COVID-19 Positive cases: 454,638
COVID-19 related deaths: 5122
Recovered COVID-19 cases: 374,926
Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County updated Tuesday, January 18, 2o22. Find more COVID-19 information from TCPH here.
*These data are provisional and are subject to change at any time.
Deaths and recovered cases are included in total COVID-19 positive cases.
Tarrant County will be activating a COVID-19 surge testing site in Arlington. The Tarrant County Office of Emergency Management requests volunteers to assist with line management and other miscellaneous duties.
Volunteers will work 3.5-hour shifts with three volunteers per shift. This work will be outside and require standing for long periods. Volunteers will not be involved with the testing procedure. Water will be provided. Face coverings are recommended.
Dates: January 20, 2022 – February 10, 2022
Time: 9:00 a.m. to 7:00 p.m.
Location: Globe Life Field, Parking Lot M 1205 Pennant Dr, Arlington, TX 76011
Volunteer Sign-up:
If you have any questions, please contact:
By Brent Annear
Published by the Texas Medical Association on January 14, 2022. Read the original article here.
The omicron variant’s illness has been described by some people as “less severe,” but physicians urge their colleagues to help patients keep their guard up. In addition to making people sick enough to miss several days of work and school, the virus remains a serious threat to people at high risk for severe illness. Some physician practices have had to close due to COVID-19-related staff shortages or have gone to 100% telehealth visits.
“This illness may seem mild to some, but right now we don’t have enough effective treatment if too many high-risk patients get sick all at the same time,” said John Carlo, MD, a TMA COVID-19 Task Force member.
So far, only a single monoclonal antibody treatment (sotrovimab) is effective against the omicron variant. Supplies are extremely limited.
“On top of this, the omicron variant is incredibly infectious, even more so than previous variants,” Dr. Carlo added.
The Texas Department of State Health Services has reported more than half a million cases since Jan. 1.
“The good news is we know how to protect ourselves,” Dr. Carlo said. “Vaccination with a booster, diligent and effective mask-wearing, and avoiding poorly ventilated indoor settings are effective.”
Physicians also worry about Texas hospital beds filling up too quickly, as area hospitals already face staffing shortages due to sick workers. “We want to make sure we have the space for every patient who needs care,” Dr. Carlo said.
TMA’s COVID-19 Task Force recommends reiterating to patients the following protective measures:
“This current wave is spreading faster than ever before, and the only way to slow this down is for everyone – not just some people, but everyone – to be vigilant,” said Dr. Carlo.
by Kathryn Narumiya
This piece was originally published in the January/February 2022 issue of the Tarrant County Physician. You can read find the full magazine here.
Isn’t it great when a business has more clients than they know what to do with? Of course! It’s a problem most business owners would beg for unless they are providing critical medical services to those in need.
At Project Access Tarrant County, we are honored to have the opportunity to provide surgical treatments to our client base. While PATC can always use more volunteer general surgeons, gynecologists, and orthopedists, lack of volunteers is not the main issue. Many of you have eagerly and graciously given of your time and expertise to these patients. We are all grateful for your time and efforts.
Unfortunately, the number of patients far exceeds the volume that Tarrant County hospital partners can provide on a charity basis. For us, having clients on long wait lists or undergoing emergency surgery because PATC is unable to coordinate their surgeries is heartbreaking. We don’t want these outcomes to become normalized or acceptable.
In 2020, we began working toward reducing our wait times. While progress has been slow, we have made significant strides in this direction. After considerable research into alternative services offered by peer organizations across the country, we have identified an opportunity to strengthen the number of patients we can serve through an additional lane to our current panel of services. To be clear, Project Access Tarrant County as it currently exists is not going away.
Introducing – Access Surgery Partnership.
Based on Surgery on Sunday, a medical nonprofit organization in Lexington, Kentucky (www.surgeryonsunday.org), Access Surgery Partnership will host surgery days in a separately leased surgery center on a periodic basis on a day when the facility would traditionally be closed. The surgery center partner(s) will receive compensation for use of the facility. The surgery center staff will be comprised of teams of volunteer surgeons, nurses, and ancillary staff, both medical and non-medical. The united surgery center staff will perform multiple outpatient surgeries and procedures in one day, effectively eliminating long surgery wait times.
