It's hard to image what life was like a month ago since so much has changed. The world seems surreal right now: little to no traffic, the hustle and bustle of our cities gone, and the quiet. So much quiet.
Life has changed significantly in our home, as I attempt to strip at my backdoor after returning from work, wash my hands, wipe my keys, phone, and wallet down, then head up stairs for a shower and change of clothes before familial reentry. I sleep in a different bedroom, shower in a different bathroom, and wonder (like a worker after the Chernobyl accident) what my viral "load" is at any point in time. Every accidentally-aspirated chicken noodle soup noodle and results in a coughing spree clears a room. I scratch my nose: "do I need to wash my hands again?"
Life as a physician is really weird now. We are healers and potential vectors all at the same time.
Yet so far we are lucky. Italy announced 969 deaths in a single day yesterday. Many, if not all of them, died alone. The ripple effect on their families must be enormous. And the poor doctors, nurses, health care workers there. New York is starting to feel this too. Will it get this bad here?
Our hospital system has been very proactive and open about the situation with us. They acknowledge the worldwide shortage of personal protective equipment (PPE). They are conserving necessary supplies for those most likely to confront new patients or those with suspected or confirmed COVID-19. All OR's and emergency procedures require full PPE, which is awkward when a non-COVID-19 patient enters: where is the transition to full PPE made? In the holding area? The lab itself? It's all a work in progress. Ventilators? Enough now, but later? Sands shift.
Still, it's impressive to see an ambulance bay converted to a negative flow screening area. Separate hospital's ICU and inpatient ward adapted for designated for COVID-19 patients. Contignecy plans for overflow are already in place. Outpatient drive-thru testing established for people who are most likely to warrant testing and have taken an online screening questionnaire. Six-foot markers are on the floor in the cafeteria, meetings, if they occur at all, are via Zoom or teleconference. Nearly all patient visits are virtual. Elective cases are a thing of the past. 425 physician volunteers are on standby - for extra duty - sometime.
At first, then percentage of people tested with positive coronavirus tests in 24 hrs was 15.8%, then 17.2%, and this AM was 19.1%. 7% of those hospitalized. Lots and lots of testing, planning, wondering, waiting. Today we admitted more people in a single day than everyone that was admitted when we started monitoring a week ago. It's coming.
The preparation seems so logical, but I wonder: will we be overwhelmed? We really don't know. But the non-COVID patients are still out there too: the LVAD patients with ICD shocks, the kids with broken bones, the baby deliveries, heart attacks, cancer patients, and patients with complete heart block, and more. They haven't stopped coming but they, too, are scared.
It's reassuring to see so many good folks giving it their all: from the doctors, nurses, administrative staff, clerical workers, laboratory staff, environmental workers, engineers and transporters. We work together - we have to - and with that effort comes the rekindling of respect for the special skills of everyone.
Once relatively simple things to treat take much more strategic coordination now. Atrial flutter w/rapid rate in a patient with fever and cough just a month ago would get a TEE/cardioversion without a moment's hesitation. Now, that patient is COVID-tested, isolated, procedures performed in full personal protective equipment, and tensions between colleagues heightened. The truth is, the vast majority of us that contract the disease will recover, but no one wants to be that other statistic. Patients need us. Families need us. So we wear a mask, we wash our hands, we wipe our tools, keys, keyboards, phones, then strip, wash and reenter. Are we effective? Honestly, I have no idea, but what else can we do?
Thanks to everyone who have sent prayers, words of encouragement, and support by staying home. We will all get thorough this.
Take care out there and take comfort in the fact that you're not alone.