MedStar Health Blog

Traveling by plane, train, or automobile isn’t what it used to be. With so many of us wanting to enjoy the beaches or visit family around the country, we need to be alert about avoiding an uninvited guest—coronavirus.

A lot of people are asking: Can I travel during this pandemic? As a general rule of thumb, the answer is “yes,” but you should minimize the number of people with whom you interact. Avoid large groups. Seek a less crowded part of the beach if you can. Travel in your own car as opposed to a bus.

About Family Gatherings

It’s natural to want to enjoy time with family during these warm summer months. However, it’s critical that we take precautions around vulnerable family members. These include grandparents, aging aunts and uncles, and anyone with weakened immune systems or medical conditions.

Here’s something you should know: A small percentage of people are testing positive for COVID-19 without displaying any symptoms. It’s important to be aware of the fact that people can be sick but not seem to be. This means you and your family could unknowingly be at risk for catching—or spreading—the disease wherever you go.

So, even if you’re feeling well and don’t display any symptoms, take extra precautions when visiting those at higher risk. Wear masks and be diligent about washing your hands when you’re in others’ homes. The risk of a well person transmitting the virus while wearing masks and practicing physical distancing is low, but it’s not zero.

If you’re hosting or attending a family get-together, do what you can to stay six feet apart from each other. Try to gather outside. Separate the chairs around the grill. Don’t engage in contact sports.

Precautions Before Traveling

• Consider testing: If you’re going to visit someone who is at high risk of developing complications from COVID-19 infection (such as an older person or someone with underlying health problems), you could consider getting tested five to six days before traveling. Some of the firehouses in Washington, D.C. offer free testing. If you’re exposed to somebody who has the coronavirus, it’s recommended that you quarantine at home for 10 to 14 days before your trip. Exposure is the key here. The risk of acquiring COVID-19 after a brief interaction is relatively low. On the other hand, if you’re indoors with somebody for an hour, the risk is much higher—which means you definitely need to quarantine.
• Prepare a virus protection kit: If you must travel, make sure you pack a COVID-19 kit that includes face masks, wipes, and hand sanitizer to help you reduce the risk of exposure to the virus.
  • Cloth or single-use face masks must cover your mouth and nose.
  • Bring disinfecting wipes and wipe down high-touch surfaces like bathroom toilet and faucet handles, doorknobs, the phone, TV remote—and don’t forget your cell phone.
  • A hand sanitizer that contains at least 60% alcohol or 70% isopropyl alcohol is a must for those times when you can’t wash your hands.
  • Travel-sized laundry detergent will help keep your cloth masks clean.
  • In general, gloves aren’t recommended for routine use. It’s better to just wash your hands periodically. However, packing a set of latex gloves to use in case someone becomes sick is reasonable.
  • Nonperishable snacks and water may come in handy if restaurants are closed during your travel.
• Go online: Check out the health department website of the location you plan to visit and get an idea of conditions in that location. Personally, I would have second thoughts about visiting states that are COVID-19 hotspots right now.
• Contact your doctor: If someone in your family has a fever or other marker of the disease a day or two before your trip, call your doctor. He or she might suggest you come in for testing. Some people get very sick from this virus, and you wouldn’t want to be in a location far from home if you’re affected.

Precautions While Traveling

• Air travel: The first concern is the airport. That’s a lot of people interacting indoors where the virus can be transmitted through droplets. Then there’s the airplane itself. If you consider that 1%–3% of people in general carry the virus and there are 100 people on the plane, the risk is that one to three of your fellow passengers are infected. The risk is relatively low if everybody’s wearing a mask—and I recommend staying masked for the entire flight. Still, I would think carefully about how much I want to fly versus going somewhere I can drive.
• Hotels/motels: I actually had to travel recently and can share my personal experience. The rest stops along the New Jersey Turnpike had physical distancing measures, and the hotel I stayed at was very good. They had markers to assure you stayed six feet away from the other person in the check-in line. Check-in was quite fast because the hotel staff wanted to get you to your room as quickly as possible. There was no indoor dining—only room service. I think most hotels are moving in this direction, although every place has different standards of cleanliness.
• At the pool or beach: The risk of acquiring COVID-19 from an outdoor environment appears to be very low. The virus is dispersed quickly in the breeze. Also there is no evidence that it can survive in a body of water. So, going to a pool or beach is potentially safer than being in a closed room for a long period of time. That said, I wouldn’t go to a beach where people are packed towel-to-towel. If you’re on a crowded beach, the CDC recommends wearing a mask. Use common sense and set up your beach blanket in a less populated area, trying to stay six feet away from others.
• In your RV: Recreational vehicles are a great way to travel safely. You’re in your own space and don’t have some of the concerns that come with other forms of transportation.
• Telehealth: If you’re feeling ill during your travels, you could probably seek out an out-of-town doctor in your insurance network to evaluate you. But you may find it easier and more reassuring to have a telehealth visit with your own doctor, which can be done using your cell phone. Remember, coronavirus is not the only threat out there: check with your provider for an accurate diagnosis.
• Kids, toddlers, and babies: Children can definitely contract the coronavirus. Although they appear less at risk of severe disease, it unfortunately happens. My children are grown, but if I had young kids, I would definitely put a mask on them, and try to separate them from large groups. Newborns and toddlers are a different story. You can’t really mask them, but you can make a conscious effort not to let everyone hold them, so they aren’t exposed to a virus carrier who doesn’t show symptoms.

