an emergency room during the pandemic, those who need to go will find themselves in a transformed environment, thanks to administrators and doctors on the lookout for creative ways to treat coronavirus patients while keeping health care workers and other patients safe.

At Hennepin County Medical Center (HCMC) in downtown Minneapolis, a screener at the door gives patients colored stickers indicating how likely it is that they have coronavirus. 

“One of our biggest goals is to keep COVID-19 patients separated from trauma patients,” Dr. Rob Reardon, ER doctor at HCMC, says. “People are going to keep on breaking bones and having car accidents and heart attacks, and we want to keep them safe and away from patients who might have it. That’s a lot of our effort right now. As we know from Italy and China, there were big problems in emergency rooms with patients who didn’t have it not getting proper care.” 

So patients with green stickers, which indicate they are lower risk for coronavirus, are shuttled into an area with other non-COVID-19 patients. And anyone with a yellow or red sticker demonstrates a higher COVID-19 risk and begins another patient journey. All patients are separated from family, but for some, says Dr. David Plummer, also in the ER at HCMC, “they come in with their loved ones and know they have a super high risk of dying, that it might be the last moment they see them alive.”  

Reardon and Plummer, who have worked together for decades and describe it as a “blast,” share a lot, including credentials: Both are full professors in emergency medicine at the University of Minnesota. Both are widely published and cited as leaders in using ultrasound for emergency resuscitation of critically ill and injured patients, diagnosis, and treatments. Both have lectured nationally and internationally on emergency resuscitation, airway management, and point-of-care ultrasound for resuscitation.

They realize it’s up to them and their fellow health care workers to help patients and families communicate. But the first hurdle is getting patients to the emergency department critical care area while continuing their breathing treatment—and not putting health care workers at risk, Reardon explains. In the first weeks of COVID-19, that usually meant stopping the treatment while the patient was rushed to a negative-pressure room. Once there, health care workers wearing “super PPE,” including scrubs, gowns, and N95 masks with goggles, could safely restart treatment. But the safety protocol means doctors can’t touch and comfort patients in the ways they usually do, Plummer says.

As those early days revealed opportunities for improvement, the Slack channel for HCMC ER doctors shifted from focusing on administrative business to being an outlet of “almost constant chatter” on what was foremost on every doctor’s mind: COVID. Even while fixing a broken arm, Plummer says, his thoughts turn to: “Am I protecting this person sufficiently from COVID?” So, doctors use the channel to share everything from big-picture tips on treating critical cases to reminders to replace lights in the backup intubation scope. “Tons of ideas get posted, sometimes from the ED in the heat of battle, sometimes at home, reflecting on the situation,” Plummer says. “These conversations are rapidly reviewed by the rest of the faculty, and very quickly (sometimes real-time), we come up with and distribute a solution.”

For example, Reardon connected with another ER doc with a penchant for home repair projects to work out a solution for transporting patients without stopping their breathing treatment. Emergency Department physician Dr. Marc Martel built a frame out of PVC piping that holds a large plastic bag, creating a tent around the patient that allows breathing treatments to continue while a patient is transported from an ambulance to the emergency room or from the ER to the ICU. People chuckle when they see it, Martel says, but it’s been well received by both health care workers and patients as a “goofy thing in a goofy time, but an added layer of safety.” The plastic hood is set to be published in Annals of Emergency Medicine. 

The team has also worked out innovative communication measures to replace face-to-face interactions between doctor and patient. HCMC rolled out remote-control robots in April, for example: An iPad attached to a mini-Segway-like robot scoots around the patient’s room, allowing the patient to consult with a specialist or even connect with a family member. 

Some of these measures are simple, common-sense gestures: Reardon and Plummer make sure to scribble down the cell phone numbers of every new patient so they can communicate with them. Now that entering a room requires gearing up in head-to-toe PPE, a call or text back and forth makes a lot more sense, Reardon explains.

The doctors remind themselves that they are fortunate to be in a situation where COVID-19 patients can readily be admitted to the hospital. “We’re not overrun like New York was,” Plummer says. 

