I have now been on the frontline of the Coronavirus Disease 2019 (COVID-19) healthcare response in Seattle for over two weeks. I am currently on the infectious disease team, so I have witnessed changes firsthand. Things have progressed rapidly since I last wrote about the transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19. The World Health Organization declared that COVID-19 is a pandemic, the United States government announced a national emergency, and Washington state closed its schools. We have been in the unique position here in Seattle as the first epicenter of the pandemic in the United States, and the decisions we make here will inform the rest of the country’s response. On a personal level, it has been a surreal and humbling experience to have gone from previously researching viruses like SARS-CoV-2 to seeing patients afflicted by COVID-19. Meanwhile, I have received messages of support and questions from family, friends, and colleagues. Many have asked me what things are like here, and while it is difficult to fully describe, I have tried to distill some of my feelings below.
Uncertain. There is much that is unknown about this virus and the disease it causes. New studies and reports are being published daily across the globe. As we race to obtain experimental treatments for patients, we are not sure what effect they will have on the disease. As I wrote about previously, there is still much unknown about the transmission of this virus. Trapped between uncertainty and limited resources, hospital administrators have had to make difficult decisions regarding protocols such as who to test and what personal protective equipment to wear. While it may seem ideal to have confirmed and suspected patients on airborne precautions until we understand the full risk of airborne/aerosol transmission, hospitals have quickly run out of the proper spaces and equipment. The research side of me wants the healthcare system to take the safest, most evidence-based approach to protect healthcare workers. The physician side of me recognizes that resources are limited and we have to do the best we can in the moment to help patients. Ultimately our healthcare workers are also a finite resource, and it is uncertain how ongoing changes will affect them. The rapid progression of this pandemic has led to daily changes and updates to protocols, and this has led to further confusion and ambiguity. I hear whispers and side conversations among all levels of staff about COVID-19, from maintenance workers, who provide the essential service of cleaning patients’ rooms, to decision makers, who develop the hospital protocols. Among the uncertainty, it is important to remain calm and take each day at a time while trying to assess future needs.
Overwhelmed. When I come home each night from a day on the hospital wards, I feel the overwhelming magnitude of the situation that we are in. As I learn about new cases and the stories of the patients whom we are caring for locally, my wife keeps track of the national and international updates. The pandemic has quickly overwhelmed our healthcare system that was already working near peak capacity. What we all fear is a surge in cases, which would completely overwhelm our limited hospital space and workforce. Given current limitations in contact tracing and testing patients, more cases are impending. One of the rationales behind the new popular term “social distancing” is to prevent this surge. China responded to their cases in Wuhan by building a new medical center in under 2 weeks. How will we respond here? When one thinks about the existing health disparities in our country and the trajectory of this pandemic, it is disheartening. One of the most important aspects of mitigating the pandemic is quarantining those who are infected so as to not infect others. The homelessness crisis in Seattle and across our country leaves many at risk without shelter or resources for self-quarantining, as we have already seen with existing epidemics of other infectious diseases among these populations. A territorial battle erupted over a proposed motel to help quarantine patients locally. We need more creative ways to help solve these issues. Local businesses are closing and no one will be going on a cruise anytime soon given the outbreaks on cruise ships. Perhaps we could use these spaces to help quarantine confirmed patients who have mild symptoms? This is just one example of the many questions I ask myself about this unprecedented time.
Isolated. Perhaps above all else, this pandemic has felt isolating. Patients and entire demographics have faced stigmatization. First it was widely perceived that this was a “disease of foreigners” since the first cases originated in China. As it spread across the globe, COVID-19 caused other people and places to become stigmatized. When case fatality rates emerged along with local outbreaks in nursing homes, this became a “disease of the elderly.” After more studies on risk factors and patient characteristics, those with chronic medical conditions or compromised immune systems felt targeted. But in the hospital, I have seen that this disease affects everyone. While certain people might be at higher risk, we must respect that each case is different. Things have become more isolating with social distancing practices, which are necessary to help contain the virus and flatten the epidemic curve. Recently, our hospitals banned visitors to help prevent infections, making this disease even more isolating. Now patients with COVID-19 or other illnesses may die alone without their loved ones at the bedside. This hit me hard the other day as I watched a mother carefully dip Oreos into milk to feed her ill son, who was nearly my own age and undergoing rule out for COVID-19.
Hopeful. As I wrote about each of these concerning thoughts and feelings, inevitably I found myself ending on something positive. Despite the uncertainty, I have been inspired by healthcare workers who have remained calm and have dedicated themselves to helping others. Despite the overwhelming scale of this situation, the community of globally-minded healthcare professionals and researchers have paved the way with disseminating information and developing new ideas. And despite the isolation that we may feel, this pandemic reminds us of one thing — we are all in this together.