15 March, 2020

From the Trenches …

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.