The traditional PATC model will still exist as we realize that not all procedures are appropriate for an outpatient setting, and not all physician volunteers will participate in the new model. We will still need our current hospital partners in order to serve our client base.
We are not doing this alone. We are building a strong foundation for this new service line by collaborating with Brittain-Kalish Group and Dynamic Development Strategies to complete a proforma, business plan, timeline of milestones, and a long-term development plan. Several funders have shown interest in backing this initiative, and we are continuing to cultivate and update those parties as we progress. In fact, the Sid Richardson Foundation has singlehandedly funded the “discovery phase” of this project as we research and plan.
A lot of work remains to be done with various challenges to overcome. Our primary and most imperative challenge is finding a surgery center partner. Additional challenges include recruiting volunteer medical non-physician staff and obtaining our own surgery center license.
This is where you come in. We need your help!
1. CONNECTIONS to Leaders!
o Do you know leadership at a Tarrant County surgery center?
Please make an introduction to PATC!
2. Staff VOLUNTEERS! Talk to your medical staff about volunteering.
3. STEP UP YOURSELF! If you have not been able to volunteer previously due to conflicts, this new model may be more conducive to your schedule.
o Contact me and we can discuss options!
As other opportunities to help arise, we will let you know about them. We will also keep you apprised of our progress towards making Access Surgery Partnership a reality. With the Tarrant County Medical Society membership, we know we are well on our way.
By Hujefa Vora, MD – Chair, Publications Committee
This piece was originally published in the January/February 2022 issue of the Tarrant County Physician. You can read find the full magazine here.
The medical students were sent into hiding. We chose not to risk their bodies to the unknown illness. Instead, most of them sat alone at home in front of computer screens. They attended lectures virtually. Physical contact became taboo. Learning turned into rote memorization of presented facts, with little opportunity for the hands-on training of our time.
In our clinics, we went into hiding as well. Our appointments became virtual. We too hid behind these computer screens. Physical contact became taboo. To start a visit note, we would write that the patient had consented in an informed fashion to participate in a virtual visit, utilizing a platform with audio and visual capabilities. Patients would take their own blood pressures using their automatic home monitors. Often, they would not only create their own objective findings, but also their own interpretations of their subjective history. When we no longer touch our patients, when we can no longer hold their hands, we become severed. The patient-physician relationship is powered by the force of our connection to our patients.
A story that needs to be told. I had a patient who smoked incessantly. He was referred to my office by his cardiologist, who explained his worsening shortness of breath by saying it is not his heart. He came into my office for the first and last time in March of 2020 just prior to the lockdown. We spoke of his three packs a day habit. We talked about how for the last month, he was unable to walk across his living room without becoming short of breath and coughing until it felt like his heart would pop out of his chest. Fearing the worst, I sent him out to get a chest x-ray. Those fears were confirmed with the finding of a complete white out of the right lung. A CT scan confirmed the presence of malignancy in the setting of emphysema. We couldn’t get a biopsy right away because the lockdown happened. Many of you will remember that elective surgeries were put on hold. Biopsy of a mass which I was sure was cancer was not necessarily elective, but getting the procedure done became nearly impossible. I had to present the case to our surgical review board at the hospital in a Zoom meeting. They authorized my procedure and scheduled the next available interventional radiologist. As the day of the biopsy approached, we were informed that the patient would not be admitted without a negative COVID PCR result. In the early days of the pandemic, PCR results took sometimes one or two weeks. We had 72 hours, and it took about that long to actually get the test done. Upon finding that we were not going to get the biopsy done, I spoke to the patient and his family over the telemedicine platform my office had just installed. If we admitted him to the hospital, we might be able to get things done more efficiently. The patient’s daughter refused this option. We will be surrounded by COVID. I can’t risk that. The patient continued smoking his cigarette pensively, deliberately. The patient was offered a pulmonary consult instead and possible bronchoscopy. It took another three weeks to get the patient in front of the computer screen of the pulmonologist, and then another two weeks after that to get the bronchoscopy done. Ten days later, a pathologist called me to let me know that the patient had waited too long to quit his smoking habit and now had squamous cell carcinoma of the lung. This is the