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Finding Promising New Therapies 

Dr. Leslie Baken is the Infectious Disease lead at North Memorial Health Clinic and medical director of Infection Prevention, Antimicrobial Stewardship, and Infectious Disease at North Memorial Health. She previously served as medical director of infection prevention and control at Methodist hospital, and she’s consulted with the Minnesota Department of Health on health care workers infected with blood-borne pathogens, participated in AIDS research and cared for HIV patients throuhgout her career, and worked as an ID doc since 1992, when she was an attending physician at an STD clinic in Seattle. And now, COVID-19 has radically changed her work.

Every day, Baken talks to her colleagues and searches through journals, PubMed, news from medical societies, Facebook, and Twitter for promising new therapies for COVID-19 patients. So, when North Memorial colleagues Dr. Daryl Tharp and Dr. Betty Pakzad told her that the Mayo Clinic was starting a nationwide program to use plasma from recovered COVID-19 patients to boost helpful antibodies in the sickest patients, Baken was inspired.

The Convalescent Plasma Expanded Access Program is currently believed to be the best method available for treating the disease. “It’s a very positive effort, and it will be important and early information if it works,” says Osterholm, the director of CIDRAP at the University of Minnesota.

Over 2,000 hospitals, including about 40 in Minnesota, have infused more than 18,000 patients so far. In the first two weeks at North Memorial, nurses hooked up 30 patients to an IV that fed them the convalescent plasma. About half recovered and went home, Baken says. It’s too early to tell how significant that is; the Mayo Clinic is in the process of collecting data for further study. 

Baken wanted in, in part, because convalescent plasma has been used successfully in the past—as far back as the 1918 flu pandemic—making it an extremely safe choice for patients. And doctors have demonstrated improvements in patients given convalescent plasma with the 1918 flu, H1N1, viral pneumonia, bone marrow transplants, SARS, and MERS. Baken has used a similar substance—lab-produced immune globulin—to combat rabies, hepatitis A, and hepatitis B.  

Ultimately, the plasma program should help doctors and scientists better understand how important antibodies are in controlling COVID infection, Baken says. Even if convalescent plasma doesn’t prove to be the perfect antidote, it’s an important step in finding something that is. The study may also help doctors and scientists understand whether antibody tests can determine if people are immune to future infections.

In addition to overseeing the plasma study, Baken also helps with “the monumental task of advising on and supporting infection prevention practices for our health care workers,” she says.

Every Wednesday since COVID-19 hit the state, the Minnesota Department of Health has hosted a call for infectious disease doctors to trade tips and discuss potential therapies. It’s given others a chance to learn from North Memorial’s experience, Baken says, and to connect research assistants from different hospital systems to collaborate on how to implement the study, interpret the directions, and converse with people at Mayo Clinic. 

“I don’t know how much of the collaboration will continue on after this, but certainly this has been a really frightening experience for the country—but it’s also given us the opportunity in different health care systems to meet, greet, and collaborate with colleagues—and that can only be good for the future,” she says.

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Thinking Outside the Box 

We’re all more familiar with surgical masks and N95s than we ever thought we’d be. But in the early days of COVID-19 in Minnesota, several local doctors realized that protection beyond masks and gowns would be key for health care workers to stay safe during critical moments of taking care of patients with coronavirus.

Not surprisingly, others around the world had already started working on the problem: Doctors in Taiwan had created a plastic box that sits over a patient’s neck and shoulders with two armholes for a provider to reach through to deliver breathing treatments. The easily transportable, clear box protects the health care worker from droplets that may carry the virus.

At the University of Minnesota Medical School, professors Dr. Kumar Belani and Dr. Gwenyth Fischer recognized the problem with this device—independently of each other—and the potential for an improved solution. They’d need to collaborate with other departments with unprecedented speed.

