To be fair, I’m not an epidemiologist or public health professional. My specialty is respiratory diseases, so this pandemic strikes at the heart of what I do on a daily basis. What I say is a matter of perspective from one person on the inside. I know people are tired of hearing about coronavirus, but hear me out. I’ve been watching the media coverage, paying close attention as things change on an hour by hour basis. This has been the state of healthcare from the moment we had our first reported case. A policy could change within hours, and they do.
Before I say anything else, PLEASE, PLEASE, don’t panic about the coronavirus, but also take it seriously. As with any viral illnesses, we have become too complacent and we need to do better at cleaning our hands and isolating ourselves when we’re sick.
It’s been eerily quiet in the hospital most days now. We have patients, but there is a weird feeling. And quiet isn’t a word we EVER use in the hospital. If you work in one, you know that you could get mauled by your coworkers for even saying the letter Q. We’ve gone on lock down. There’s a tension that is floating across the surface of our daily workload. We’re screening any and all who enter the facility, including staff. We prepare and plan for biological events like this and we train our staff for incident command situations.
Never did I see it coming like this.
A View on the Inside
It’s been about four weeks since we started discussing preparations for COVID-19, four weeks that feel like a lifetime ago. We’ve studied and discussed. We prepared protocols and plans based on the latest information. We’re all exhausted as we prepare for a war that is on our very doorstep. This isn’t a war like we see in the movies. We are preparing for a run on our system, a taxing of limited resources by infected individuals seeking treatment and non-infected individuals who may believe they need treatment.
It’s kind of crazy from the inside. Lots and lots of varied opinions. As schools close and cities go on lock down, we are forced to adapt to new verbiage like “social distancing” and “self isolation.”
Other new terms we’ve learned this year are coronavirus, SARS-CoV-2, COVID-19. The actual virus causing this particular issue is SARS-CoV-2 or Severe Acute Respiratory Syndrome-Coronavirus 2. The disease that it causes is COVID-19, or Coronavirus Disease 19.
What We Are Discovering and Seeing
We are quickly learning about the clinical presentation of these patients, which we use to form a differential diagnosis. It might seem interesting, but we can’t always look for the zebra. Oftentimes, other differentials work to the surface before we consider COVID-19. But because of the pandemic, it’s always in the forefront of the mind. We see from New York and other places that patients diagnosed COVID-19 and whom are hospitalized, are at greater risk for developing Acute Respiratory Distress Syndrome (or ARDS as we call it).
These patients end up needing progressively higher levels of respiratory support, from High-Flow Oxygen systems, to BiLevel therapy, to Invasive Mechanical Ventilation. This is where my job comes in. Even in the largest of hospitals, there is a finite amount of systems to go around and respiratory therapists and nurses to manage them. In smaller facilities these resources could be little to none, and are probably being used on existing patients suffering from other complex respiratory disorders.
Those disorders don’t stop just because a pandemic decided to rear its ugly head.
Beyond COVID-19, we’ve seen a surge in influenza across the country in the last couple of months. That’s not to mention those who think they may have the virus. There are many who question the strict moves of the government. As a libertarian at heart, my first reaction is to buck against these restrictions, but the healthcare worker in me sees a different side of things.
It’s a weird cognitive dissonance that I feel. I hope in the end this was all an overreaction. I would like nothing more than to be wrong about what could be headed our way.
For a free society unused to curtailing of freedoms, the governmental implementations feel stifling at best and totalitarian at worst. The CDC says this is our best chance to slow down the spread. And when I listen to Dr. Fauci from the National Institute of Health say these things, he isn’t panicked. He is calm and measured, and I tend to believe him. I have immuno-compromised people in my family, and I want to keep them safe, so I will do what I have to, for them.
I can’t tell you how many discussions I’ve had about viral illnesses, even in the hospital.
People will say something like, “Oh, when it gets warm, this will all go away.”
That could be, but we are seeing cases in warm places like Costa Rica, Iran, and sub-Saharan Africa. And there are many places that may not have the testing capabilities we have, so there numbers could be under-reported.
“Oh, this is just the flu.”
Wrong, the flu is the flu, and the flu is still really bad stuff. Pretty much every year we have an influenza epidemic without fail. The CDC estimates that in the United States between October 1st 2019 to March 7th 2020 (the latest data), that we’ve seen between 36-51 million flu illnesses and 22-55 thousand deaths. That is bad. It kills a lot of people. That means in the worst case scenario, 0.1% of the people that get it (and who reported it), end up dying. Which means 99.9% of people end up recovering. Those are good odds for recovery, but that 0.1% could be anyone’s loved ones. Those lives are precious to us.
In regards to COVID 19, since the first reported case in the U.S. there have been approximately 144,103 cases and 2,580 deaths. These numbers will likely change by the time this is posted. Definitely not as big of numbers as flu so far. However a study in The Lancet, shows an estimated case fatality rate that is proportionally higher than seasonal flu. Just like with the flu, those are precious lives lost to us. Any lives lost is a big deal. Unlike the flu however, there are varied opinions on treatment regimen. And a vaccine? Well hopefully we will have one of those soon, but it’s still on the horizon.
Does Percentage Matter?
Yes, because that percentage is our vulnerable populations. Regardless of whether it’s influenza or COVID-19, those are our parents, grandparents, and loved ones. We have a civic duty to try and protect others. But beyond a civic duty, there is a case to be made that a covenant people should seek to do our best to protect our brothers and sisters, as if they were our brothers and sisters. In my case, it could be patients at the facility that I work in. And if we can do anything to mitigate any of those deaths, we need to try.
