16 Healthcare Staff Clarify COVID-19 Circumstances In Their Cities | WIRED

published on July 2, 2020

[emotional music]

– I'm a physician,

– I'm an ER doctor,

– Physician assistant,

– Emergency medicine physician,

– Vascular surgeon,
– Primary care doctor

[emotional music]

– 72 hours since our first corona patient

[speaking in Spanish]

– Three and a half weeks

– It's been about a month

– Four and a half weeks

– Five weeks ago

– This is the fifth week

– About five weeks ago

– Five weeks

– We saw our first case at
Northwestern in early March

– It's been about six weeks ago

– Seven or eight weeks ago

– Eight weeks

– 12 weeks

[emotional music]

– We have two positive cases
at our facility currently

[speaking in Spanish]

– Now we have about 30

– There's around 30 positive cases

– In total we have 94 patients

in the whole country in the ICU

– For the whole of Washoe County,

I know there are around 360

– We have over 400 patient
admitted in the hospital

– We have a minimum of 400 COVID
cases in my facility today

– We've got basically a 400 bed hospital

on a day to day basis,

and it's virtually 100%
COVID at this point

– Most of our folks are changing
in the garage completely

and sanitizing themselves
before they enter their homes

– I have wipes in my car

'cause I'm driving patient to patient

so I wipe down my car before
and after every visit

And then when I come home, I usually leave

my jacket and shoes outside of the house

at least overnight

– You change out of your
clothes outside of the home,

you basically immediately
shower at the hospital

I have my protective
equipment stashed in a place

that I know I'll be able to find it and

I take very close care of that
protective equipment as well

– You know, disinfecting my shoes,

immediately my clothes, myself

The surroundings,
anything metal in my home,

anything metal in my car is disinfected

– Making sure that your phone is in like

a sealed plastic container,

your hair is in a hair net,

and all of the kind of usual precautions

And then soon as your home,

making sure any clothes
that you've been wearing,

even just at the hospital,

are kind of thrown into
a high degree wash

– I take off everything
before I go inside,

including my whites, bodysuit,
I go out in everything

and I put it outside
for fresh air to kill,

and then I, or put it in the oven,

70 degrees Celsius, for my masks

And then I take off my, all my clothes,

strip completely down,
put it into laundry,

and then take a shower, and let it run

Takes about 30 to 45 minutes

– I have a dedicated footwear

to go back and forth to the hospital

– I usually shower at the hospital

but I leave my sneakers
outside, I put Lysol on them

I wash my cell phone
with alcohol, my hands

I take out all of my clothes,

I put them on a different
basket on the laundry

[emotional music]

– Psychologically it's

It is stressful

– Obviously I miss, being
around my family a lot

That's the hardest thing

– I am having nightmares at night

which I've never had before in my life

[speaking in Spanish]

– As the day passes, you learn how to

put on your gear, you shower
like three times a day,

it becomes a routine

– With all of the new changes

and how protocols are
switching from day to day,

are those things enough?

Or, you know, are we gonna find out that

we need to be doing more, or

– It is, you know, sad to
see a lot of the patients,

you know, be unventilated
and things like that

You gotta be as professional
as possible as well

– Broke down, three weeks
ago, in the middle of a shift

I never break down

What's gonna happen to our
mental health afterwards?

What's gonna happen to us afterwards?

You're gonna have a huge
wave of survivor's guilt

after this pandemic is over

– I mean it's definitely been exhausting

I wanna be really careful
not to bring the virus

into someone's home

– I feel good because I
know that I can do something

for my hospital and for my
country and for the people,

which is, which is good,
makes you feel good

– We're starting to see some real hope

for getting some of these
people back to their families

and back to productivity

[emotional music]

[speaking in Spanish]

