Interventional Radiology and the Response to COVID-19

This editorial is being written the evening of April 5, 2020. I am not certain when it will be published—there is usually a several week delay between submission and publication. The weird thing about this particular editorial is that I have no idea what our specialty, the health care system, or even the world will look like in a few weeks. With that in mind, I wanted to simply communicate some thoughts to you during this time, as we continue to prepare for the continued surge in the COVID population in the country, and start to see the effect it might have on our health care system.

One important question I keep asking myself is “what is our role in the response to the epidemic and what, in particular, can we do to be meaningful members of the response team.” I know from direct conversations with my colleagues that many of us feel that we aren't contributing enough, that we feel that we could and should be doing more to provide care to all of our patients. In many cases, we have been redeployed in different ways, and we all experience that on a daily basis. I know that I have been redeployed, and 85% of my time is now spent acting as a liaison between our physician group, the College of Medicine, and our health care system. I know that this is an important role and that if I put enough time and effort into it, I can be successful, which means that everyone in our system pull in the same direction to fight this epidemic. But other than call I am not on the front lines, and that bothers me.

Other responses from colleagues, both in interventional radiology (IR) and diagnostic radiology, runs the gamut of the feeling of residents adjusting to more autonomy and uncertainty on whether or not they are being educated to be ready for the next phase of their lives; or the uncertainty of the anticipated surge and how that will affect us as attendings; or concerns about direct patient exposure by the proceduralists. This redeployment takes many forms as our jobs change.

We are no longer just diagnosticians/interventionalists, but have truly become both true consultants and the gatekeepers of whether interventions should be performed now or later. This rationing of care—let's call it what it is—has fallen squarely on our shoulders, and part of our job right now is in dealing with the ramifications of those decisions. Whether we feel this is fair or not doesn't really matter—it is our new job, and one that we need to perform to add to the best care for all of our patients. This too will be a moving target, and we will need to adjust as dictated by the situation. And isn't that what we do best, adjust to new challenges?

Some of our contributions will come after this epidemic has passed. We will have horrific backlogs that we will have to work our way through, as well as doubling down on our educational programs. That, however, is how we can add our expertise to this effort, and may be our primary role—that being on the backend of things. Our patients now and in the future, COVID+ and non-COVID alike, will need our services, and I know that we as a specialty will be up to the challenge.

I despise war analogies to anything. However, I will make an exception here. We are truly in such a warlike situation as we battle this virus and what it has done to turn our world upside down. As with any effort, 90% of the work is supportive to the spearhead effort. Our role as IRs has changed, and our efforts are vital to the success of our institutions to this effort. Make no mistake about it, we as IRs have an important role, and that is to do our job regardless of what the job looks like right now. As we've all heard innumerable times, many groups have deferred all elective exams, and now find themselves doing the things we have always done in new ways. Line placements and thoracenteses, often done in COVID+ units, have taken over many of our practices. I have no doubt that we as a collective field are ready and willing to make these changes.

I am amazed the way we have bonded together to get through this pandemic. I'm not surprised, but amazed. Everyone with whom I have spoken has pitched in and done their job without complaint, understanding that now more than ever our patients and referring providers need our guidance. I am incredibly proud of our response and couldn't be more honored than to be part of this exceptional team.

Thank you, sincerely, for all your efforts. Thank you to the IRs who are doing their jobs and more, sometimes functioning out of their specialty simply because they might be the closest thing to an ICU attending that a system has left. Thank you to the trainees who are functioning as medical house staff again. Thank you to the administrators who are cobbling things together as best they can with limited resources to try and get through this damn thing. I do know one thing. We will get through this and be stronger because of it. And we will get through this together.