Be Safe and Enjoy Your Summer

I know these last few months have been difficult and everyone wants to get outside and enjoy the summer weather. Just make sure your safety and the safety of those around you is top of mind. Wear your mask. Stay six feet apart from others. Wash your hands frequently. These small steps can make a big difference.

Around the world, COVID-19 has put the entire healthcare system to the test. Here at MedStar Washington Hospital Center, our team mounted a comprehensive response quickly and effectively. That effort likely saved countless lives and would not have been possible without the culture of quality, safety and readiness built here over decades.

At the Hospital Center, every member of the team is focused on patient safety. That’s what we do, every day. It drives every decision we make.

Since March, our leadership team has met around the clock, solving problems and innovating solutions under constantly shifting conditions. Our bedside caregivers on the units and in the Emergency Department have shown phenomenal dedication, delivering an outstanding level of care for patients with COVID-19, while protecting those who were not infected. We remain flexible and responsive, reassigning our resources quickly to put associates wherever they’re needed.

Of course, when it comes to this coronavirus, we’re not out of the woods yet. But I can say without hesitation that MedStar Washington Hospital Center delivered a stellar performance during the worst of the crisis—and we remain at the ready.

I have no adequate words to express my pride, appreciation and gratitude for this team.

Top-to-Bottom Approach to Safety

We are doing everything in our power to provide the safest environment for our patients and staff. We have reinstated routine tests and other elective procedures carefully and thoughtfully. There is no reason to avoid the hospital or delay care for any health issue. In fact, delaying care for a serious problem can be significantly more dangerous than venturing out. Routine, easily treated problems may quickly become life-threatening if left unattended. I can’t emphasize this enough.

I make regular rounds in the hospital and meet daily with the leadership team. We are well trained. We have the Personal Protective Equipment (PPE) that we need. And we have made a number of policy changes to stay ahead of the virus:

• All patients, visitors and associates are required to wear masks in the hospital and Physicians Office Building.
• Signs are displayed in areas that could become crowded so that we stay six feet apart.
• Waiting rooms are redesigned for proper physical distancing.
• Appointments are staggered to avoid crowding.
• We sanitize and disinfect all patient exam and procedure rooms after each appointment.
• High-touch areas are cleaned regularly.
• All patients and approved visitors are screened for symptoms.
• We have ramped up inpatient and outpatient COVID-19 testing.

We took preventive steps early, including recognition of symptoms, carefully managing access to the hospital and contacts with patients, and conducting temperature screenings. We designated specific units to isolate patients who tested positive for COVID-19. Coupled with consistent use of PPE, these tactics have been important in protecting both our patients and our staff.

We’ve also dramatically increased our use of telehealth. MedStar Health e-Visits and Video Visits have soared since March. Both of these platforms were in place before the pandemic, and I am thrilled that our patients were able to utilize these resources as the crisis unfolded. Telehealth kept them safe as we continued to learn more about the virus, and likely reduced the overall number of hospitalized patients.

Probably the most important aspect is keeping patients connected with their providers. We don’t want to lose those relationships, which are so critical to health and well-being. Telehealth at the Hospital Center is a huge asset now and has tremendous potential for the future.

Responding Quickly and Decisively

As challenging as this crisis has been, especially for those who’ve lost loved ones, it pales in comparison to the 1918 Spanish flu pandemic. The CDC estimates that Spanish flu killed at least 50 million worldwide, although some evidence puts that number near 100 million.

COVID-19 is a real challenge, but health care has improved dramatically since the turn of the 20th century. In today’s pandemic, most people who contract the disease will recover—a testament to the dedication, skill and resourcefulness of the global scientific and medical community.

With all the advances in immunology, epidemiology and other health sciences, we know more about this 2020 virus than our predecessors could have imagined. And with millions of dedicated professionals working on it around the globe, we learn more every day.