kind of news that needs to be conveyed in person, not something to be said over the phone. The patient refused to break his lockdown, so that meant the phone was how this would happen. Unfortunately, the patient’s daughter was unavailable, so we were unable to establish the video component of the virtual visit. I told my patient he had cancer over the phone, unable to reach out and make any physical contact, not even something as simple as a handshake or a pat on the shoulder. I couldn’t see his face to read his thoughts, get some signal of the inner turmoil he might be experiencing. I did my best to follow his verbal cues. We talked about the plan. He wanted to know our next steps. Well, it took another month to get the patient onto a Zoom call with an oncologist. Another three weeks got us into the virtual room of a cardiothoracic surgeon. The surgeon agreed that the patient would need surgery to remove the tumor and at the very least improve his quality of life by making it so he could breathe. The patient was referred back to our original cardiologist for cardiac clearance prior to surgery. In order to get his stress test, he was subjected to another PCR test for COVID-19. This came back a little quicker than expected, negative as was expected. The patient underwent his stress test and was negative for inducible ischemia. He was cleared for surgery. At his preoperative evaluation for his scheduled surgery, the patient was told he would need another COVID-19 test. He refused, as he had the PCR just two weeks prior at his stress test, and he was tired of the runaround. Unfortunately, this assertion of control, this blatant attempt by the patient to avert further procrastination, further delays of his surgery, backfired. In the meanwhile, I had been following the patient’s progress for the past six months with monthly phone visits or Zoom calls. And so, I tried to take control of the situation. I spoke to the surgeon, questioning why it had been necessary to delay surgery for a cardiac clearance in a patient with known cancer. We would not have delayed the procedure for CABG had this been necessary. So we had lost more time. I produced the records of three COVID testing results over the past few months. I again met with the hospital’s surgical review board. We worked out a plan of care. I brokered a deal. The patient would go for surgery as soon as the surgeon scheduled. We had one last meeting before surgery. It was now September. The patient asked me if he would be recovered by November 4th, election day. I told him that I was not sure. He informed me that he would not schedule his surgery until after election day, because he needed to vote in the election. The surgeon reluctantly agreed to schedule him for surgery on November 5th. The oncologist interceded and demanded that another PET CT be done prior to scheduling the surgery. Another PCR was ordered and refused. Another deal was struck. The patient’s PET CT showed progression of the disease – not a surprise. On November 5th, the patient finally went for his surgery, 249 days after our opening salvo. Ten days in the ICU. I didn’t see him because we were in the heart of COVID at this point. You know this patient though. He was too stubborn to let this cancer beat him, too tough and thick-skinned to allow even COVID to get through. He survived all of this. The oncologists offered him chemotherapy and radiation treatments, but he refused. He went back home to his couch and his cigarettes. Behind the scenes, I continued to coordinate his care with the surgeons, his oncologists, the cardiologist, and the pulmonologist. To him though, I was just another voice over the phone, a talking head disrupting his existence. Molasses. Quicksand. COVID testing.
Our patients went into hiding. Their trust of the medical establishment is broken. Our relationship with them, though we looked out for their best interests, is broken. We have socially distanced ourselves into a corner. It is time to come out of hiding. It is not taboo to touch our patients’ lives. It is what they expect. With this new year, we must wake up. We must remind our patients that we will always fight for them, whether we are fighting against cancer, against COVID, against politicians, against ignorance, against fear. Never against them, but always with them. My patient survived, thrived, but I have never seen him again. This is the Last Word.
Cook Children’s pediatrician and TCMS member Dr. Jason Terk shares the tragic way one of his young patients was impacted by COVID-19, and why it is critical to protect the health and wellbeing of children by getting vaccinated.
COVID-19 Positive cases: 441,134
COVID-19 related deaths: 5111
Recovered COVID-19 cases: 373,903
Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County updated Thursday, January 13, 2o22. Find more COVID-19 information from TCPH here.
*These data are provisional and are subject to change at any time.
Deaths and recovered cases are included in total COVID-19 positive cases.
by Allison Howard
All too often, struggles with our health bleed into other areas of our lives. “Melanie’s” hernia did not just cause her stomach pain and inflammation – it stopped the mother of three from playing soccer with her children. It made her struggle with depression and lack of motivation. It made her worry about the future.
