14
Mar
2020

Life on the Front Lines of the COVID-19 Pandemic

Alex Harding, MD

The Massachusetts General Hospital COVID-19 Surge Clinic is a converted parking garage normally used as the ambulance bay for the Emergency Department. It is isolated from the rest of the ED by two sets of sliding glass doors and can only be accessed by badge.

The garage has blue fluorescent lights and no windows, making it impossible to tell day from night.

In a corner of the garage, I stand over a masked patient who is pale and subdued. I’m wearing a long yellow gown, a turquoise, cone-shaped N95 mask, and goggles. My hands are crossed in front of me so that I don’t touch anything by accident, and I fire questions at him.

“Have you had contact with someone who has COVID-19?”

“Have you had any contact with Biogen employees?”

“Do you have fever? Cough? Headache? Sore muscles?”

I feel sweat trickling down my back. My goggles are fogging up, indicating that there is a leak around my mask, and I open my mouth slightly, trying to form a better seal with the bridge of my nose. The mask makes it hard to breathe; I’ve felt like I’m slowly suffocating for the past 4 hours.

The patient answers “Yes” to many of my questions. I ask a nurse to swab his nose for COVID-19 and we give him IV fluids.

I learn later that he tested positive for COVID-19.

This has been my life over the past week, on the front lines of the COVID-19 pandemic.

In retrospect, I realize that, given the globalization of our economy, an event like this pandemic was inevitable. Yet it still has come as a surprise to me and most of my colleagues. The past week has created a set of strong emotional responses here on the front line: confusion and frustration are certainly among them.

But the emotion that I’ve seen the most is fear. Fear of becoming ill, of passing that illness to family, fear of an impending surge in cases that overwhelms our hospital’s capacity to care for patients, fear that if the infection becomes widespread, we may need to ration care, fear of running out of protective equipment.

My biggest fear is the loss of other hospital staff. Doctors, nurses, and other caregivers who develop cold or flu symptoms are all getting tested for COVID-19. Aside from my concern for their own health, if these health care workers test positive for COVID-19 it means that they will be unavailable to see patients for at least 14 days. As the line of patients gets longer, our list of available caregivers is starting to dwindle.

The line of patients is getting longer fast. The volume of patients in the Surge Clinic has doubled almost every day for the past few days. This rate of increase seems to mirror the exponential growth in infections seen in other places affected by the virus. So I’m afraid that the hospital will see an overwhelming number of cases of COVID-19 and there won’t be enough healthy doctors and nurses to take care of everyone.

I mentioned frustration also. The biggest point of frustration is with the botched early response to this infection at the state and federal level. For the past several weeks, in my regular walk-in clinic at MGH, we were seeing patients who had clear risk factors and symptoms of COVID-19, but we were unable to test anyone. We saw patients coming directly from high-risk countries, with healthcare exposures, and with fever and cough, whom we could not test. For a long time, only patients who were sick enough to be admitted to the hospital as inpatients could get tested. I can’t help but think that some of those patients were in fact infected with COVID-19 and continued to spread the infection in the community.

Testing has improved over the past week or two but is still way below where it needs to be. Unless someone is coming in with specific exposures or risk factors (e.g., a healthcare worker), we are not testing them for COVID-19. Yet, we also know that the infection is spreading within the community and multiple confirmed cases have no known exposures. So, I have no doubt that we are sending patients with COVID-19 home without testing.

MGH is working as quickly as possible to develop an in-house COVID-19 test, which should be ready for use this week. I’m sure other institutions are creating their own tests also, in an effort to compensate for completely inadequate preparation and responsiveness at the national level.

So we’re frustrated that this catastrophe could have been kept under much better control if governmental leaders had taken faster action.

Confusion is also a prominent feeling. Guidance on COVID-19 testing, self-quarantine, and use of protective gear changes by the minute as the infection spreads. Masks and goggles become increasingly scarce. It is common to be told two or three different policies by different administrative leaders during the course of a shift. To some extent, this is a reflection that we are adapting quickly to rapidly changing circumstances. But it still adds to anxiety, as staff don’t know whom to believe or what policy to follow.

In spite of all this fear, frustration, and confusion, I am still grateful for my colleagues who are able to find a reason to smile or laugh. I can feel the esprit de corps growing as we all adjust to the new circumstances and prepare for what is going to be a long battle. The only way we’re going to get through this crisis is by working as a team and signing up for more than is expected of us.

For people outside of healthcare who want to help, my advice is to take immediate measures to avoid spreading the infection in the community.

You can no longer continue business as usual. Companies should advise employees to work from home. People who are sick should call before coming into the doctor. If you’re wondering whether you need to be tested for COVID-19, call before coming in. And if you are sick—whether or not you have been diagnosed with COVID—isolate yourself from other people. These measures will slow the spread of the virus. The healthcare infrastructure is being stretched. We need to bend the curve of infections to make sure it doesn’t snap.

UPDATE: 8:50 am ET Mar. 15. MGH is developing an internal qPCR test. Local biotech companies can help. See this list of kits and instruments that are in need.

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