It’s hard to believe that we began posting COVID-19 Diaries on March 27th – exactly 4 weeks ago. Tonight I re-read the entire series of posts. If you haven’t done that, it doesn’t take long and it’s a fascinating window into the pandemic and the way that medical science advances – on fast forward. The things she observed in her blogs were reported in fast track journal publications within a few days of her posts. We have been watching medical science progress – as if it were a reality TV show. Her accounts have been unvarnished and sometimes require editing into complete sentences because the author was too tired to complete a sentence when she wrote them. Through her accounts, we have watched as good clinicians became great clinicians and as dedicated healthcare workers of all types found the courage to keep going in spite of their legitimate fears. It’s not over yet. But when you compare today’s post with the first one 4 weeks ago, it doesn’t seem like the same person wrote them. In fact, I don’t think it IS the same person. Our COVID Diary author has been changed forever in the past 4 weeks, but then, so have we.
In the post below, she refers to this April 27, 2020 article on Guidelines for Protecting Healthcare Workers: SARS-CoV-2 Found in Aerosols in Hospital Staff Areas, Public Places, and you may want to check out this previous blog with the illustration showing viral loads in relation to patient beds.
This week I return to the pulmonary consult floors. I had always felt personally “safest” in the ICU (because intubated patients are not coughing everywhere), but now my PPE (personal protective equipment, CF) is second nature and being exposed to the breathing/coughing patients on the pulmonary consult floors doesn’t concern me as much as it used to. As I had suspected, we now know that the viral RNA concentrations in the air and on surfaces are relatively low in patient areas like the ICU and telemetry units. That wasn’t the case in the Medical Staff areas where staff would remove PPE or take breaks. These areas had high SARS-CoV RNA levels, which improved when sanitation measures were taken. Looking back at the healthcare workers who got the virus, most were infected in the beginning when we didn’t understand these issues.
In retrospect, we did some things well. Getting the intensive care unit up and running rapidly was a win. The innovation and team spirit, the tirelessly working staff doing what they could to save patients was admirable. Leadership was walking the fine balance of ensuring adequate PPE stockpiles and trying not to promote fear. In retrospect, wearing at least the paper surgical masks or allowing staff to wear their own masks earlier probably could have prevented several health care workers from getting sick. I think with 20/20 hindsight, we should’ve worn PPE sooner, assumed patients were carriers or sick with COVID sooner and treated all patients as though they had COVID. Easier said than done, I recall at the very beginning of the pandemic, I had a coughing patient – who was offended when we offered her a mask, telling us it was a sinus infection. It may HAVE been a sinus infection, but we will never again apologize for asking a patient (or a staff member) to wear a mask.
The Census is Finally Dropping
I’m looking back, because we’ve come so far and the census numbers are dropping. Ten days ago we had over 100 inpatients, today 71 inpatients. The ICU is down from 22 to 17 with only 13 ventilated patients. We still are seeing peaks and valleys but are on the downhill side of the slope now. We’re seeing more patients come to the hospital for non-COVID illnesses. We’re also seeing COVID re-admissions for non-COVID diagnoses, like aspiration pneumonia, GI bleed, falls. This is a disease with an aftermath.
Look How Far We’ve Come
The community support has been incredible. Cards, posters, emails from schoolchildren, friends, churches, first responders. My wound clinic outpatients keep calling and asking how we’re doing – thanking us and wishing us safety and wellness. I get lovely hand written notes from so many people. I get text messages from friends and family, acquaintances. Everyone is praying for us and I have to tell you I feel covered! Covered by the prayers, protected by the wishes for our safety.
I’m grateful that I wake up every morning. It feels good now to look back and see how far we’ve come. How much growth has occurred in just a few short weeks. It pleases me so much to see how many people have become such good clinicians. There is good that has come of this terrible virus. We will never be the same, but we will share this camaraderie, because we know that we went through something together that scared us, and that was so much bigger than us individually but galvanized the front line into a force to be reckoned with. We have the strength, courage and training to combat this multifaceted illness and bring many patients from the brink of death back to the living. For that, I am truly grateful.
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/channel/UCbxBv_PCAYkbUCvnCjTzW0A/videos