Melanie had to go to the ED several times because the pain became severe, and she worried that her condition would become worse. Her children were anxious about their mother’s health, and she was concerned about them – her youngest is only one year old.
She sought care at Cornerstone Health Network, and it was there that Melanie was referred to Project Access. At that point she was relived – there was hope for the future. Melanie knew she would receive the care she needed, the care that she could not otherwise access due to lack of resources.
Melanie was referred to Project Access volunteer Dr. Mohamad Saad, who agreed that she needed surgery to repair the hernia. Dr. Saad performed her surgery at Harris Southwest Hospital, and anesthesia was provided by US Anesthesia Partners – Southwest Division.
Now, Melanie is again playing with and taking care of her children without pain. She is grateful to everyone who made this possible – from Project Access to Dr. Saad and his staff – because it has given her the opportunity to live a better life.
One of the things that makes Melanie happiest is knowing that it doesn’t stop with her – that many other people have also received critical care through these services. She shares her thanks for the help and genuine care that is extended to Project Access patients.
By Shanna Combs, MD
This piece was originally published in the January/February 2022 issue of the Tarrant County Physician. You can read find the full magazine here.
Welcome to 2022! This is going to be our year. Things are going to be better. So long, COVID . . . Oh wait, maybe not. Doesn’t this all sound a little too reminiscent of the start of 2021? As I write this, we are in the beginning stages of a new variant, Omicron. There is still much we do not know about this variant, and hopefully, by the time you are reading this, it will have turned out to be not as bad as the last one.
Thinking back to the start of 2021, we were elated to have new vaccines to fight off and end the COVID pandemic. Many of us in healthcare were racing to sign up to get our shot and show it off on social media. We finally had some armor to protect us in this fight, and soon enough it would be available to protect our families, friends, and patients. Yet the conversation quickly turned to, “It was made too quickly,” “You can’t mandate that I get the vaccine,” “I am healthy; why do I have to get the vaccine?” or “It is all fake news.” So now, here we are, entering the “terrible twos” of the COVID pandemic. If there is one thing that has been demonstrated during the COVID pandemic, it is that the innate trust in physicians, medicine, and science is, unfortunately, no longer so automatic. We as physicians must continue to be voices for science and for medicine who, at the end of the day, want the best health outcomes for our patients.
As we enter the terrible twos of the pandemic, I encourage my physician compatriots to be the voice that our patients and our society need to hear. Whether that is in your day-to-day interactions with patients, conversations with family and friends, or in public venues, we must continue to be the voice of medicine. Ways to amplify that voice exist within our own county, state, and national medical society. Those of us in medicine often focus on what makes us different, but now more than ever we need to focus on what brings us together.
We are all tired and exhausted from this fight, and more than once I have heard others as well as myself say, “Can’t we just go back to how it used to be?” Unfortunately, I hate to say, COVID is with us for the foreseeable future. Yet, those of us in medicine went into this field for a reason. For me, that reason always comes down to my patients. I want to provide the best care to optimize the health and well-being of my patients. During these terrible twos, I call on my colleagues to remember why you embarked on this journey of medicine, and when you see a colleague struggling, help them to remember why they came to this profession. Not only can we be the voice of medicine to our patients, but we can also be the voice of support and camaraderie for our fellow physicians.
As we embark on this new year, I want to say that I support you as a fellow physician, and I look forward to the amazing work that you all contribute to your patients and to our society. Thank you for what you have done and what you will continue to do.
by Allison Howard
This piece was originally published in the January/February 2022 issue of the Tarrant County Physician. You can read find the full magazine here.
When Dr. Shanna Marie Combs was a little girl, she knew when she grew up that she wanted to be a doctor and a ballerina. Not a doctor or a ballerina – she wanted to dance and practice medicine. So that’s what she did.
The combination might seem odd, but when the OB/Gyn, who is a self-declared science nerd, ended up seeing multiple orthopedic surgeons throughout her childhood to manage dance-related ankle complications, the interest came organically.
“I was seeing orthopedic surgeons at the age of 12,” Dr. Combs says. “They all wanted to operate on me, and I would push back and be like, ‘No, I need another option.’” She laughs as she remembers her juvenile determination. “It came to the point I would have orthopedic surgeons print out journal articles for me.”
