Spurred By A Preventable Death, One Project Has Become A Major Tool To Combat COVID-19

Aug 3, 2020

It all started at Dr. Sanjeev Arora's clinic in New Mexico.

"One Friday afternoon, 18 years ago, I walked into my clinic in Albuquerque to see a 42-year-old woman who had driven five hours with her two children," Arora said before a recent Senate committee hearing.


She'd been diagnosed with hepatitis C eight years before, but was just then seeking help because she'd heard it would require a dozen or so trips into Albuquerque for treatment "and she couldn't afford to take the time off work."

But now the pain had increased so much she had to come in. By then, Arora said, it was too late. Her untreated disease had caused liver cancer. She died a few months later.

"I asked myself, 'Why did this mother of two children have to die from a treatable disease?' She died because the right knowledge did not exist at the right place at the right time," he said.

Arora told that story to senators in June to demonstrate the power of what he later developed: Project ECHO.

Project ECHO, which stands for Extension for Community Healthcare Outcomes, is now a national organization with hubs throughout the country. It allows healthcare professionals to regularly consult with specialists at larger institutions over video, and those specialists also get to learn from reviewing the cases in rural areas.

In other words, "Everyone's teaching, everyone's learning," says Lachelle Smith, who leads ECHO Idaho. And she says ECHO has been extremely helpful lately.

"ECHO does really well with addressing things that are complex, they're rapidly changing or there's a high cost of lack of treatment – and COVID was all of those things in Idaho," she says.

In some ways Project ECHO was built for places like Idaho, which has the fewest primary care providers per resident than anywhere else in the country. Smith added that the entire state also has a shortage of mental health specialists.

"What that means is, if you are in a larger urban setting, maybe you would send that patient off to a specialist," Smith says. "Well, that would be a referral to nowhere in Idaho. So you get to do it."

And Smith says there has been an appetite for the trainings here, too. She says ECHO Idaho’s first seminar on COVID-19 had so many people wanting to join, they had to ask some to watch a recording after, instead. Even the governor joined.

The ECHO trainings do even more than teach, though, helping healthcare providers stay at work at a time when so many in-person conferences have been canceled and educational credits have become harder to get.

"Getting those free continuing education credits that you need to maintain your license anyway is just like icing on the cake," Smith says.

Dr. Megan Dunay is the medical director for ECHO Idaho's COVID series. She says most of those calling into its trainings are in rural areas with fewer resources, "which is tremendous and really, really helpful and important here in Idaho as we face down this pandemic, in particular."

Those virtual COVID-19 sessions include updates on things like drug trials and treatments, and presentations on major COVID-19 issues like how to care for critically ill patients. Participants also submit real-life examples of cases they've faced and have everyone discuss how they might deal with it, like whether to admit someone with borderline COVID-19 symptoms.

Project ECHO's trainings already helped more than 200,000 health care professionals nationwide learn about the disease as of June, according to its founder. And ECHO Idaho has seen a nearly 50% uptick in participation during the pandemic, which even includes some people from outside the state. Like Lynn Kohlmeier, an endocrinologist in Spokane, Wash.

"I think I've applied everything I've learned," Kohlmeier says. "Even from just a practical standpoint of talking to my patients and answering their questions, that I might not otherwise know how to answer as well."

Project ECHO's COVID program isn't just for doctors like Kohlmeier, though. It’s for a wide mix of healthcare professionals, which can cross-pollinate ideas on how to help patients with everything from end-of-life discussions to ventilator settings. Participants include nurses, pharmacists and social workers like Chrystal Anardi. Arnadi manages outpatient social workers for Kootenai Health in northern Idaho.

"It was really important for me to be able to glean what I could from that – that I could share with my staff or support my staff, and working with the patients and helping just ease that anxiety and the fear of the unknown and what's to come," Anardi says.

And beyond even that, Anardi says it's helpful to hear everyone else's fears and questions, and just know that during this stressful, ever-evolving crisis, she isn't alone.

This story was produced by the Mountain West News Bureau, a collaboration between Wyoming Public Media, Boise State Public Radio in Idaho, KUNR in Nevada, the O'Connor Center for the Rocky Mountain West in Montana, KUNC in Colorado, KUNM in New Mexico, with support from affiliate stations across the region. Funding for the Mountain West News Bureau is provided in part by the Corporation for Public Broadcasting.