Karen Brust, M.D.: Keeping patients and employees safe in uncertain times

By Janna Zepp | Photography by Rusty Schramm, BSWH

Karen Brust, M.D., Infection Prevention and Control Director Central Texas Division at Baylor Scott & White Health, remembered sitting at the desk in her office at the end of December and hearing about “pneumonias of unknown etiology” occurring in China. It was then that she picked up the phone and started calling her colleagues to let them know BSWH in Central Texas needed a coordinated response to this unknown disease, and they needed it soon.

“In the infectious disease world, we knew something was cooking pretty early,” she says. That “something,” initially referred to as novel coronavirus, was COVID-19.

Those early December phone calls quickly led to meetings in which Brust and her team began constructing a response plan that they had in place in late January. At the time she said they did not know how COVID-19 started, but they did know the epidemiology behind it.

“If you ask infection prevention leaders across this entire nation if they knew this was going to happen, the answer is ‘yes,’ and we planned for it and communicated about it,” Brust says.

Among the things Brust and her team discussed was virus testing, and they created a platform for this early on to get ahead of the game. She says there was constant communication among them. She says there were days that they were on the phone from 6:30 a.m. until 3 a.m. because the information they had at the time was constantly changing.

The goal of keeping BSW patients and employees safe was the one thing that remained the same throughout the process.

History played a part in BSWH’s response to COVID-19, particularly the Ebola outbreak in 2014.

“We learned a lot from Ebola and we modeled our response based on that,” Brust says. “Current infection control prevention practices require maximal prevention practices. This is not typical operation for most viruses or normal coronaviruses. But then, this is not a typical coronavirus.”

Brust says that working in the ICU, she sees people die from influenza and she just doesn’t want to throw COVID-19 into the mix.

“This is a high consequence infectious disease. We have a vaccine for influenza. We currently do not have a vaccine for COVID-19,” she adds.

The staff considered everything: disease transmission routes, incubation periods, what kind of personal protective equipment for employees and patients, how much PPE would be needed for each shift, how to identify and isolate infected patients from others and inform hospital public health partners of new infections.

Brust has complete confidence in her team and their response. She says the situation with COVID-19 can feel chaotic at times but the BSWH staff is pretty calm about the whole thing. They thought about the plans, they thought about how to ask patients at every entry point about their symptoms. They don’t have to try to figure out how to keep the travel website up to date. They have logistics on spreadsheets. She is totally confident about her colleagues.

“We’re just trying to keep up with the information that’s been given to us. Every single day there’s something new,” she says. “I’m not worried about being in the room with the patient because this is what we do. If I’m wearing my PPE properly and washing my hands, I’m practicing good infection control and I am in good shape.”

While Brust’s focus is on infection control at BSWH, she says there is much the community can do to help.

“Wash your hands. That’s the pillar of infection control. We can’t talk about infection control without washing your hands. Stay informed. Check your sources of information for credibility. Be aware during travel. Know where you are going and make smart decisions about those types of things. Stay home if you are sick. That’s what you can do.”

Karen Brust, M.D. works at Baylor Scott and White Health in the Infectious Disease Division as an Assistant Professor and serves as the Medical Director for the Central Texas Division of BSWH Infection Prevention and Control. Dr. Brust studied medicine at the University of Texas Health Science Center at San Antonio School of Medicine. Dr. Brust previously held positions with Bell County Public Health District, Scott & White Hospital, and the University of Texas Health Science Center.