Education: Meet Dr. Kakarala, a Professor at the University of Kansas

Could you tell us about yourself and your occupation? How does your occupation impact the local community?

I am a head and neck cancer surgeon, which means I did training in otolaryngology, known as Ear, Nose and Throat, and then I did some more specialized training to treat people with head and neck cancer, in particular to do surgery for them. I have been doing that for the past 8 years here at the University of Kansas Hospital in Kansas City. My practice is serving the whole state of Kansas and parts of Missouri and some surrounding states. We basically take care of any patients that have not only cancer of the head and neck region but also other noncancerous conditions that might need surgery and more advanced treatment that cannot be provided in their own community. People travel from long distances to our hospital to get that kind of care.

What does a typical hospital day usually now look like with the outbreak of COVID-19?

It is changing every day, and we’ve had to be very flexible and adapt to new information and the current circumstances as they change. It’s not normal by any means, but it is becoming more normal in the sense that my week usually looks like a couple of days of seeing patients in the clinic and then a couple of days of doing surgeries in the operating room. We’re back to doing all of those things, it is just modified to keep both the patients and ourselves safe from COVID while we do it.

"It is changing every day, and we’ve had to be very flexible and adapt to new information and the current circumstances as they change."

What was the greatest challenge you faced in dealing with COVID-19, either in your personal life or hospital?

I would say that the biggest challenge has been and continues to be that we do not know a lot about the virus. We are guessing based on prior experience from other similar types of viruses but this is a new virus and the extent of its spread has been unprecedented at least as of recent history. We have to learn on the fly how to deal with it, and that’s why things are changing everyday. We’ve had to be flexible and adapt to the newest evidence as it comes out and try to do the best we can with the information best available.

With the recent news and studies regarding the lack of effectiveness of hydroxychloroquine, are there any new medical developments that could possibly alleviate the impacts or effects of COVID-19?

I am not really involved with treating the virus itself, but we are obviously hopeful for any kind of medical treatment for it. We don’t have the evidence to say for sure if [certain treatments] work or not. We might not have a medical cure for COVID-19, but the cure that I think is going to help us get through it is immunization, and that is something I think people are making really rapid progress on but, unfortunately, that really needs to be tested very rigorously to make sure that it is safe and effective before you roll it out to the whole population. It might be many months off, but at least I think there is hope to put an end to this.

How did your hospital and the state plan testing efforts for COVID-19?

In particular, I don't have the highest level view as to how things are run at the state level, but from personal experience, it has been important for us to understand what patients’ status is with respect to the infection before we consider doing a surgery on them. Specifically, the type of surgery that I do involves operating in the nose and throat area where the virus can be easily spread to anyone in the operating room. It can be very dangerous for me and my staff to operate on someone who has the virus, which is one problem. The other problem is that, we know from other countries and now in the US, if a patient has COVID and you do a surgery on them, the risk of them dying during or after the surgery is very high. So it is not something one wants to do unless it is an absolute emergency. This is a long-winded version of saying we need to test patients before we do surgery; we have now gotten to the point where we test all of our patients within 48 hours of doing a surgery. It is not perfect but I think it gives both the patient and us some peace of mind that it is ok to proceed.

"...If a patient has COVID and you do a surgery on them, the risk of them dying during or after the surgery is very high. So it is not something one wants to do unless it is an absolute emergency."

Would you say the number of patients entering your hospital has roughly increased, decreased or stayed the same?

Well, actually, the total number of patients in the hospital decreased because we canceled all of our elective, or non-emergency, surgeries and medical admissions were postponed. That was especially true at the beginning of the pandemic before we had a full understanding of how many patients were going to be seen, and what the need was in our local area. Luckily, we did not experience anything like what happened in other areas; In New York for example, where the hospitals were near or past capacity. We never got close to that, but I think it was prudent to stop some of the elective procedures. I think we are slowly making progress toward getting back to normal, with the appropriate precautions.

What do you think is the most significant impact that COVID-19 will have on the clinical research and academia at medical schools such as yours?

I would say one thing that has been nice is that it has given us some time, since we have gotten less busy, to focus on and develop some research questions and tailor research to answering questions in our field that might relate to the virus. With regards to clinical practice, the virus has kickstarted is the idea of TeleHealth; I am using Zoom to visit with patients. A lot of our patients travel from really far away, up to 8 hours, and sometimes I need to see them in person but sometimes I think a video visit is reasonable. This has kickstarted the movement to make TeleHealth more available, which I think will be a good thing for some patients who may not have been able to access the healthcare system before.

To what extent do you think the recent Black Lives Matter protests might stunt the medical and societal advancements that we’ve experienced thus far?

That is a difficult question to answer. When people come together in large groups and are not protected in terms of distancing and masks that certainly has been shown to be a risk for the virus spreading. We will not know for sure, for a few weeks here, what the numbers are because there is a lag time between some of these gatherings and when patients start to get sick from it. So, there is certainly a risk and we will have to keep an eye out for the numbers as they come.

What do you believe others can do to generally maintain public safety?

Use your common sense and keep an open mind. Unfortunately, some of the ways people are reacting to this have been colored by politics. Try not to let personal biases or opinions get in the way of listening to scientific evidence that is available. Obviously the evidence we have is not perfect and it does change, but I think our public health officials are doing the best that they can to give good information. We all have to make choices for ourselves and our family but trying to incorporate that best evidence to protect yourself and your family but also try to protect your community and people who are more susceptible to the virus. Even if you are not as at risk of dying from the virus, there are others who are, and your activities have an impact on them. The more people get sick, the more likely it is that our healthcare system might get overwhelmed like it was in New York and other places, and so everyone doing their part to keep themselves healthy and keep others healthy is helpful.

"Unfortunately, some of the ways people are reacting to this have been colored by politics."

What is the greatest lesson we can learn from this pandemic?

My hope was that maybe such an important, traumatic, and world altering event would be an opportunity for humanity to draw together, as opposed to become more tribal, meaning splitting off into our own little groups and biases. I think there has, unfortunately, been a little bit of a movement towards people using this as an opportunity to become even more separated from each other, but there is still an opportunity...for us to all come together and pull in the same direction, and realize that this virus has shown us that we are all human. No one is immune, so to speak, from being susceptible to this [virus]. Any human being can get this virus, and so we all have a shared responsibility to respond to this in the best way we can as a community and not just as individuals. Hopefully it is something that can bring us all together to respond in the best way we can.