Editor’s note: The health sciences librarians and healthcare professionals we work with are on the front lines responding to the COVID-19 pandemic. We are honored to be able to bring you some of their accounts about what those efforts look like.

Elisabeth Marrapodi, B.A.
Library Director
Trinitas Regional Medical Center

Copyright by and used with permission of BMJ Insiders.

“Nothing prepared me for this experience”

As the COVID-19 pandemic challenges healthcare systems worldwide, some hospital librarians find themselves being labeled “essential”, having to shift their key priorities, and taking on new responsibilities – often unrelated to the library.

On May 21, 2020, Elisabeth gave us a peek inside Trinitas Regional Medical Center in New Jersey.

Q&A

Please describe the type of transformation you have witnessed at the medical center during the past few months.

In early March, operations were still relatively normal. But, in a matter of another week or so, things escalated quickly. We transformed from the typical hustle and bustle of a large, urban teaching medical center, into a COVID-19 centric acute care hospital. With New Jersey being the #2 hot-zone in the country, things got very real, very fast. I’ve worked in the healthcare setting since the 1980s, so I’m well aware of the cycle of life within hospital walls. But this was different.

Over the years, the medical center has dealt with numerous emergent diseases, such as SARS, H1N1, Swine Flu and the Ebola scare, to name a few. And, even though I am a former fire/rescue EMT who has seen a gamut of emergencies, nothing prepared me for this experience.

One of the first visible changes I noticed in the hospital involved the clinical staff since the Medical Library is located on the ICU and surgical floor. The clinical staff now wore protective gear from head to toe: plastic face shields over N95 masks, all gloved up in hazmat-type suits. It was startling. Universal masking for employees was ordered and no one could walk anywhere in the hospital without them. In addition, temperatures were taken every day by a guard before entering the hospital and all other entrances were closed except the main entrance. On the overhead PA, “Code Blue” calls were replaced by what felt like an endless stream of “Code Blue 19s” for COVID-19 patients. Outside, a triage tent was erected and a decontamination area.

It was clear we were at war with this virus and my area was in the thick of it.

As a teaching hospital, has TRMC been able to involve its Residency Programs or School of Nursing in the COVID-19 response?

The residents remained in the hospital and our nursing students were utilized as needed to support staffing.

What type of transformation did the library undergo?

The biggest change was the sudden absence of medical students studying all day. Usually students camped out in the Library, along with the Residents. On any given day, every seat is claimed, but now the seats were empty. Students were no longer allowed to come into the hospital by their schools. Medical Residents visited the Library less and less during those first days. There is a light sensor in the Library and the lights go off when there is lack of movement. For a few days the Library was dark in the study areas. However, very soon activity picked up as literature searches and interlibrary loans were being requested again.

As the pandemic and numbers of infected patients increased, changes needed to be made. Fairly quickly into the pandemic, I limited the number of patrons allowed in the Library and the visit had to be related to patient care. To encourage social distancing, brightly colored tape was placed on the floor in front of the Reference Desk and Director’s office. Before COVID-19, the plan was to increase the number of computer stations, but the pandemic changed those plans; every other computer station was shut down to force distancing.

I surveyed the Library with a critical eye, looking for all areas of potential infection, from door handles to computer keyboards. As a result, more hand sanitizer wall dispensers were added for patrons to use before entering and upon exiting the Library, containers of antiseptic wipes were placed for patrons to wipe down the computer equipment area after use and finally, a Plexiglas protective barrier was installed at the Reference Desk. There was a learning curve, but I think the Library became a safer place to visit as a result. Right now we are waiting for the medical students to return, which hopefully will be soon. We are also very hopeful the new first year residents will be able to arrive, too.

Have the priorities of your library changed? Are you taking on activities that are not typical for a librarian?

For many years, I’ve managed the social media accounts for both the Library and the institution. This work became integrated into the day-to-day workflow, but during the pandemic, the pace grew more frantic as there was a greater need to communicate with the community on a much more frequent basis. During the height of the crisis, this evolved into being on-call seven days a week for postings as the demand for information became a high priority.

Interestingly, the Library’s social media accounts didn’t get the same attention from its followers as the hospital accounts did despite posting the latest updates in COVID-19 research and other related news items. In fact, the Library’s social media accounts had little growth and engagement. My guess is that Library followers didn’t need the latest updates and facts about the pandemic because they were already being inundated with news and alerts on radio, TV and other outlets.