While her interest in medicine only grew as she did, Dr. Combs realized that she should pursue dance first if she wanted a real shot at both of her passions. After all, professional dancers have limited careers, and Dr. Combs was facing an even bigger challenge with her stressed ankle.
“I used to joke that medicine was my backup career for ballet,” Dr. Combs says with a grin.
She pursued a Bachelor of Fine Arts in ballet at TCU while taking all the necessary prerequisites to apply for medical school. Even though she wasn’t ready to take that step, she wanted to be prepared. It was a hectic time – she always took the maximum number of hours and had to take her science classes in whatever order they were available to work them around her dance classes.
After graduating, Dr. Combs joined the Ballet Theater of New Mexico in Albuquerque, where she had danced in high school. While there her life revolved around ballet – she performed, worked with students, and even managed the studio’s front desk.
Dancing was fulfilling, and Dr. Combs looks back on that time fondly. She created a special bond with her “ballet ladies,” one that holds strong these many years later. Still, the time had its challenges. Money was tight, and she ended up taking another job as a physics lab tech at a community college.
Dr. Combs was also physically feeling the impact of constantly dancing, so after a couple of years of performing professionally she decided it was time to move on to medical school. It was at that point that she hit a snag in the plan; she didn’t get accepted to the places where she had applied.
“I kind of had to have a real heart-to-heart with myself as to whether or not I actually wanted to do this again,” Dr. Combs says. “But ultimately, I was like, ‘No! You want to be a doctor.’ So I retook my MCATs and applied broadly and got in.”
She attended medical school at the University of New Mexico. Based on her childhood, she had thought she might go into orthopedics or perhaps pediatrics, but when she began her third-year rotations, she found she was drawn to obstetrics and gynecology. No one was more surprised than she was.
“I said I would never do OB/Gyn as a first-year med student, and here I am, as an OB/Gyn,” Dr. Combs says. “I did not understand the scope of what an OB/Gyn does, and probably my first day on the rotation I was like, ‘Oh, I kind of like this.’ So I fell in love with the field.”
It has been her passion ever since. She completed medical school in 2008 and began her residency in obstetrics and gynecology at JPS. She finished the program in 2012 and then began working for JPS Health Network in private practice as well as in education for the residency program.
Her love for teaching and education led to her involvement in the curriculum development of the TCU and UNTHSC School of Medicine, and she ultimately became the OB/Gyn clerkship director at the new medical school. Though Dr. Combs recently left that position, she is continuing to work with students; it’s one of her favorite roles as a physician, to prepare the next generation of doctors.
“When you work with students, I always say you can learn what to do and what not to do, and I always wanted to be somebody where they hopefully learned what to do in working with me,” Dr. Combs says. “I’d always loved teaching, so once I discovered that, oh, I can teach in medicine too, I kind of continued that in residency working with medical students and residents who were below me as I moved up and ultimately into education and working with students.”
In spite of her focus on education, Dr. Combs has maintained an active private practice. Last year she transitioned to Cook Children’s Physician Network, which has been an amazing opportunity to marry her love of pediatrics and OB/Gyn, two fields of medicine that rarely intersect.
“A lot of gynecologists won’t see kids younger than 16 or 18,” Dr. Combs explains. “There was definitely a need; it’s totally blown up. And I love it. I can’t tell you how many times women have brought their daughters and been like, ‘We’re so glad you are here.’”
“[Dr. Combs] has taken on the awesome task of advocating for female teen and young girls’ health,” says Dr. Hannah Smitherman, a pediatric emergency medicine physician who is one of her colleagues at Cook Children’s. “It’s a niche that many shy away from . . . Teens are struggling with the stressors of a rapidly changing and conflicted world. Dr. Combs is there to help support these children, soon to be adults, through their often very personal medical issues.”
Currently she sees any patient between the ages of 0–22 that needs gynecological care, but the bulk of her practice is made up of teenagers. “I love taking care of my little ladies,” Dr. Combs says. “I try to provide a very safe place.”
Recently, after displaying quite a bit of anxiety during her appointment, one of her young teenage patients came out to Dr. Combs as lesbian when they talked privately. It was something she had been afraid to tell anyone.
