Featured Jason Chung

Strange Times in Public Health

By ANISH KOKA, MD

A number of politically tinged narratives have divided physicians during the pandemic. It would be unfortunate if politics obscured the major problem brought into stark relief by the pandemic: a system that marginalizes physicians and strips them of agency.

In practices big and small, hospital-employed or private practice, nursing homes or hospitals, there are serious issues raising their heads for doctors and their patients.

No masks for you

When I walked into my office Thursday, March 12th, I assembled the office staff for the first time to talk about COVID. The prior weekend had been awash with scenes of mayhem in Italy, and I had come away with the dawning realization that my wishful thinking on the virus from Wuhan skipping us was dead wrong. The US focus had been on travel from China and other Far East hotspots. There was no such limitation on travel from Europe. The virus had clearly seeded Italy and possibly other parts of Europe heavily, and now the US was faced with the very real possibility that there was significant community spread that had occurred from travelers from Europe and Italy over the last month. I had assumed that seeing no cases in our hospitals and ICUs by early March meant the virus had been contained in China. That was clearly not the case.

Our testing apparatus had also largely been limited in the US to symptomatic patients who had been to high-risk countries. If Europe was seeded, this meant we had not been screening nearly enough people. When I heard the first few cases pop up in my county, it was clear the jig was up. It was pandemic panic mode time. There was a chance that there were thousands of cases in the community we didn’t know about and that we were weeks away from the die-off happening in hospitals in China and Italy. So what I told the staff the morning of March 12th was that we needed to start acting now as if there was significant spread of COVID in the community. This meant canceling clinic visits for all but urgent patients, wearing masks, trying to buy masks, attention to hand hygiene, cleaning rooms between patients, screening everyone for flu-like symptoms before coming to the office, and moving to a skeleton staff in the office. I left the office that day wearing a mask as I headed to the ER.

Featured scripthacker

The Call to Medicine
During COVID-19

By JOHN RHEE, MD

. Li Wenlian of Wuhan, the whistleblower who tried to alert the World to the emerging coronavirus pandemic.

In the past few weeks, I have seen a lot of heroism from my colleagues. Just the other day, an email went out asking whether people would be willing to volunteer extra shifts in the hospital, should the worst situation happen where a large part of the staff could become either sick or quarantined from the coronavirus. Immediately, I saw the Google Spreadsheet fill with names, despite the fact that we already work close to 80 hours a week, some of those being 28-hour shifts. Yet, I continue to see my fellow residents step up for each other.

However, there is another emotion that is palpable and spoken about openly: fear. For the first time in our medical careers as trainees, we have come within arm’s length of a fairly unknown infectious disease, with mortality estimates ranging from one to as high as four or five percent. And each of us has heard of at least one young person in a critical care unit from the virus. Furthermore, given we are working in the medical field, we are also acutely aware of the fact that we are among the high-risk groups (the six-feet rule is impossible when you are trying to assess when someone is having a stroke or not), and we know there are doctors who have contracted COVID-19 in critical condition¹. Though we entered this field knowing that there were to be risks involved, while studying for Step 1, that reality was less imminently tangible.

Featured scripthacker

The Brabant Method

By JAN KLUYTMANS

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We have implemented an interesting approach to prevent hospitals to be overwhelmed with #COVID19 cases in The Netherlands. This may be useful for others to consider. It is based on spreading of the burden of disease for hospitalized cases over larger areas.

As we have observed in China and Italy, COVID-19 often present in hotspots while other areas are affected less severe. In The Netherlands the first case was found on February 29 in the Province of Brabant (2.5 million inhabitants). On March 15 we had 24 people who had died from COVID on a National level and 21 originated from Brabant. Hospitals in this area were seeing an increasing amount of cases and prepared for larger numbers.

Based on a mathematical model that estimated the number of infected people based on recent deaths it was anticipated that the number of cases would soon be too high for the local hospital and especially the ICU’s.