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COVID19: Notes From the Front Lines

by Elizabeth Hofheinz, M.P.H., M.Ed., April 16, 2020

There is probably not a time that we can recall when the helpers—seemingly all of them—needed more help.

Branden Lawrence, M.D. is an emergency medicine physician in Phoenix, Arizona. “When I first heard about the coronavirus in December it seemed contained and too far away to think that it would become a serious threat to us. For most of January through mid-February people were saying that the seasonal flu was worse. Then more and more people started dying…then Italy fell apart and things got real.”

“Here in Phoenix we were preparing for the seasonal flu and we thought, ‘Well, if we get a few coronavirus cases then we can put them in separate rooms and swab them.’ We were not expecting massive amounts of people.”

And while evidence-based medicine is the ideal, that evidence takes time to mount…and examine.

“Yes, we are looking for fever and cough, but there are not a few outliers. Some of the Chinese data is questionable…we are now awaiting more Italian data. In the meantime, we are extra cautious. When someone has aches and their temperature is only 99 degrees, they can still be positive for COVID19. “

Dr. Lawrence, who says he is allotted one mask per day, has gotten into “FaceBook Fights” with people who don’t seem to be taking Covid19 seriously enough. “I called out one guy who posted a picture of himself out and about. His child was recovering from cancer and his other child has lupus. People have to understand that this is not just affecting elderly individuals.”

On the respirator front, Dr. Lawrence states, “I have even seen a forum discussing how to use one respirator for three patients. This is just an incredibly unpredictable disease. I had one patient in his early forties with bilateral pneumonia…and by the time my shift was over he was on a BiPAP machine in the ICU.”

“As of my last shift, all of our ICUs and COVID beds were full and my shift ended with another intubation and a code as I was trying to walk out the door.”

The view from a physician assistant in Manhattan:

“Our hospital has been converting units to Covid-only areas, and each time we open one up it pretty much fills within 24 hours. In a typical night you might see from 2-4 people who need the ICU…now these units with 14 beds are filled with ICU level patients in 24 hours.”

“This hospital was initially doing its best to have one ICU nurse per patient with an additional nurse to watch you put on PPE, ensure you were OK in the room, then help you get out of the room. If that nurse saw you contaminate something they would speak out. That quickly went out the window because there were so many admissions. And then you add in the stress of having PPE shortages. All PPE is locked up; you must check in with charge nurse and what you get is based on what you are doing that day. We are at the point of reusing masks and shields.”

“My primary concern now is our ability to have the appropriate staffing ratios to handle the influx of patients. We are running out of ventilators when we are dealing with a disease that demands that people need a long time on those machines.”

“Overall, nurses are the most exposed personnel. They are entering patient rooms for labs, to ensure the patient is alright, treat their pain, etc.”

And the slight ray of good news per this physician assistant?

“We are all joining forces against a common enemy.”

And from a nurse practitioner in Virginia:

“There are an alarming number of younger people getting this disease. The youngest I have seen was 21. Our hospital system is using private labs and is able to test all patients who meet official CDC criteria, but we have also been able to expand testing to include first responders, patients who are high risk for complications, as well as primary caregivers of patients who are in high-risk groups. Masks and gowns, however, are another story…we are critically low on those items. We have one mask per shift.”

“For patients who are suspected to have Covid19 we set up pre-triage area outside the ER doors. If a patient has a cough/runny nose/ fever they get a mask and go to that area.”

“I work in a private practice as well and our anxiety patients are off the charts with worry these days. We are dealing with panic attacks left and right.”

This nurse practitioner has a young child at home. To protect her little one, she has a routine. “I wear scrubs, leave them at the hospital, enter my garage and change clothes, leaving my shoes there. It’s a whole new world.”

And we wouldn’t be able to handle any of it without these and other incredibly dedicated healthcare workers. Thank you.

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Elizabeth Hofheinz

Two time winner of the MORE award Ms. Hofheinz was the first writer employed by Orthopedics This Week. The MORE award is granted annually by the American Academy of Orthopaedic Surgeons to recognize excellence in journalism. Ms. Hofheinz is currently the Director of Communications for Ortho Spine Partners (OSP).

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