When this pathogen began to cause epidemic infections around the globe, and it became apparent that it would not behave like the average flu virus, we sprang into action. We activated a pre-planned Incident Command Structure, assigning very specific roles to managers in key areas. From supplies to lab testing, bed management to staffing, Incident Command optimizes at least two dozen critical areas to prepare for a potential wave of infection. This team has been the bedrock of our response to the pandemic.

Our hospital has rigorously followed Centers for Disease Control and Prevention (CDC) recommendations. Early on, we also knew that recommendations would shift, as experts learned more about the virus and adapted workflows and procedures.

From the beginning, our medical providers, nursing staff, technologists, nutrition associates, and environmental services specialists have had the training and PPE needed to protect themselves and their patients—including masks, eye protection, gowns, head covers, shoe covers and gloves.

Our experts across the MedStar Health system worked hand-in-hand to share knowledge during this pandemic. Remember, this has been an ever-changing situation. We started by screening people who had traveled to China. Eventually, as the virus spread, travel became a non-issue. Although we learn more about the virus and possible treatments every day, success in treating our patients depends on expanding our knowledge. All our leaders continue to meet regularly to exchange information and request help, when needed.

Preparation Makes All the Difference

Preparedness for a community health crisis doesn’t happen overnight. At MedStar Washington Hospital Center, we excel at crisis management—the result of decades of making patient safety priority one. The entire MedStar organization is committed to that mission and every team member is empowered to support it.

• Safety is data driven. We continually measure and report key quality indicators.
• Our teams are experienced and, if they come across something unfamiliar, they work together to leverage their knowledge and deliver safe and quality care.
• We partner with the MedStar Health Institute for Quality and Safety to improve monitoring and reporting. That sharpens our focus for addressing small issues before they become big problems.
• We embrace the High Reliability Organization framework—an organizational system that airlines, nuclear energy and other commercial organizations implement to ensure safety.

These and other initiatives are integral to our care delivery, giving us a proactive, nimble organization that stays on its toes, every minute of every day. We never rest on success.

Staying Ready for a Healthy Future

We have not seen anything on the scale of COVID-19 in our lifetime and, like most of my colleagues, I can’t point to any specific experience that prepared me for it. However, as Chief of Medicine at Walter Reed Army Medical Center and Director of Education, Training, and Research for the National Capital Region, I had the responsibility of merging Walter Reed with the National Naval Medical Center. Success in joining two distinct operations demanded exemplary organization, teamwork and having the right people in place to carry out a plan. The same components are required to effectively deal with the pandemic.

Every day is a learning experience. We’ve learned that teamwork and clear, constant communication with our staff and our patients are imperative. Being part of MedStar Health’s distributed care delivery network has allowed efficient sharing of resources, from PPE to staff, to assure we deliver the best care possible.

If you’ve ever been a patient of MedStar Health, you know that your providers care about you like family. We celebrate and share the joy when patients are discharged and able to go home. During this pandemic, our associates have planned weddings and birthday celebrations and helped facilitate virtual web meetings between patients and their families. They’ve responded and adapted to constant change and embraced the best-known standards of care. They have been diligent about cleanliness, assuring our facility is always clean and ready for patients.

We know this has been a difficult time for our patients, especially with the suspension of visitation. We hope we’ve provided some measure of warmth and compassion in the absence of families and loved ones. And we’re grateful to those who chose our Hospital Center to provide that care.

I know I’m biased. But I love this hospital and trust our providers and caregivers to keep our patients safe and well cared for. We will always be here for you, whenever you need us.

Kidney (renal) cancer is on the rise. In Washington, D.C. alone, 100 to 150 people a year are expected to be diagnosed with this disease. That number doesn’t include potential new cases in our surrounding counties.

On a broader scale, as one of the 10 most common cancers in the U.S., it will be newly diagnosed in about 75,000 Americans each year, and claim the lives of about 15,000 people annually. Although the reasons aren’t clear, more men than women are affected by this condition.

Incidental Diagnoses

In about half the cases, people discover they have the disease when they visit their primary care doctor for a separate reason. They may have back pain, abdominal pain, gastrointestinal upset. The kidney condition only becomes apparent when a scan reveals a tumor in the kidney. This is why it’s critical to have a good relationship with a trusted primary care doctor.

When I receive a referral from a patient’s primary care doctor, I may order either a high-quality CT scan or an MRI. With those images, I am able to understand the stage of the cancer and surrounding areas with which it may be associated and can determine a path forward if surgery is a recommended option for that patient.

