SCHENECTADY — During the dangerous and hugely disruptive COVID-19 pandemic, Ellis Medicine is in the fortuitous position of having a chief medical officer who has been fighting germs for a third of a century.
Dr. David Liebers joined Ellis Hospital in 1987 as an infectious disease specialist and still retains a small caseload today despite his administrative duties and his teaching role at Albany Medical Center.
A dozen Capital Region hospitals formed a partnership in mid-March to face the crisis as a team. When the leaders gather to update the news media on the situation, they defer technical questions to Liebers. His knowledge and experience are valuable, and they are in short supply, for not many young doctors choose infectious diseases as their career path.
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It’s among the lowest-paid specialties and one of the less glamorous, underappreciated until all of a sudden it’s really important.
Liebers was born in Brooklyn, lived in the Bronx as a young child and moved to Schenectady when he was 5. He’s now 63 and a Niskayuna resident; he and his wife, Bonnie, have three grown children.
At Ellis Medicine, he is also vice president of quality services/medical affairs and previously was chief of staff.
He spoke to The Daily Gazette in mid-April about the pandemic and his role in the response to it.
Q: What led you to medicine?
A: Family tradition, interest in science and nature. My dad is a retired oral surgeon. He worked here at Ellis in the years when we were a trauma center and he would let me join in on some surgical things in the office. So I had a lot of exposure to medical stuff growing up. My grandfather was a dentist as well.
Q: What led you to your specialty?
A: In medical school I was always interested in infectious diseases, interested in the interplay between environment and disease. The wide variety of infectious diseases, the geographic variety of things depending on where you lived and I think the acute nature of infectious disease — the fact that you could with a proper diagnosis impact things very appropriately. So it continued through my residency and I decided to pursue a fellowship in that.
Rising to the Challenge: Faces of the COVID-19 crisis in the Capital Region
- Saratoga County commissioner of Emergency Services has passion for public service
- Glenville Town Board member is also a longtime first responder
- Foss: Montgomery County health chief says compassion is key in this crisis
- Schenectady County staffer redeployed in relief effort does a little bit of everything
- Saratoga County EMS coordinator logging 7 days a week to keep medical workers supplied, informed
Q: Asking about society in general, not you, do you feel infectious disease, pathology, etc. are underappreciated specialties until a crisis?
A: Absolutely, and it is disappointing. The field of infectious diseases is one that’s greatly relied on by health care systems but you’re right: It’s a cognitive speciality, it does not have a “procedure” and the field has been wanting for new blood over the past maybe even 10 years. In recent times, the fact that the American medical student is saddled with huge amounts of debt, to go into a field like family medicine, pediatrics or infectious diseases is less attractive because you’re not going to earn the kind of incomes that other specialties do. Even the best programs are not filling, and we’ve had close to a 50 percent decline in the number of individuals going into that field. Right now we have a tremendous community shortage of infectious disease [specialists] in the Capital Region.
Q: Has there been anything in your career that has been a dangerous foe but has evolved over years instead of weeks?
A: I think in terms of danger and uncertainty and anxiety, the onset of AIDS. I started medical school in 1978, so that coincided, though we didn’t know it at the time. By the time I became an infectious disease fellow, AIDS had really exploded, particularly here in New York state. There was a great deal of anxiety. We knew that blood and body fluids transmitted the infection. At the time there was no treatment and HIV was considered a slow but certain death sentence.
Q: Have you seen anything comparable to COVID-19 in scale, either for danger to health or societal impact?
A: I don’t think so, no. This is an easily transmitted virus related to the common cold virus that produces severe infection and severe clinical disease in a pretty high percentage of people. Obviously the societal impact has been unprecedented in my lifetime and probably, in some respects, in this country’s lifetime.
Q: Is there a historical precedent?
A: I think this is the kind of thing that was always feared. We had the H1N1 Spanish Flu in 1918, which probably for different reasons had a lot of death and a lot of societal impact without overwhelming a medical system that was really fairly rudimentary in that time. We had tremendous fear with the bird flu, that it would be transmitted much more easily; the mortality rate was much, much higher than what we’ve seen with COVID-19. So I think we’ve had scares like this but nothing that’s evolved like this.
Q: Do you think the response locally or nationwide to this pandemic becomes the new normal, such as during a bad flu season or COVID-21?
A: I think there will be a new normal in some respects on how we deal with certain things. I think a lot depends on the ensuing months, how well we see this epidemic flatten out and decline. Will we have effective and tolerable therapeautics available? And perhaps most important, will an effective vaccine be developed? That social distancing is how we’re protecting [the elderly] right now. We don’t really have another weapon. I’ve not even seen my dad in a month. And is that going to be a new normal? It’s hard to speculate on that.
