This post is the first in a series exploring Project ECHO’s work to support COVID-19 response efforts around the globe.
From the beginning, COVID-19 has forced frontline clinicians to play catch-up, obliging them to make critical patient care decisions about a new and deadly infectious disease in a crisis environment without the benefit of established protocols or best-practice knowledge.
It turned out that, as much as they needed personal protective equipment (PPE) and ventilators, doctors, nurses, emergency medical technicians (EMTs), and other providers also needed up-to-the-minute medical knowledge from the field. And they needed expert guidance on how to implement emerging best practices.
The Project ECHO community stepped up to help fill this void, working swiftly with partners to organize virtual communities of learning and practice for addressing the COVID-19 crisis. In many cases, existing ECHO programs switched gears to focus on the pandemic.
ECHO mobilized a response on two levels:
- Amplifying the public health response to COVID-19 in areas like rapid testing, isolation of patients who test positive, contact tracing, and follow-up to contain the spread of the virus.
- Scaling the clinical delivery response. Across the country and around the world, doctors, nurses, EMTs, and other clinicians in the field needed to know how to treat patients with COVID-19. That meant providing them with the best available information — even in the absence of firmly established science — in as close to real time as possible, and with the guidance to put that knowledge into practice with their patients.
From Necessity, A Hybrid Model Emerges
To meet the enormous need for information and support during the coronavirus pandemic, ECHO had to adapt its model. Traditional ECHO program sessions are intentionally limited to at most a few dozen learners from remote locations. But, by necessity, the new COVID-19 programs must meet the needs of a whole new magnitude of participants — hundreds, even thousands, in some cases.
That meant switching to a webinar platform capable of accommodating large numbers of participants. And it meant changing up the format of the learning sessions, with less focus on case presentations and more on topics such as proper use of personal protective equipment, ventilator management, support of patients in quarantine, infection control in nursing homes, and even administration of advance directives.
Instead of voicing their questions, participants now turn to the chat room, which often receives several hundred queries, comments, and observations per session.
As of late July, ECHO projects in 34 states and the District of Columbia had pivoted their efforts to COVID-19. In addition, the ECHO Institute has partnered with the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services to launch a COVID-19 Clinical Rounds program that serves as a peer-to-peer learning platform for frontline clinicians in the United States and globally.
ECHO has also partnered with Indian Health Service (IHS) on a response to the pandemic in Indian Country, convening weekly COVID-19 Clinical Readiness and Patient Care ECHO sessions with Tribal providers, many of whom work in rural areas with limited resources, in real-time, peer-to-peer clinical learning.
Combating the Novel Coronavirus Globally
Globally, special teleECHO sessions have addressed COVID-19 education with providers in the Americas, Africa, and Asia, reaching thousands of learners. Ongoing programs include the Centers for Disease Control Global Webinar Series, a new Global Conversation series to plan for the “new normal” in health care post-COVID-19, a new program on COVID-19 in Latin America, and ECHO India’s COVID-19 training and education programs.
It’s hard to say exactly how many people have received education and training on COVID-19 through ECHO — more than 175,000 in the United States and even more in other parts of the world, including upward of 400,000 in India. They range from village health workers in rural India to primary care physicians in Oregon to health ministry workers in Africa.
The COVID-19 response is not the first time the ECHO model has been applied in a public health emergency. Project ECHO has also organized programs to prepare for and respond to outbreaks of H1N1, Rocky Mountain spotted fever, and Hanta virus in the United States; Zika in Puerto Rico and the Pacific Island territories; and Ebola and cholera in Africa. But the COVID-19 response is on a far greater scale.
In the coming weeks, we will provide a brief look at ECHO in action on the frontlines of the coronavirus pandemic, as well as how the ECHO model may be scaled to address future public health crises.
· Nationally, ECHO’s unique partnership with ASPR and some two-dozen professional medical societies and organizations has fielded thousands of COVID-19 questions from more than 7,500 learners in all 50 states and 30 countries.
· In the state of Oregon, primary care providers in rural areas are receiving training on how to deal with various aspects of COVID-19.
· Globally, ECHO India has made the pandemic its laser focus, mobilizing 54 of its 56 hubs to launch programs that have trained thousands of people — from village health workers and educators to urban doctors and nurses — in COVID-19 response.
Stay tuned for these stories and more.