So they built a model based on the Taiwanese concept and figured out what they wanted to change. Colleague Dr. Hai-Thien Phu, an internal medicine and pediatrics resident, had no luck finding people with aerosol science knowledge over email, so she walked over to the mechanical engineering building one day in late March. The building was deserted due to stay-at-home orders except for Chris Hogan, a professor of mechanical engineering who was gathering the department’s supply of PPE to donate to medical workers. He saw Phu wandering the halls and asked who she was.

“She said, ‘I’m a physician looking for an expert in aerosol science,’” says Hogan, who happens to be editor in chief of the Journal of Aerosol Science. “I’ve never had anyone say that to me.”

Phu cried from joy when she got to her car. “I finally found someone to help with this device that I thought has huge potential to save lives during this pandemic.”

Since then, a team of about 17 people has collaborated on two new versions of the aerosol box. M Health Fairview hospitals launched the second version, with 13 boxes in use so far. The boxes feature four armholes so that three health care workers can reach the patient at once, and the openings are better protected than on the original. Volunteers tested version 3.0, which features the addition of a HEPA filter on the top.

“There is active (powered) filtration through the HEPA filter to clear the air in the box. So the HEPA filter sucks up anything that is aerosolizing, like if the patient coughs or sneezes,” Belani says. “So, the patient can be using BiPAP, high-flow nasal oxygen, and it will not come into the room.”

The HEPA filter allows just three of every 10,000 particles to pass through, whereas an N95 mask allows one out of every 20 through, Hogan says.

“It adds an extra layer of protection,” says Fischer, who adds that health care workers would keep their PPE on while working with patients in the boxes. The newest version could be a game-changer in the case of a local surge, Fischer says, since many patients could use the vent box and save negative-air-pressure rooms for those who need them most.

The team believes the new version is the only model that combines three things: a rigid structure, ports for multiple providers to access the patient, and active filtration. “We would like to have one for every Fairview hospital–and we’re getting requests from outside Fairview, too,” Fischer says.

Phu thinks the device may provide another service to patients who are currently isolated: “Hopefully if we can contain the spread of aerosol, they can be surrounded by loved ones again during these scary times,” she says. 

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Responding on the Frontline

As a registered nurse of 30 years, Jeanne Scholz has never known what her workday in the emergency room will bring. But since the first case of COVID-19 hit Methodist Hospital in March, never-before-implemented rules and strategies due to the pandemic mean her 12-hour shifts are unlike any she has experienced before.

A full set of PPE (N95 mask, face shield, cap, scrubs, and gown) is worn for every interaction with every patient, even to treat a laceration, just in case the person is COVID-19 positive.

To save critical PPE, when Scholz is assigned to a critically ill COVID-19 patient, she stays at the bedside for hours at a time, never leaving the room. She spends her shift hanging fluids, adjusting medication, checking blood pressure—everything that has to be done face-to-face. If she needs new medication or anything outside the room, she uses the call light to request a dropoff at the patient’s door. 

These shifts are certainly more stressful than pre-COVID-19, but everyone is now used to donning and doffing procedures, she says. “It’s not as scary as it used to be for me.” Often, though, it is heartbreaking. “Working in the ER, it’s a front-row seat to raw grief and sorrow. But COVID seems to multiply it because people can’t be with their loved ones when they’re very, very ill,” she says. “In the ER, COVID becomes very raw and real.” 

A few things get the team through those raw days: The hospital’s detailed contingency plan, she says, ensures she and her colleagues are prepared for a surge. “That enables all of us to be very brave and confident, knowing they’re going to do the right thing,” she says. “Doctors and clinicians are on the lookout for us,” she adds. “They have brilliant minds and big hearts, and they always look out for our best interests as nurses.” 

She’s also buoyed by the signs of good will: cards and hand-drawn pictures from kids taped to the walls, restaurants sending meals, sewing groups making masks, grandmas sewing scrub caps. Like many in medicine, Scholz considers her work “a profound privilege.” Scholz believes health care workers will emerge from this pandemic stronger. “This has brought up a level of compassion and bravery and we’ll-get-through-it attitude that’s inspiring every day.”

