From the Trenches …

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From TPM Reader XX, an emergency room doctor in the Bay Area. The email is from yesterday. The note contains a lot of sobering, scary information. I urge you to read it as one person’s rapid fire report in a chaotic situation and put it in the context of other news reports from other sources. I share it with you mainly to highlight the decisions, sacrifices and experiences of health care workers who are knowingly putting themselves in danger because it is what their professional commitments require and what they choose in a moment of crisis. I have removed a few brief asides to preserve XX’s anonymity.

From XX …

I’m a long time reader, but have rarely (if ever?) taken the time to write in. I’m an emergency physician at a hospital in the Bay Area … Perhaps this is all common knowledge and not informative – but I find the disconnect between what I see at work and in the news disconcerting so figured I’d add my two cents.

Everyone I work with seems resigned to a sense of impending doom, and an expectation that we will all be infected in the weeks ahead, and that we have no alternative course of action without abandoning our patients.

Many coworkers live with their parents, immunocompromised family members, etc, and are terrified about what they will do when they get sick. Live in a call room? stay in a hotel? not go home for 2 months? We’re slowly changing our operations, adding staffing, infectious screeners, etc – but there is organizational resistance to make the big changes that are already necessary. Despite near-daily reports from Italy of WWII-era triage decisions, shortages of key equipment, PPE, etc – we are still operating as if we can add a couple shifts to the schedule and otherwise operate normally. We’re not isolating URI patients from other patients in the waiting room, nor keeping them out of the “clean” areas of the hospital. We still have zero ability to test anyone who isn’t critically ill. We’re still using PPE for individual patients, discarding it, then using a new set for every patient. This would obviously be appropriate under any other circumstances, however we have recently been told that we will run out of PPE, most likely masks, within several days. Colleagues in the NYC area report that in the last few days there has been a surge of ill ARDS/covid patients, including one facility which intubated 5 of these patients in a single 12 hour stretch. In addition they have been told only to wear masks if intubating because of shortages … Reports from China suggest Covid patients typically require ventilators for 2+ weeks before improving.

There are reports coming out of South Bay that hospitals there are inundated in covid patients – but everything is being kept hush-hush for no discernible reason. All the staff I work with (MD, RN, tech, etc) are quite certain that we are headed for a catastrophe of somewhat epic proportions. Some people in the news have been saying we can do it better than Italy – I think the opposite is likely true. We have less beds per capita than any other industrialized society, and a completely inadequate number of ventilators, prone beds, ECMO circuits, perfusionists, etc for the wave that seems to be coming. We have a population that is half-heartedly pursuing social distancing measures, and no capacity to truly isolate the infected (home quarantine is a joke. the majority of the cases in China were transmitted via family clusters). We have national leadership that is both arrogant, incompetent, and seemingly determined to pursue political advantage regardless of the price to the nation. There will be some extremely difficult decisions ahead for our leaders, and I have less than zero faith they will be able to nimbly guide us out of a crisis.

We are used to dealing with regional disasters in the US: hurricane in NO: send aid from the rest of the country. Fires in CA: send in firefighters from the other regions. We haven’t faced a crisis that occurs in every state simultaneously since…? WWII?
I think our leaders, health departments, hospitals, emergency managers, etc have grown complacent that any shortcoming will be resolved when the cavalry arrives in the form of a federal/national response. In this case I think there will be very limited reinforcement. This will hit WA, northern CA, and NY first, then the rest of the country will follow within 2-4 weeks due to the lack of testing capability and governmental inaction. I find myself daily wondering how we have had a less effective public health response than China, South Korea, New Zealand, Italy, etc. Our persistent lack of testing capability is incomprehensible, crippling, and infuriating at this stage of the crisis.

I’ve cared for loads of patients in situations that were plenty scary. I don’t think I’ve ever been as scared for myself, my colleagues, my neighbors, and our country as a whole.
Sorry if this is a bit scattershot, lots of long shifts this past week with not enough sleep – and the wave hasn’t even hit yet.

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