- In the first few weeks of the pandemic, the number of COVID-19 patients in the United States has exponentially increased to over 2,500,000 confirmed cases.
- We chat with doctors in Chicago, New York City and Sacramento, California over the course of three days to hear their stories as they work within the realms of the U.S. healthcare system.
- They tell us their experiences working on the frontlines of the COVID-19 crisis.
- Visit Business Insider’s homepage for more stories.
Following is a transcript of the video.
Tasnim Khan: We’re still in the trenches, and not really clear on where that’s gonna go.
Saquib: The things I’m seeing in the hospital, this is really no joke, and I’ve never seen anything like it.
Ahmed Nadeem: Right now, I have so much to offer them, but you don’t know how it’s gonna be next two, three weeks.
Medha Imam: In the last couple of weeks, the number of coronavirus patients has increased exponentially to now over 400,000 confirmed cases in the United States. We contacted physicians in Illinois, New York, and California to hear their perspectives. But since things are evolving so quickly, we spoke to them over the course of three days. Here are their diaries.
Saquib: This is day No. 1.
Nadeem: This is day one.
Noel Lasala: Day one in the fight against coronavirus.
Saquib: Well, we had our fast patient on the floor die, which was really sad. It’s tough, what we’re going through. That interaction with, you know, the doctor who was taking care of that patient, and, you know, he just kinda looked at me incredulous and he’s just like, you know, “I knew it was possible that was gonna happen, but it just happened so fast.” There isn’t necessarily set protocols ’cause no one knows how to deal with a pandemic, so we’re really figuring a lot of stuff out on the fly.
Lasala: Patients today had mostly routine chronic medical issues. Luckily, today was not like three days ago, when we had our first highly suspected COVID-19 patient.
Nadeem: The greatest challenge was seeing these two patients. One of them was a sickly 64-year-old female, and the other one was a 26-year-old young gentleman. Both of them had similar symptoms. They were a little tough to manage just because we were understaffed today. Not too many people showed up.
Khan: We’re still in the trenches, and not really clear on where that’s gonna go. We evolve day to day; we evolve hour to hour. It’s been such a challenge to keep up with the ever-changing recommendations and even sometimes confusion and conflicting recommendations.
Saquib: We’re just not resourced appropriately for something like this, and right now it’s definitely been an uphill battle.
Nadeem: You see a lot of people cough a lot, and this 26-year-old is coughing quite a bit. I had about two gowns each time I went to see him, I went to see him four times, so you have about eight gowns, you’ve got about eight masks, you got eight pairs of gloves. It’s very easy to run out of all this equipment that you have, whether it’s masks, whether it’s ventilators, and whether it’s nasal cannulas to give them oxygen. I think the next challenge we’re gonna address is the surge that’s gonna be coming in the next couple of days. One of the biggest challenges is trying to calm yourself when patients come in because almost everyone is nervous. You’re the captain of the ship, so to speak, so you have to really have your whole composure there, you have to really be, not get nervous at all.
Khan: The one word that seemed to resonate and seemed to be common, commonly expressed by most of our team was abandonment. Neglect, isolation.
Nadeem: The rates of deaths are gonna increase. We know that. We know that from Seattle. Getting prepared for that is a little scary because we’re not really quite sure how much equipment we have. Right now I have so much to offer them, but you don’t know how it’s gonna be next two, three weeks. So when you think about that, it’s a little depressing.
Khan: We’re rationing our tests, so that means that there’re not enough. What I have heard from just the phone conversations with health state officials is that the labs just can’t keep up with the demand, the testing demand.
Saquib: We really need to emphasize social distancing just because we have to limit the spread, be smart, and recognize that this is now a public-health issue and we need to act collectively.
This is day two.
Lasala: There’s been a surge for our city of COVID cases with some moralities, too. Some people have died from it. We continue to fight the fight here in the trenches.
Saquib: The ICUs are getting really full. Initially we had put all patients who were very severe in the cardiac ICU, but now that’s completely full. They’ve moved all patients out of the surgical and medical ICUs and created a makeshift ICU, and now those ICUs are being prepped for coronavirus overflow patients. I have never encountered a situation where you’ve had to create intensive care units on the fly.
Khan: We had a high no-show rate today. So we had a lot of people who just didn’t come. We converted a lot of our visits to phone consults. On the good side of things, the Health and Human Service Department has waived HIPAA requirements, so we can pretty much use Skype, FaceTime, to do a video visit. For me it’s a challenge to tell people to be in the front line, and I as the chief medical officer of my group feel very responsible for people. And if I can’t protect my people or my providers, it does present itself as an ethical dilemma to me to tell them to go see patients and they don’t have the right protection.