– I've had a patient who's
84 who I've seen once a month

for the last two years

I've had to tell him that
I cannot see him at home

because I don't even
want to take the chance

that if I were to come into his home

and potentially give him the virus,

that would be extremely
detrimental to his health, so

I'm really his only social
outlet at this point,

he really doesn't have a
close family otherwise,

and it's been really tough
for him to have to be

in isolation without
proper care, you know,

with someone he's relied on
for the last couple years

– So the decision as to
when you intubate somebody

is a particularly weighty
one with coronavirus

because the data that we
have at our disposal shows

that it's difficult
for many of these folks

and a majority of these folks really

to get off of the ventilator

So making that decision has become,

it's already a complicated decision

– So there have been a lot
of difficult discussions

over telephone with
devastated family members

who had their relatives dying in hospital

with nobody around,

and that was very, very difficult,

those conversations over telephone

when you can't even
really build the rapport

that you'd like to because the telephone,

you can't see people's emotions,
you can just hear crying

– And unfortunately there
are times when the virus wins

and we have to decide that
we've done all that we can

for that particular individual

And nobody likes to give up

– This patient we treated on Tuesday,

she had been with internalized
catheter for 15 years

And she had no access

So we were trying to
get some venous access

so she could get dialysis

because she could not
be dialyzed for 10 days

And she coded on the angio suite

and our decision was to, what do we do?

We don't have a lot of ventilators

She's more than 70 years old

What's going to happen?

But at the end we did
cardiopulmonary resuscitation

and the patient is
currently on ventilation

She got one dialysis but, being unstable,

you, sometimes you cannot
do the whole dialysis,

but you always think that,

"Okay, this elder patient, she's
going to get a ventilator,"

then you could get two younger patients,

and at the end, well she
was not a COVID patient so,

we decided to intubate her

and give her all of the
maneuvers that we could

– I will say, it is incredibly difficult

from an emotional standpoint to,

to interact with patients
and their family members

We don't let visitors into our hospitals

and there are no hospitals

around this country that do, right?

Our whole workflow around
that is different now,

and so it's crazy to tell someone,

"Hey, you know your family
member's critically ill

"but you can't come in here right now"

– One of the things that's really been

unusual for us is that we are limiting

the aerosolized medications,

so the medications that
we give for people with

exacerbations of asthma or wheezing

or exacerbations of their COPD,

they are really concerned
of our aerosilizing

and causing more spread of infection

So whereas normally when
a person had wheezing

we would just put on a mask
and a nebulizer treatment,

not even think of it,

now we really have to make decisions,

is the risk to the patient and the crew

of having this aerosolized medication

compared to the benefit
that they're gonna receive

from having that wheezing or
shortness of breath relieved?

So two days ago I had
a patient who was sick,

I don't know yet if they were COVID

but they were definitely
in respiratory distress

I went ahead and gave
the albuterol treatment

with the HEPA filter
on and then stopped it

before we made it to the hospital

and it did seem to improve them,

so I feel like it was
the right thing to do

but all the time I was
wondering, you know,

is this one really sick
enough for us to do that way?

Or should I wait until they
can have a different way

of delivering the medication?

Fortunately it worked out but,

you know, never had to
think about it twice before

– I think the hardest decisions

that we're having to make right now

in the US and around the world

are in terms of resource allocation

And so continuing to have to triage people

and make educated guesses about
who most needs to be tested

and who's most likely to be infected

continues to be a struggle

– I think the hardest
decisions still come,

comes back to when do
you need to order tests

for your patient?

Ideally, it would be good if
we can do tests for everyone

but realistically, they just
not the resource to do that

– I think, you know,
treating patients with corona

is the patient that asymptomatic

I have subsets of patients that

one is symptomatic and one is not

Who do we test, who do we not?

– It'd be nice to have
a retrospective scope

and say we could have done
anything better, right

The issue's that none of us,

human beings have been notoriously
bad at predicting things

all the time

So otherwise we would be
prepared for this pandemic

And if anything we could
do better is really to

asking humanity to change human nature

[emotional music]

– This has taken a very
big emotional toll on me

I miss my children, I
miss my grandchildren,

and yes, it has taken a very big toll

– I haven't cried yet, but I've definitely

been on the brink a couple times

– [Interviewer] When was
the last time you cried?