The case fatality rate of COVID-19 may likely decline in the U.S as more get tested according to Dr. Fauci. We will likely see a leap in positive tests as more tests and testing sites come online. My hope is that we not only slow the rate of this, but maybe our rates of influenza and the common cold will also decline as a result of self-isolation and good hand hygiene, and maybe help us get ahead of some of this.
Blunting the Curve
We’ve all seen the curve Dr. Fauci is using to discuss trying to blunt the number of cases hitting the system at once. I’ve read estimates that at any given time the healthcare system runs at about 65% capacity for bed space. That seems like a conservative estimate in my opinion, but let’s go with that. These are patients suffering from any number of illnesses and ailments.
Some of the studies around the world are showing a 5-10% hospitalization rate for those diagnosed with COVID-19. Assuming we do nothing to stop the spread, that’s a lot of people on top of the existing cases in the hospital, who will now be seeking care at nearly the same time. The hope of social distancing and self quarantine is to prevent that from occurring, so the system can stay ahead of this, and be able to treat ALL of our patients effectively.
In incident command we train our staff that for every one patient experiencing an illness in something like this, 5 will present believing they also have the illness. So beyond the possibly affected, you have additional burden on the system of people just wanting to be checked out and assured they’re okay. I get this. And it is our job as a healthcare system to assure people and take care of people.
In a situation where even our staff may be needing to stay home because they are sick, this can quickly become overwhelming, and wear out existing staff. Which is why, despite my desire to be out of my house, I support Dr. Fauci’s recommendations.
The Good News
The good news is that we have an amazing healthcare workers who are dedicated to healing. I know, because I work with them.
But we cannot pretend that pandemics don’t exist. They will happen. SARS, MERS, Avian Flu, Swine Flu, Ebola. These things happen. It’s all in how we prepare. We need to be prepared for the worst case scenario, which is why we train and educate ourselves regularly. It’s also why we are all exhausted. Beyond what our families are dealing with in the disruption of their lives, healthcare workers are waiting on the cusp of a storm that we can see on the horizon, and we can feel the anticipation and anxiety rising. Some of us are in the midst of the storm already, and my heart goes out to you.
If you consider that we are already dealing with existing disease and hospitalizations, a pandemic level event can quickly overrun our systems which are already seeing shortages of critical supplies, such as gowns and masks. As someone who deals with respiratory illnesses on a daily basis, the masks are what keep me safe and ultimately, my family safe.
The Bright Side
I have seen the best of camaraderie in my fellow coworkers. I can’t tell you how many times I have heard or said, “We are in this together.” And we mean it. This is a family to us. Oftentimes we spend more time with our co workers in the hospital than our own families. We jest that we are the orchestra on the Titanic at the very end, but most of us wouldn’t trade a moment of this. We do this job because we love taking care of others. It’s why we are healthcare workers. Healing people is our business.
Amidst the chaos we can look at what a blessed time we live in. Our once busy and bloated schedules are remarkably clear. My wife and I looked at our calendar and suddenly it was blank. Nothing is going to get in the way of family dinners around the table, which for us is a cherished thing. But for many around the country or world, this may be the first time they’ve been able to slow down enough to be together at the table.
Don’t take this time with your family for granted. To use an already overused cliche, we’ve all been forced to slow down and smell the roses in front of us.
Our private sector is working at an immeasurable pace trying to come up with vaccines and anti-viral treatments, taking care of a large brunt of the workload. I’ve seen the FDA speed through items which might otherwise take years and hurdles of red-tape to ever get through. If they ever did. 3-D printing companies doing their part and helping to print high demand items needed for patient care.
I’ve seen people come together in a new way to help each other. Don’t get me wrong, there will always be some, who amidst the chaos, attempt to exploit others, but overall, I have witnessed people just trying to help other people. Heck, my daughters were thrilled to find out that Disney was releasing Frozen 2 three months early on Disney + for kids who are stuck at home. I can only assume this probably lost them a substantial chunk of money in potential DVD sales. As small of a gesture as this was from a multi-billion dollar company, it was huge to my girls. And Disney isn’t alone. Private sector education companies are offering all sorts of academic options for kids now forced to do school at home.
A Note of Faith
I said to my wife, “It is nice to be able to sit with my family again for church.” That may not seem like a big thing to most, but it is for my family.
It’s really looking for the small blessings in all this.
Our Prophet has ushered in the era of home-centered church. What a prophetic implementation that was many months ago. One that we couldn’t fully see the fruits of at the time. We’ve been encouraged to put more focus on the home as the center of Gospel learning. And now we have the opportunity to do just that. Our homes have literally become our churches for the foreseeable future. With temples closed temporarily, we can spend some time digging into our genealogy, doing indexing, preparing for when they do open back up. Because the work still needs to roll forth.
President Nelson’s recent message of hope quickly trended on YouTube, which is not a small feat. It definitely brought me a sense of peace as he testified of the ultimate physician who knows us and hears our prayers. Despite the tribulations of the world, we can find peace in Jesus Christ.
I keep telling my kids to journal about this, because they will want to remember what they were feeling and experiencing during this time. Imagine the volumes we could feel with the spiritual experiences we will be having in our homes and in our lives. I know our Ward Historians would be thrilled if we had stories like these to share.
The next few months are not going to be easy. I know that we don’t want to be locked inside. None of us like feeling like our freedoms are being taken away. But let’s try to look at this from a different perspective.
We now have an opportunity to minister in a new way to our fellow brothers and sisters. We can seek new opportunities to support and sustain our families. There are opportunities to study and broaden our knowledge, and more importantly deepen our faith.
We will make it through this temporary trial.
And when we come out the other side, even if we are bruised and tattered, we can hopefully say, we did this together as a human family.