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Researching Vaccines and Immunity 

Since 1991, Dr. Mark R. Schleiss has been studying cytomegalovirus, a common virus that can cause health issues in babies, who can be infected during pregnancy. He’s acutely aware of the need for more research on vaccines and pregnancy to safeguard the health of kids and moms. So when the first case of COVID-19 was confirmed in Minnesota, the professor of pediatrics in the University of Minnesota Medical School tweeted: “Why does COVID-19 seem to spare children? Need to study this!”

He applied for funding: Could a potential COVID-19 vaccine for a pregnant guinea pig result in antibodies in the guinea pig and the newborn pup? 

“The reason I felt so strongly about it was that, from experience, we never study infectious diseases (or indeed most medical issues) as much as we should in infants and children,” says Schleiss, who is a member of the Institute for Molecular Virology. “Infants and children always get the ‘short end of the stick’ when grants are distributed by the NIH and other agencies. That is, at least in part, because there are not enough people in positions of influence to speak up for children.”

And now that the disease does seem to be impacting some adolescents through an inflammatory syndrome, this work has taken on a new urgency. There’s also some evidence that newborns are susceptible to the virus.

Everyone wants a vaccine tomorrow, Schleiss acknowledges, but the main reason development takes so long is to ensure safety and effectiveness. He and lab colleagues Dr. Yuying Liang and Dr. Hinh Ly hope to have a study ready to test in guinea pigs soon. Finding the right vaccine candidate to test may seem elusive, but for vaccinologists, “this is not our first rodeo,” he says. If the trial produces an immune response, the researchers could challenge the animals with an infection. 

This research could improve confidence that human moms and babies will be able to get safely inoculated when a COVID-19 vaccine is produced. Even if the vaccine his lab tests isn’t licensed for humans, Schleiss is hopeful that his lab will have been able to prove the concept of whether any vaccine given to a mother during pregnancy would protect her baby and be safe for both mother and baby. Based on other vaccines, such as for the flu and whooping cough, there’s reason to be hopeful it would be safe and effective. 

In the meantime, the lab also started looking through its collection of saliva samples from newborns from a separate project, realizing they could contain clues toward when SARS-CoV-2 actually “appeared” in Minnesota. If tests could show that asymptomatic babies were actually infected with COVID-19, it would not only show how early the disease appeared in the state, but also how the virus may have evolved genetically as the pandemic emerged across the United States. 

“There is a lot of discussion about virus mutation and how that might affect vaccine design,” he says. “The more we know about strain variation and evolution over time, the more knowledge we have that helps inform vaccine design.”

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Preparing for the Future 

Dr. Seth Baker was a fellow during the H1N1 outbreak in 2009. All of the surge planning and meetings about patient care at Rush University Medical Center in Chicago turned out to be something of a blessing in disguise. “It got me a little prepared for the mental stuff of how to adjust on the fly,” he says.

So when the threat of the current pandemic loomed, Baker was thinking ahead. Now a pulmonologist and intensive care doctor for Allina, his non-COVID patients weighed on his mind. He’d had to put lung cancer treatments on hold. Patients with new lung masses couldn’t get biopsies. Hospitalized patients couldn’t have visitors in the intensive care unit. He had to deliver probable lung cancer diagnoses over the phone. 

But Baker also has a degree in public health, and he understood early how the actions of every Minnesotan would affect his patients. The day after Minneapolis Public Schools closed its brick-and-mortar doors, Dr. Seth Baker drove home, shaking his head at the teens he saw huddled together, kids playing together. He’s not much of a Facebook user, but he typed out a 354-word post asking people to adhere to social distancing rules: “I would ask how would you feel if your child doesn’t have their grandfather because he died...not from Covid...though it certainly could happen…but because he had a heart attack and we couldn’t treat him well because we didn’t have a bed…or your 25 yo brother gets routine pneumonia and he goes into respiratory failure and we don’t have a vent for him...this affects everyone.”  

That post has been shared over 18,000 times. “People have really changed their mentality in this state, and that’s really helped us,” he says. 

