When COVID-19 began to emerge as an urgent healthcare issue in Birmingham, UAB physicians from several specialties, including infectious diseases, internal medicine, and family and community medicine, began to discuss the idea of opening a specialized clinic for COVID-19 patients. On April 10, the concept became a reality with the opening of the COVID Respiratory Clinic, informally known as the 19-COVID Clinic as a nod to UAB's renowned 1917 Clinic.
"We want to identify people who need hospital admission to prevent rapid progressive disease. Early hospitalization, when needed, can save lives," said Turner Overton, MD, professor of medicine in the UAB Division of Infectious Diseases. "This clinic will keep patients from going to the emergency room, where wait-times can delay evaluation and also place other patients at risk."
The transition to telehealth, which most Birmingham practices have utilized during the pandemic, was one of the drivers to starting the clinic. "Telemedicine can be a good first step," said Irfan Asif, MD, who is the chair of the Department of Family and Community Medicine at the UAB School of Medicine. "During a telemed visit, when someone has symptoms, which can include fever, cough, or shortness of breath, we decide whether to send them to our drive-through testing site or start a video visit.
"Over the video, we get the chance to see them and understand their appearance, and based on our experience as family medicine physicians, we can spot potential problems. For example, maybe the patient is breathing a bit fast and looks short of breath. We use an algorithm to help decide the person's risk level. That's based on their symptoms as well as other conditions the patient might have like diabetes or lung conditions. It also takes some socio-economic factors into account."
If the patient appears to be high-risk, they are referred to the clinic. The facility has a number of safety protocols in place. Only one patient enters at a time, and the patient is given a mask, while all the providers and staff wear personal protective equipment.
"Other than the exam patients get by the provider, our goal is to offer at least four things," Asif said. "First, we get their vital signs, including their heart rate, blood pressure, oxygen saturation, and temperature. We follow that with a chest x-ray, EKG and labs."
Based on this information, the clinic providers can make the decision regarding whether to send the patient home with some supportive treatment or send them to the hospital for a more in-depth evaluation. Patients who go home are also given the opportunity to enroll in some of the investigative therapeutic trials that are being conducted.
"We are seeing several patients a day," Asif said. "It's been increasing steadily. It's been nice. In addition to the team who work here, we have medical students who call the patients for follow-up, checking to see if they are getting better or need any help. With the shutdown, some people may have food insecurity and need help with groceries. Also, isolation can be difficult, so we ask if they feel depressed or anxious. And we work with pastoral care."
When planning for the clinic, the UAB group knew there were a set of specific conditions that were necessary. They needed the COVID-19 patients to be separated from the larger patient population, but they didn't want the patients to be so isolated that they would feel like outcasts. And, as luck would have it, they found a near perfect location.
An empty Regions Bank branch building stood on Richard Arrington Boulevard within walking distance of UAB Hospital. "We were fortunate to find the space," Asif said. "In just a few days, we were able to move in all the equipment for x-rays, EKG, and labs, transforming the place into a clinic with four exam rooms. This could have normally taken a year. It was amazing for a system to be able to turn on a dime and do all the things related to moving, as well as putting together a partnership with multiple UAB departments. This only happens with folks who are genuine and willing to collaborate for the greater good."