Nadeem: Definitely one of my low moments was when I was told that we don’t have enough nurses to work the night shift. Some nurses had called in sick, and we had a ratio of about six patients to one nurse, which is actually pretty high.
Khan: In a developed country, you would expect to have supplies, you expect to have a system, and our system is just inadequate. We’ve attended several calls where they’ve told us to reuse our protective masks.
Saquib: Today it was kinda nuts, but we were taking care of one patient who suddenly developed a cardiac arrhythmia out of nowhere. He obviously had coronavirus. And while we’re getting in the process of putting pacer pads on him, another patient starts to fall apart, and they had to intubate that patient on the other side of the floor, and you’re just kinda looking like, how many shoes can drop all at once?
Khan: We’ve got to find other ways to work better and smarter and reconfigure how we’re dong care so that we’re not burning ourselves out too quickly, and we’ve got to be able to sustain the system.
Saquib: The ER is doing a better job of admitting only patients who there is a lot of concern, but, just, the numbers keep growing.
Nadeem: We have to really protect ourselves. I think my anxiety and stress level rises when I go see patients.
Saquib: The things I’m seeing in the hospital, this is really no joke, and I’ve never seen anything like it.
Khan: We really need to spend some time and learn from countries where they’ve managed to rapidly control and corral the virus and the spread and pushing back a little bit on the expectations of healthcare providers and clinical support staff. I think we need to speak up. I think we need to find ways where we get resources, as a developed country would be expected to deliver upon. And so I often wonder with all this money that’s being infused from the Feds and at the state level, how much of that is going into assuring that we are actually increasing the supply of personal protective equipment?
Lasala: This is day three of going antiviral. We had another case of confirmed COVID infection in our clinic. Staff now seems more apprehensive now that we’re seeing another case. Understandably so.
Nadeem: The volume today in ED was low. This is partly because of the stay-at-home order that was issued by the governor about two days ago. So people stayed at home. What it did for us was give us more time to recuperate, arrange for things, arrange our isolation rooms, get more equipment in.
Khan: Many of us feel very scrambled because everything is changing constantly. Can’t keep up with the guidelines. Can’t keep up with the confusion around doing phone consults. Can’t keep up with the constantly changing testing. Every minute was accounted for. Every minute was talking to people. Every single minute. You know, not even a chance to go to the bathroom. The greatest challenge of today was keeping providers motivated to stay in place and not panic, was keeping them focused on the fact that we need to be here to support what we expect will be a surge.
Nadeem: The greatest challenge today was probably a surge of patients I received between 11:30 and noon. Received about five patients. All the patients had similar symptoms as coronavirus patients. They came with fever, chills, cough, runny nose, and two of them actually had shortness of breath. So it’s an issue because we have only two isolation rooms in the ER and we can only accommodate two of those patients at one time.
Saquib: As far as the situation in the hospital, it’s definitely getting crazier. Our census of patients who either have coronavirus or who are suspected of, you know, has jumped from, I think it was, what, six middle of last week to around 85 today. Existing ICUs are now only for coronavirus patients, which is nuts. I’ve never seen anything like it. And then on the floor, patients are just falling apart kinda left and right. It’s definitely gotten real. And it’s progressed faster than I thought it would. I knew it would be quick, but nothing really can prepare you for it until you actually see it.
Nadeem: We need to be concerned about how are we gonna treat our sick patients if you got two, three sick patients at one time and I use up my isolation rooms, what are we gonna do with the other two or three patients who are actually sick?
Saquib: Every time I send someone out, I get two more back. Patients on the floor aren’t getting better as fast as I’d hope, and sometimes they’re even getting worse. Patients are presenting in ways that I can’t expect. They’re having complications I don’t foresee.
Khan: It’s somewhat inevitable that we are going to see a large rise in cases. We’re going to see possibly positive cases in our own facility. Possibly employees.
Saquib: As more and more of the hospital becomes full of coronavirus patients, how do you keep the virus from spreading internally? I think I’ve resigned myself to the fact that at some point, I’ll get sick. I’m just trying to hold on for as long as I can until we get this under control, because right now, we just need bodies to take care of all these patients.
Khan: Don’t go to the doctor. Call your doctor, call your provider. Find out if you need to be there.
Saquib: You know, the concept of social isolation, really preventative measures, handwashing, being cognizant if you’re sick to stay away from others, taking good care of yourself, because unless we get this under control, it’s going to just deplete the resources we have. So please, everyone, be safe, take care of yourself, and take this seriously.
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