“As they were leaving, the patient kind of hangs back a little bit and she’s standing next to me,” Dr. Combs says. “And I’m like, ‘What’s up?’” Her voice is hushed as she reenacts the moment.
“And she said, ‘Can I give you a hug?’ My heart just broke. I just got the impression that she felt heard and supported . . . Stuff like that – it’s the best part of the job.”
Dr. Combs says there is one simple answer when it comes to organized medicine: “Do it!”
“As a medical student, I got involved in the New Mexico Medical Society and the AMA as well, and I remember talking with colleagues and fellow students,” Dr. Combs says. “They were like, ‘Ugh! I don’t want to deal with that stuff.’”
While she understands the hesitation physicians might feel, especially those just beginning their careers, she believes that it is critical for them to be involved in anything that impacts medicine.
“Am I a businessperson or a politician? Absolutely not,” Dr. Combs says. “Would I rather just practice medicine? Absolutely! But all those outside influences affect how I can practice medicine, so I’ve always wanted a seat at the table to kind of influence those decisions and choices.”
And if you feel underrepresented by an organization, Dr. Combs believes that is all the more reason to get involved.
“You can stand on the outside and throw stones and say, ‘They don’t speak for me,’ or you can say, ‘They don’t speak for me; I need to join that organization.’ Because the only way it’s going to change is if more membership gets involved.”
Dr. Combs tries to encourage medical students to participate just as some of her mentors encouraged her. One of those mentors, Dr. G. Sealy Massingill, who is an OB/Gyn practicing in Fort Worth, interviewed Dr. Combs when she applied for a JPS residency spot, and when she joined the program, he suggested that she participate with TMA and TCMS.
“I encouraged her to seek out opportunities in the community and feel grateful she chose to become involved,” Dr. Massingill says. “Her commitment to equity, diversity, and access to care have been drivers for her.”
Several years ago, Dr. Combs participated in TMA’s Leadership College. Since then, she has served on the TCMS Women in Medicine Committee and Publications Committee, and on the state level, the Membership Committee and Maternal Health Congress, as well as one of the AMA alternate delegates.
Now, she is ready to lead TCMS as she begins her term as the 2022 president. Dr. Demequa Moore, who is also an OB/Gyn taking care of patients in Fort Worth, says one of Dr. Combs’ greatest strengths is that she is driven by her deep care for others. “[She] has always practiced with empathy and compassion,” Dr. Moore says. “She continues to seek opportunities to learn and improve the health of her community.”
As Dr. Combs looks back over her career, a physician of particular influence comes to mind: the late Dr. Tracy Kobs. Dr. Kobs worked with JPS residents in the operating room when Dr. Combs was in the program, and she strives to emulate him as both a physician and educator.
“The more I learned about him over time, the more I respected him,” Dr. Combs says. “Operating, you want to get in, you want to do the job correctly, and you want to get out. And so when you’re working with learners you have to be very patient because they’re learning, and he never got frustrated or upset when things were taking too long or anything like that. He was always so patient . . . with the breaking down of steps. And even working with students now, teaching them how to do just basic knot tying and suturing, a lot of the mechanics I learned from him I bring to teaching with students.”
She is grateful for the cheerleaders she has had along the way, and her parents have been chief among them. They supported her at every step she took and challenge she faced.
At one particularly memorable moment, the family was driving back to Texas from Colorado when Dr. Combs found out she had passed her board exams. Her mother insisted that they had to celebrate immediately, so they pulled the car over so they could dance for joy.
“I love my parents,” she says, a big smile crossing her face. “I have to say, I’m very blessed.”
When she isn’t busy teaching, seeing patients, or attending meetings, Dr. Combs enjoys traveling with friends and family or spending time with her dogs, Duke and Poppy, and her partner, Mike Bernas.
While she has enjoyed her varied career and life experiences thus far, Dr. Combs looks to the future with anticipation because she sees it centered around her work as a physician, something that over the years, she has realized is more than just a passion.
“At the end of the day, I call it a calling,” Dr. Combs says. “You know, you hear people talk about their calling to ministry and things like that, but to be a physician has always been what’s at the center of me.”
