Date Posted: Feb 2, 2025.
By: Avery Nennmann
An interview with Dr. Ashwin Shankar on Forging Community Bonds and Pediatric Healthcare during the COVID-19 Pandemic
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On October 17, 2024, researchers Avery Nennmann and Dr. Sarah Wagner interviewed pediatric and adult allergist and immunologist Dr. Ashwin Shankar regarding his experiences during the beginning months of the COVID-19 pandemic.
Dr. Shankar grew up in Houston, Texas, and went on to study opera performance and music composition alongside nutrition for his Bachelor’s degree. During that time, he burned the wick at both ends by DJing at clubs, getting up to tutor calculus at 8 am, and, for a little fun, joining a breakdancing team. His interest and devotion to medicine took shape when his mother’s health declined in college. He said he “wanted to empower people through medicine” and thus pursued this calling that later landed him in residency in Detroit, MI, at the Children’s Hospital just as the pandemic hit.
Dr. Shankar shared that during his time in medical school and residency, he was drawn to allergy and immunology, especially in the pediatrics unit, where he appreciated seeing children’s resilience and joy as a part of their recovery. In March 2020, Dr. Shankar was working the night shift. At the time, hospital staff noticed patients coming in with unusual symptoms, such as healthy children suddenly going into heart failure, and other more serious conditions. “We didn’t know what was going on… There were some rumblings that there was something kind of going around out[side] of the country, but we didn’t really think much of it. We thought maybe this is something that we just haven’t seen before.”
As the rumblings grew into concern, clinics shut down, and medical professionals began scrambling to determine how to act and what to do. The problem, however, was that no one had the answers. Dr. Shankar reflected on the silence for the first few months after March as they waited for cases to come in. “We knew we’re going to be having long nights… actually we didn’t know when would be the last time we’d see any family members or friends, and so we were all kind of prepared, and then the pandemic hit.”
May brought chaos to the hospital, and the ER was soon overflowing with COVID cases. Dr. Shankar had colleagues whose patients passed away while waiting in the hallways before they were even able to be checked in. Prevented from assisting because of liability concerns, those working in pediatrics “felt like we were useless… even though we were in the medical field.” “All of us were willing to run into the fire, … and so we were trying to figure out what are ways that we can help connect the community and help connect people.”
Dr. Shankar channeled that feeling of helplessness into action and became the chair of an organization called Pediatrics Educating and Advocating for Community Health, or PEACH. The group created Zoom meetings and outdoor activities for kids and their parents to be able to connect and mingle in a safe manner. A lot of what drew Dr. Shankar to this community effort was seeing an increase in Adverse Childhood Experiences (ACEs) from the compounding trauma of the pandemic. As he continued his efforts to heal through community, pediatric cases kept coming into the hospital. In June and July 2020, once again the ER was flooded, as kid after kid arrived with possible COVID-related breathing difficulties, heart palpitations, and fatigue. “Every single inflammatory marker was out of whack.”
As the pandemic raged on and the volume of patients increased, colleagues—healthcare workers themselves—began to get sick. Dr. Shankar’s concerns and efforts spread beyond the hospital to those being affected socially, especially within the population of children. He explained how isolation often compounded people’s fear of sickness: “You know, if they [children] ended up getting sick, a family member or a friend getting sick… even in the beginning when schools were closed, some of my patients had lost a parent/caregiver already because of COVID and they didn’t know how to react, they didn’t know what to do, and then on top of that, you know, you’re telling people, okay, you have to seek out your support group, but how can you seek out your support group if you’re supposed to isolate?”
When vaccines finally arrived, Dr. Shankar and his colleagues had a new challenge to contend with: distrust and skepticism. Through Zoom meetings and open forums, they sought to reach people where they were, to address their fears and answer their questions. People in the community began to respond. “You could hear the pep in their voice.” They began following up with their prescribed therapy and their checkups. For him, it was a crucial learning opportunity.
Towards the end of the interview, we asked Dr. Shankar about his proudest and hardest moments from the pandemic. The hard part for him, he explained, was being away from family—they were in Texas while he was in Michigan. The way through the isolation for him was connecting with community and becoming close with his residency family. He said, “That second layer that was very difficult was having patients pass away on me. Whether it was in the pediatric ICU or the neonatal ICU… these are people who didn’t even have a full life.” Dr. Shankar’s proudest moment emerged once the pandemic was in full swing and vaccines were passed out. The tipping point he recalled was when patients saw him and his colleagues get vaccinated; they did too. This 180-degree turn in trust gave him hope for community care and mutual respect for physician authority. “Seeing families and kids bounce back, like getting gurneyed into a room, and then walking out of that room with balloons and a smile. The numerous patients that happened to, and continuing to be at the hospital because of vaccinations, because they saw their doctor do it. That was probably one of the most exciting things.”
Dr. Shankar voiced his concern about the relationship between doctors and patients, which is doubly complicated in pediatrics since the parents/family of the patient are inextricably involved in their care, adding another potential layer of politically influenced strife in addition to the standard stress of having a seriously ill child in the hospital. The national increase in distrust of the medical community was also a factor in Dr. Shankar’s experience, especially in places like Texas and Michigan with the release of the COVID vaccine. Dr. Shankar explained that trust is as important in vaccine distribution as it is when treating a patient. He would ask, “Do you trust me? And they say, Yes, I trust you, Dr. Shankar. I said, Okay, would I ever stray you? Like, would I ever, you know, make you think something that’s not correct or not true? And they said, no. I said, okay, let me lay out all the facts for you. And so, my goal was that any decision we make, we have to make this together.”
Among the many lessons of the pandemic, Dr. Shankar stressed the importance of caring for oneself in order to care for others. “You kind of have to make sure your cup is full and you’re taking care [of yourself] before you can kind of give back and serve people.”
“Sometimes,” he explained, “when you’re hitting a roadblock every single day, it can be really hard. And it can be really easy to give up. But I think the reason why, like, myself and a lot of my colleagues didn’t give up was because … we were surrounding ourselves with the right people. We knew none of us had all the answers.”