Q: Is there something the Capital Region has done or not done that has reduced the intensity of COVID-19 here, or is it mainly things such as a lower population density than New York City?
A: I think population density really helps a great deal. The Capital Region in my view has done a very good job of coming together [to fight the disease].
Q: How did the regional alliance of hospitals come about?
A: That seems so very long ago! Albany Med really organized the hospitals and health care systems into a morning phone call so that we’re all on the same page, such that we’d be moving in lockstep and I think gain the confidence of the general public. I think Albany Med did a good job stepping up to that leadership role.
Q: How did you develop the leadership and organizational skills to be chief medical officer of a 3,300-employee organization?
A: When you’re in the field of infectious disease you have the opportunity to interact in a significant way with all aspects of the hospital. Then there are the administrative roles of antibiotic stewardship and, in particular, infection prevention, which goes way back, even to the AIDS era, when there were big issues on how do we protect our staff from AIDS, multidrug-resistant tuberculosis, and other infections that have graced the cover of Newsweek over the years. We’re also good at creating care teams for that person who has the life-threatening infection that may require quick mobilization of medical subspecialists, imaging and surgery. And we get pretty good at that. So in some respects we get a lot of on-the-job training. Conflict resolution, building teams, persuasion and those kinds of skills come into play as well.
Q: Who else has shaped the Ellis Medicine response to COVID-19?
A: I can say unequivocally, this has been a great team effort. [I’m] not surprised, but I’m very pleased how everyone in this organization has stepped up and contributed. Obviously we are blessed with having a very energetic chief nursing officer [Leslyn Williamson] who is not only doing her administrative work but is in the hospital at dawn every day, rounding on the units, understanding where the organization is and is also a cheerleader. We have both employed and private physicians stepping up in various roles, in particular our critical care physicians, our hospitalists and our ED docs, and the leaders in those areas have been tremendously helpful.
Q: Ellis has standing plans for all manner of crises, and rehearsed for COVID-19 once it shaped up as a threat. How has the reality differed from the anticipated scenario?
A: What is different is that we have seen a slower increase in the number of cases than we anticipated. There is a continued pressure on staff and supplies, but the epidemic here in this area has evolved more slowly than we expected. At this point [April 9] it’s very hard to predict. That model is still in its infancy at this point.
Q: Have you seen that “One Shining Moment,” either for yourself, for Ellis or for the community?
A: Every day we have a shining moment in the front-line staff who are taking care of these patients understanding that there is a risk to medical professionals. Not that we’re the same as Italy — but remember, Italy lost many physicians, many front-line staff, and everyone’s acutely aware of that. I have not heard a peep, not one complaint from critical care, hospitalists or ED doctors, where they don’t want to work at this point. I’m sure there is anxiety, there is fear — it is normal — but the job is being done without complaint.
Q: I’ve heard that the Ellis nurses are going above and beyond the compassion they bring to their jobs, becoming surrogate families for COVID-19 patients transferred up from New York City, who are a long way from home and frightened.
A: Let me add to that: Right now we’re not allowing visitors into the hospital for COVID patients at all. So our nursing staff really has had to step up and become the family for [all] these patients.
Rising to the Challenge: Faces of the COVID-19 crisis in the Capital Region
- Saratoga County commissioner of Emergency Services has passion for public service
- Glenville Town Board member is also a longtime first responder
- Foss: Montgomery County health chief says compassion is key in this crisis
- Schenectady County staffer redeployed in relief effort does a little bit of everything
- Saratoga County EMS coordinator logging 7 days a week to keep medical workers supplied, informed
Q: Same question, opposite direction: Has there been a notable failure or missed opportunity at any level?
A: I would say not. One can always say in retrospect that when we had a case emerge, that was unrelated to travel, you could say “Wow, that means there was community spread,” and maybe that was the time to do what we did a little bit later. We call this the retrospectoscope in medicine. Everything seems so clear when we use the retrospectoscope and say, “Of course, why didn’t we make that diagnosis earlier?”
Q: Last question is a delicate one: You are approaching the age demographic most vulnerable to COVID-19. Do you worry about your own health?
A: (Laughing) Let’s put it this way: If I stop worrying about my health, I get reminded by my family. Like, “Dad, you’re in the risk group. Dad, be careful.” So yes, we do worry. So how do you tackle that? You do the right stuff. We cannot rush when we do our job here, we have to be thoughtful, careful, and we have to watch out for our colleagues so they’re doing the same thing.
Categories: Rising to the Challenge, Schenectady County