It’s a relief that people listened, he says. The initial stay-at-home orders and social distancing efforts that allowed hospitals time to create more room for COVID-19 patients in case of a surge proved to be critical in ensuring care for lung patients, allowing some procedures to be reintroduced in May. The social distancing success was also essential, he says, in ensuring that Minnesota didn’t face a PPE shortage of the sort that had New York health care workers decked out in Yankees rain jackets instead of gowns. 

Knowing hospitals and clinics in Minnesota are prepared, he says, lets him and his colleagues work through a “palpable sense of fear.” In his Facebook post, he wrote about the relevance of one of his favorite quotes: “Chance favors the prepared mind,” from Louis Pasteur about 150 years ago.  “We, the medical community, are the prepared mind...however we need chance...which is our communities, states, countries, and the world to help us out.”

Now, he’s thinking ahead again, this time to how COVID-19 may impact his patients for years to come. Once the acute pandemic is over, he says, he expects he’ll have a lot of new patients.  “The ones that don’t need to go to the hospital will probably be fine, but the ones who get really sick, with inflammation in the lungs, could end up with chronic respiratory problems,” he says. 

In the meantime, he hopes Minnesotans remember that COVID-19 is ongoing, whether or not restrictions are lifted. For him, going to work every day still means stripping down in the garage and running to the shower when he gets home, keeping any hospital germs away from his family. And the actions of everyone around him will impact him and his patients.

“I’ve learned how dedicated my coworkers are,” he says. “It’s part of our calling in our field, but no one ever anticipated anything like this.” 

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Meet the 2020 Top Doctors

See the complete list of doctors selected to this year's Top Doctors.

The 24th edition of our Top Doctors list includes 824 doctors in 46 specialties. Here’s how we put it together. When compiling a list that’s as relied upon as our annual Top Doctors list, research is essential. We asked physicians to nominate one or more doctors (excluding themselves) to whom they would go if they or a loved one were seeking medical care. From there, candidates were grouped into 46 specialties and evaluated on myriad factors, including (but not limited to) peer recognition, professional achievement, extensive research, and disciplinary history. Doctors who had the highest scores from each grouping were invited to serve on a blue-ribbon panel that evaluated the other candidates. Only doctors who acquired the highest total points from the surveys, the research, and the expert physician review panel were selected to this list. Of course, no list is perfect. Many qualified doctors who are providing excellent care to their patients are not included on this year’s list. However, if you’re looking for exceptional physicians who have earned the confidence and high regard of their peers, you can start your search here. In addition, this year’s crop of Top Doctors will join a prestigious group of doctors from more than 20 cities around the country who have been selected to Super Doctors, the full list of which you can find at superdoctors.com.

Editor’s Note: Many of our Top Doctors have specialty certification recognized by the American Board of Medical Specialties. This board certification requires substantial additional training in a doctor’s area of practice. We encourage you to discuss this board certification with your doctor to determine its relevance to your medical needs. More information about board certification is available at abms.org. 

© 2020 MSP Communications. All rights reserved. Super Doctors® is a registered trademark of MSP Communications. Disclaimer: The information presented is not medical advice, nor is Super Doctors a physician referral service. We strive to maintain a high degree of accuracy in the information provided. We make no claim, promise, or guarantee about the accuracy, completeness, or adequacy of the information contained in the directory. Selecting a physician is an important decision that should not be based solely on advertising. Super Doctors is the name of a publication, not a title or moniker conferred upon individual physicians. No representation is made that the quality of services provided by the physicians listed will be greater than that of other licensed physicians, and past results do not guarantee future success. Super Doctors is an independent publisher that has developed its own selection methodology; it is not affiliated with any federal, state, or regulatory body. Self-designated practice specialties listed in Super Doctors do not imply “recognition” or “endorsement” of any field of medical practice, nor do they imply certification by a Member Medical Specialty Board of the American Board of Medical Specialties (ABMS) or that the physician has competence to practice the specialty. List research concluded May 8, 2020.

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