No abstract

The unique situational challenges of the COVID‐19 pandemic have demanded creative modifications to the delivery of genetic services. Institutions across the country have adapted workflows to continue to provide quality care while minimizing the need for physical visits. As the first epicenter of the pandemic in the country, New York City healthcare workers and residents had to make rapid, unprecedented changes to their way of life. This article describes the workflow adaptations of genetic counselors across various clinical settings at New York Presbyterian/Columbia University Irving Medical Center, the largest provider of genetics care in New York City, during the height of the COVID‐19 pandemic. The authors observe how the adaptations impacted clinical care and the genetic counselors. Our lived experience and account can provide guidance for others during the current and future pandemics.

Background: Rapid genome sequencing (rGS) has been shown to improve the care of critically ill infants. Congenital heart disease (CHD) is a leading cause of infant mortality, and is often caused by genetic disorders, yet the utility of rGS has not been prospectively studied in this population. Methods: We conducted a prospective evaluation of the use of rGS to improve the care of infants with CHD in our cardiac neonatal intensive care unit (CNICU). Results: In a cohort of 48 infants with CHD, rGS diagnosed 14 genetic disorders in 13 (27%) individuals and led to changes in clinical management in eight (62%) cases with diagnostic results. These included two cases in whom genetic diagnoses helped avert intensive, futile interventions prior to CNICU discharge, as well as three cases in whom eye disease was diagnosed and treated in early childhood. Genetic disorders were associated with small for gestational age birth weight. Conclusions: Our study provides the first prospective evaluation of rGS for infants with CHD to our knowledge. We found that rGS diagnosed genetic disorders in 27% of cases and led to changes in management in 62% of cases with diagnostic results. Our model of care was enabled by multidisciplinary coordination between neonatologists, cardiologists, surgeons, geneticists, and genetic counselors. These findings highlight the important role for rGS in CHD and demonstrate the need for expanded study of how to implement this resource to a broader population of infants with CHD. Keywords: cardiac neonatal intensive care unit (CNICU), congenital heart disease (CHD), rapid genome sequencing (rGS)

Theatrical lighting design and genetic counseling may seem like antipodal career choices. The former was chosen from a belief in the dynamism of the theatrical experience, as well as love of the actual work. As I grew older, the powerful personal experiences of a life encompassing miscarriages, the birth of a child with a genetic disorder, and breast cancer profoundly directed my choice of a new career; one that I also love. Clearly, the day-to-day work is very different. However, people in both professions strive to create a transformative space for their respective public. Rather than being left behind, lessons learned by working as a freelancer have served as a source of inspiration as I have matured into my new career. Three specific strategies, supported by literature on career models, have been paramount. First, keeping an eye on the big picture encourages awareness of where the field of genetics and the genetic counseling job market are headed. That awareness leads to the advocacy necessary to achieve the outcomes genetic counselors want. Second, striving for continual personal growth keeps genetic counselors engaged and personally ready for professional changes. Third, networking provides the connections to make clinical and advocacy efforts successful, in addition to essential social support.