By reducing the 45 per cent death rate among Covid lung transplant patients, the only two doctors in South Australia who specialize in this field have decided to divide and rule.
Prof. Mark Holmes, who founded and heads the Lung Transplant Department at the Royal Adelaide Hospital, and his wife, Prof. Chien-Lee Holmes-Lew, have split their clinical service in two to better support their severely immunocompromised patients.
Professor Holmes-Lew said the arrival of Covid in Australia caused her “a lot of stress about how we’re going to manage” as their unit still had the same amount of resources at the time as it did 20 years ago when it was first created.
“We decided that I would manage all Covid and (Professor Holmes) would manage everything else,” Professor Holmes-Lew said.
“I read all the data that was available internationally and the death rate was 45 percent, which was just huge.
“Based on international experience, I quickly figured out what could lead to a better outcome for our patients, and we set up a streamlined process that I watch pretty obsessively.”
The result was zero deaths from Covid among the 32 of more than 130 lung recipients in South Africa who contracted it. According to Professor Holmes-Lew, none of them spent a single day in the intensive care unit.
Her process began by emailing the state’s entire lung transplant population information on what to do if Covid starts to spread and who to call if they need help.
“We have also hospitalized everyone[patients who have contracted Covid]as one of the risks is that they can get worse very early and very quickly without warning at home,” she said.
“We were given one clinical nurse, Mary Young, as the only point of contact for patients – she is one of the shining lights of the service. Together we update the protocol. I provided medical advice and guided the decisions that were made in the department.
“After the patients leave the hospital… Mary calls every day and if there are any alarm flags, we intervene quickly.”
Although vaccination helped these patients, it did not provide the same level of protection as the general population. According to Prof Holmes-Lew, wearing masks and avoiding crowds “came naturally to them before the advent of Covid” and was now critical, while “a drug to help prevent Covid” called Evushheld is being introduced in lung transplants and other immunosuppressed cases.
“We are investing a lot in our patients (for whom the pandemic) has been very difficult,” she said.
“We used to tell them to travel, go to work, meet friends – that’s why we transplanted you so you can live as normal a life as possible. But now they have to be especially careful.”
It has been a difficult time for Professor Holmes-Lew and her husband: as the only lung transplant doctors in South Africa, they made the difficult decision to take their seven-year-old daughter out of school for a full semester at the start of the pandemic. .
“If we had Covid, there would be no one to look after transplant patients,” she said.
A third doctor has joined the South African Lung Transplant Unit, which is one of the few secondary lung transplant centers in the world.
Prior to its creation, AS patients would have to spend months away from their loved ones in Melbourne or Sydney, completing their assessment (pre-transplant testing) and waiting for a suitable donor to be found.
Patients are now being examined at the Royal Adelaide Hospital and are not flying interstate until organs are available and can be transplanted. The SA team then resumes post-operative care.
Double lung transplant recipient Flynn O’Malley said it was “unbelievable to be able to stay in my home state with friends and family and the doctors we knew so well” prior to his Melbourne surgeries in 2015 and 2020. .
A 23-year-old man’s recovery from a second transplant, made necessary after a workplace fire damaged his first set of transplanted lungs, coincided with the onset of Covid, making 2020 a difficult year for him.
“I was very careful, I don’t think I caught up with my mates for a good year,” he said. “Of course, I’m not unhappy — I live. (And) I am forever grateful for both transplants.”