Joy Marini, MS, PA-C, is Director, Women’s Health, Office of the Chief Medical Officer, Johnson & Johnson. Joy is also a Board Director of GBCHealth. She has been volunteering with the Medical Reserve Corps during the COVID-19 pandemic in her home state of New Jersey, working at COVID-19 testing sites. Joy spoke with GBCHealth about her experience on the frontlines of the pandemic and about how the pandemic is affecting her work at J&J.

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How did you get involved in this volunteer work?

When it became clear that COVID-19 was going to be a significant health challenge, J&J and our CEO Alex Gorsky quickly took a number of steps to support the COVID-19 response, including approving 14 weeks of leave for anyone who was a health professional and wanted to serve in the field. For many of us who are physicians, nurses, physician assistants (like myself), EMTs, and other health roles, this opportunity really spoke to us.

I signed up for the Medical Reserve Corps (MRC) in part because of their great efforts to ensure volunteers are supplied with PPE, given legal protection and otherwise supported end-to-end. Within 48 hours, they placed me in COVID-19 testing centers in Middlesex County, NJ. We were fitted for PPE, trained and in the field within the week.

To date, I’ve worked in a three different drive-through testing centers, and I’ve also spent time testing at the walk-up centers, which take place in negative-pressure tents.

The testing we’re offering is free, and we are testing as many as 400 people in a shift. We started out doing nasal swab testing, then we moved to the newly approved saliva test developed at Rutgers. We’re part of a research study using the saliva test, so that adds another level of complexity to the testing.

How has the situation on the ground changed over time?

In the early weeks, many people coming through the testing centers appeared to be quite ill. I don’t see that as much anymore. We still have a comparable volume of patients, but New Jersey seems to be doing a good job of flattening the curve. Our positive test rate has continued to reduce from a high of about 50%. Sadly, many people whom we see have lost family members or had significant exposure to coronavirus. There is still a high interest in the community to be tested. People are very concerned about exposing others.

Can you share more about your experience on the frontlines of the pandemic?

When you think about a healthcare team, you might think about doctors, nurses, maybe EMTs. But, it really takes a huge number of people to support a stand-alone testing center in the middle of a pandemic.

For example, with the drive-thru testing centers – about 400 people coming through a facility in one day in their cars – we need first responders like police, hazmat and EMTs to support the process and keep everyone safe. Hazmat teams prep the health team before the shift and decontaminate after. They stay throughout to ensure that everyone is compliant and safe.

There are always new situations to address, which require support staff, ranging from exposure to acutely ill patients to car batteries dying in the middle of the tunnel, which has happened several times!

Kudos to the Middlesex County Department of Health as well; they have done an amazing job organizing, keeping the health team safe, and providing an important service to the community. The process for testing is relatively fast, and, while lab results are sometimes delayed, calls with results are made as quickly as possible. It’s an incredible team effort.

Something I’ve found super interesting is how fluid and innovative the teams have to be. We’re not in a hospital where the infrastructure is designed for these purposes. We’re set up in the community at either a Dept. of Motor Vehicles (DMV) drive-through or in school parking lots with negative-pressure tents. These circumstances require flexibility and problem-solving. What happens if you have a leak in the tent, or what happens when you need to decontaminate an area as large as a 4- or 5-lane DMV? For the latter, they innovated with farm equipment to be able to cover that square footage.

Finally, I may be on test number 100 for the day, but for each patient, it’s their first test. The instructions may be confusing, and this experience is totally new for each patient. We are sensitive to the experience that the patient is having, even though this isn’t a hospital or a clinic. Having people feel good about the experience, that they were cared for in a way that was safe, that they were able to have their test with no charge, provided by their state… all of those things are important.

What impact has COVID-19 had on your own role at J&J and within the CMO’s office?

J&J has made an incredible effort company-wide to address COVID-19, from development of a vaccine, support of frontline health workers, to the volunteer policy that allowed me to go back into practice.

The CMO’s office is a science-based department within the company focused on patients first through scientific evidence. Our core work continues, but some effort has shifted to understanding the impact of COVID-19 in various contexts. Within the health of women team, we have prioritized understanding the effects of COVID-19 through a sex- and gender-lens, so things like the effects on women or throughout pregnancy are of interest.

Given your gender lens, how is the pandemic affecting women?

From a medical perspective, the science of women and COVID-19 is evolving, and we’ll continue to learn more in the future.

From a socioeconomic point of view, COVID-19 is very much affecting women, especially women who are our frontline heroes – our health workers. When 70% of the health workforce is made up of women, and the pandemic is putting more and more pressure on our health system, that inevitably affects women.

And it’s affecting them on two ends of the spectrum. The first is in the high-incidence areas, where women are asked to work longer hours or in higher-risk situations. The other end is in low-incidence situations, where health workers are being furloughed because people are delaying treatments, or postponing elective procedures. If health workers have been furloughed, a majority of those will be women.

Do you have any reflections for businesses during this pandemic? 

We have this opportunity to turn everything on its head – to act to serve immediate and vital needs, while planning for longer-term needs.

The private sector is amazing at planning for the long view; thinking about a strategy, bringing innovative solutions and connecting science to health systems, and to supporting policy. But, there wasn’t much time for putting all of these pieces in place when COVID-19 hit.

There were gaps that had to be addressed with immediacy and we couldn’t wait to connect all the dots with a long-term strategy. So, while we’re meeting the immediate needs, we’re building the plan from the broader, more holistic perspective; the private sector and our partners are good at this.

Additionally, business has shown its agility and ingenuity during this time. For example, businesses have contributed by shifting manufacturing, or leveraging their greatest assets, employees, in unexpected ways. People with experience in procurement, for example, are applying those skills to procure PPE for health workers.

I am proud and amazed at the job that New Jersey has done to provide effective testing solutions. We’ve shifted a lot; in the early weeks everyone was laser-focused on getting more people tested.

Now there are conversations about “what’s next?”. Is the normal healthcare system able to absorb the needs of the community yet? When we have a vaccine, will these centers be repurposed for vaccination? There are still many questions, but science-based decision making is the foundation for moving forward. I see the evolution from paddling hard, to lifting our heads above water and seeing the shore.