The hospital’s followers were responsive to the human interest elements of the pandemic, most especially our “healthcare heroes” series and stories about patients and community support efforts. As a result, the institution’s accounts flourished. Followers doubled and engagement soared. But, with this success came a price. More time and attention was now needed to keep these accounts “fed”, answer questions or comments, and keep a steady stream of content. Much of this which was relayed by the Public Relations Department and our Foundation, but I supplemented with a lot of original content as well.

I estimate that managing the social media accounts, photo editing, creating content, replying to comments, etc., account for a lion’s share of my workday. There is a reward though – the number of followers on the hospital’s accounts have nearly doubled with many leaving heartfelt comments of support and gratitude.

But, this extra demand on my time won’t last forever. As some semblance of normalcy resumes, the fervor will wane and once again the Library will be filled with medical students studying, residents researching and attendings conducting teaching rounds and other activities. I look forward to that day.

There is a continuous influx of COVID-19 medical literature being published. How are you helping hospital staff navigate through the clutter to find quality content?

I attended a mandatory leadership daily COVID-19 update conference call and whenever the opportunity arose, I took the initiative to send information to key staff.

Have you needed to educate or provide resource/materials to external groups, such as patients, patient family members, or the media?

For the past 10 years, I’ve managed an award-winning Consumer Health outreach project in the virtual world of Second Life, which offers educational quiz game style information about stroke, heart attack, pre-diabetes, medical terminology and Alzheimer’s disease.

In response to the pandemic, an extensive COVID-19 display was added in mid-March at our host site, Whole Brain Health, which is part of the Ageless Mind Project, a nonprofit organization co-founded/directed by Lynne Berrett, LCSW.

The display features a real time COVID-19 infection counter; consumer level language videos; and a continuously updated PowerPoint presentation that provides the latest information about pets, how to handle groceries, cleaning after illness, pregnancy, and the new pediatric inflammatory illness in children. There are also handouts that include instructions on how to make a face mask, a newly updated list of symptoms and much more. Information is available in both English and Spanish and there’s also a video for the hard of hearing.

Back in March, the virus situation was rapidly evolving and there was information overload to sift through, so I enlisted Veronica Bilenkin, a Consumer Health Librarian from Greenwich Hospital, CT, to help with gathering references during the initial phase of the project.

In the past two months since the display has been open in Second Life, over 350 visitors from around the world have visited, some taking the time to leave positive comments, such as a research scientist from Singapore. The COVID-19 display now has two additional locations and can be found at the University of Sheffield’s virtual InfoLit iSchool and at CVL, Community Virtual Library.

A good deal of the content regarding COVID-19 is not credible, or substantial. Have you needed to educate anyone internally or externally on information literacy?

Yes, part of the reason why the COVID-19 display in Second Life was created.

Have you experienced any access or technology bandwidth challenges?

None.

The increased anxiety and workload throughout the hospital must be palpable. How are you managing to navigate this challenging time, and do you have any tips for your librarian colleagues?

If your institution offers EAP, I encourage those who feel burned out or stressed over this health crisis to utilize this service. That is what they are there for. If you do not have access to EAP, private counseling is also an option. This pandemic was unprecedented and talking it out can make all the difference.

What upcoming challenges do you foresee your hospital library facing?

Unfortunately, with the shutdown of elective surgeries, diagnostics and other revenue producing activities, I am anticipating deep, hospital-wide budget cuts for the 2021 fiscal year. Hospitals were hit hard, so this won’t come as a surprise.

My budget has already experienced no growth for the past few years. We’ve managed to still offer quality services and resources by supplementing the budget with grant funding and donations. However, any further budget cuts will have a negative impact. Hopefully, staffing levels won’t be affected.

Tell me something good!
While this has been the worst of times, it has also been the best of times. I’ve never seen such an outpouring of community support for our hospital workers and frontline clinical staff in all my 35+ years of working in a hospital setting. It truly brought out the best in people who generously showered us with encouragement and support, from food to gifts and even free oil changes.

It was a dark time for us in New Jersey. I will never forget the anxiety over being an essential worker and having to report to work during a pandemic. I was frightened at times, but what I will choose to remember is that out of that darkness, there is hope. Not too long ago we lined the hallways and cheered the discharge of our 500^th COVID-19 survivor and now every time a COVID-19 patient is discharged, Here Comes the Sun is played overhead. As of today (May 21, 2020) we’ve had over 800 discharges! These people represent 800 individual success stories about survival and hope – and actually, my mother is one of them, too.