Symptoms to Be Aware of

I want to make it clear that many patients in our community who are diagnosed with localized kidney tumors have no symptoms. They feel 100% normal. But as the cancer progresses—and particularly once it spreads to other areas of the body—some patients will experience a change in appetite and unintentional weight loss. They may also have:

• Blood in the urine: This is a critical signal. If you see blood in your urine, make an appointment with your doctor
• Pain in the side
• Constitutional symptoms, such as fatigue and night sweats
• A general sense of not feeling well

Higher Incidence…or More Scans?

The rate of renal cancer has appeared to be rising since the 1990s. Many people speculate that this is simply due to greater awareness of the disease and increased use of more advanced imaging.

Because it’s become easier to obtain a CT scan, many patients who wouldn’t have been scanned 10 or 20 years ago are scanned today, allowing us to readily identify more cancers than in the past. It’s unclear whether the true number of cases is actually increasing.

Stages, Sizes, and Survival Rates

Once renal cancer develops, it can progress from Stage 1 to Stage 4.

• Stage 1: Small tumors (less than 7 cm) contained within the kidney. Stage 1 cancers actually have a very good five-year survival rate if treated—probably 90%–95%. If you have a small tumor and it’s completely removed by surgery, your prognosis is generally very good.
• Stage 2: The cancerous tissue is larger than in Stage 1, but still localized to the kidney.
• Stage 3: These tumors display signs that they’re invasive. For instance, they may be moving into the surrounding fat or the central part of the kidney. There may also be evidence of local lymph node involvement.
• Stage 4: When the disease has spread outside the kidney, we classify that as Stage 4. At this stage, we’re looking at a 10%–15% five-year survival rate, even with therapy. This is a deadly disease once it spreads from the kidney.

A Range of Treatment Options

Each patient receives a personalized treatment plan. We talk about their goals and create a plan that could provide the best outcome for them. There are several treatment options that we discuss:

Minimally invasive and robotic surgery
The mainstay of therapy for localized renal cancer tends to be surgery. Surgical options depend on many things, including the size of the tumor and its location within the kidney. Although complete removal of the kidney is sometimes warranted, in many cases, we can simply remove the tumor and spare the remainder of the kidney. This is known as a partial nephrectomy.

For many patients who undergo this procedure, a minimally invasive robotic approach offers several advantages:

• Improved visualization for the surgeon
• Improved surgical dexterity for complex reconstruction of the kidney
• Shorter hospital stay
• Less blood loss

Percutaneous ablation
Rather than remove tumors, we can often work with our interventional radiologists to kill the cancer cells within the tumor. The interventional radiologist guides specialized needles into the tumor and either freezes it using a technique known as cryoablation or heats it through radiofrequency or microwave ablation.

Active surveillance with appropriate interventions
In certain scenarios, observation of the tumors can be an option because some kidney cancers can actually grow very slowly and remain in the kidney. The patient follows up with the urologic oncologist or medical oncologist with periodic scans to ensure the tumors are not growing. If a tumor starts to grow or if new symptoms develop, treatment may be called for.

It’s difficult to know how a particular tumor will affect that patient. It could end up being life-threatening or relatively harmless. The choice of active surveillance is a decision made between the doctor and patient and is dependent on various factors.

Immune-boosting agents
For patients with more advanced disease, a variety of therapies can be delivered systemically. These aren’t traditional chemotherapy agents, they’re agents that work on the immune system and can be considered immune-boosting pharmaceutical agents to help attack metastatic cancers.

Clinical trials
For patients interested in a novel therapy, some clinical trials currently available for patients with locally advanced or metastatic renal cancer may be an option.

What to Expect

As the largest hospital in Washington, D.C., MedStar Washington Hospital Center is an excellent choice for kidney cancer treatment.

If you opt for minimally invasive surgery, you will have smaller incisions, less pain, and improved convalescence. Within 24 to 48 hours, you’re eating a regular diet and able to take care of yourself.

My major restriction is no heavy lifting for a period of time after surgery so the incisions can heal. Within a week or two, most of our patients feel almost 100%. And those without a lot of strenuous activity at work can return to the job within two or three weeks.

Looking Forward to Truly Personalized Medicine

Within the next decade or two, we hope to be able to characterize each patient’s tumor at a molecular level. That means we’ll be able to provide targeted, specialized therapy to each patient for his or her unique tumor.

To me, targeted therapy is really fascinating because it unites clinicians like myself with the translational science teams who work to develop drugs and other therapeutic agents. As we move forward in the 21st century, I’m excited about how we’ll become even better enabled to use personalized medicine to care for our patients with kidney cancer.