– Right before this interview [laughs]

– I'm sure my partner would say

that I've been emotionally burned out,

and that I've been
horrendously moody, hungry,

and tired all the time

– I've got patients with, you know,

really life-threatening
and serious problems

and me being away from home

pales in comparison to all those

But it's certainly an
experience that none of us

will ever forget as long as
we're, as long as we're around

– Like, okay I'm doing
this pretty good thing

for my country, but
what if I get infected,

what if I infect my family?

I cannot see my family

And also, it's not, it's
not easy for anyone,

but you have to stay positive

If you start thinking about how, like,

all the possible
scenarios, you cannot win,

because you are going to
be scared the whole time

and sad the whole time

– I can't remember the last time I cried

but it's definitely
very emotional, I mean

It's all been pretty hard
to be honest with you

Not being able to hold my
daughter or my newborn daughter

– The tears haven't been shed yet

because I wanna make sure that
I'm a rock for other people

But this crisis team, we've
actually all check in,

we have our own internal
crisis team for the hospital

and every week, they're rotating through

and making sure that
we've got time together,

that we're having those
debriefings when they're warranted

And in of the fact, one
of the nurses who sits

on this team actually stopped me in the ER

the other day as I was running,

like racing by and
grabbed my arm and said,

"How are you?"

And I'm, "I'm good"

She says, "No, really, like how are you"

And really just kind of nailed that home,

like, "I'm checking in with
you, sister," you know and–

– When I was in the
hospital, there was so many,

everyday you had an
opportunity of realizing that

crying would have been
a good way of, you know,

releasing some tension

Never cried for fear

Cried for patients, for
situation, for friends

[speaking in Spanish]

[emotional music]

– I think right now where
we are in northern Nevada,

is just at the beginning

We're going to be seeing
a flux of patients

but I can see that it's creeping up

and that we are probably just getting into

the really high volumes
that other more urban areas

have been receiving already

– Our whole facility just does not

have the capacity to handle the bandwidth

for large volumes of patients

– We're exceptionally lucky in Ireland

that a lot of the social distancing

and government precautions
and sentences put in place

have minimized a lot of
patients being exposed

– So right now in southern California,

I think there's a glimmer of hope

that social distancing is working

And I think that we're gonna start to see

more regional differences
in terms of caseload

– Kind of the attention span, I worry,

of folks has been used up,
meaning that we have been

under shelter-in-place
or stay-at-home orders

for several weeks now,

and we are beginning to see

some of the messaging on the news

that the numbers, even
in the worse hit areas,

are beginning to get somewhat better

This, in my view, is actually
the most critical portion

of time where you have to
double if not triple down

on all the preventative measures

that we're taking as a society

– It also depends on whether
people get frustrated

and they, the weather's really nice,

and they go outside, they take that risk

Because all it takes is one person

to encourage others to go
outside, to encourage others

And New York City's back outside

and we're spreading to one another

You know, it's a critical mass,

then we're gonna be back into
where we were three weeks ago

– I think if people
don't, don't stay at home,

this will get a lot, a lot worse

– It appears that in certain areas,

things are starting to improve,

and once we get testing
more readily available

I think that will make a big difference

– We're seeing that to
some degree at Woodhull

And we are hopeful that
we're at or perhaps just past

the apex of things

Guarded optimism would
be a good way to put it

– Hoping that we will see a trend down,

but that trend down will take a long time,

it's not gonna be one week or two weeks

And it's day by day

– My outlook is

cautiously optimistic about
the efforts we've done

for curve flattening

I don't see the virus going
away after this surge

I don't see it going away entirely,

and I expect there to be secondary peaks

because of the activities
we've done so far

[emotional music]

– At the end of the day,

we're all gonna get through this together

– The courage that I've personally seen

has been awe-inspiring

– I will sure we want to be safe

– We will look out for each other,

we will work for the same cause

– You're not alone

– Remember you're doing important work

– This will pass too and we are
going to make it through it

– I'm proud of you guys

– We could all learn
from those experiences

– You will never be
prouder than you will be

looking back on what you
did during this time

– Stay in touch with your love ones

– Thank you

– God bless you and appreciate you

[speaking in Spanish]

– Never ever lose the
strength and the willingness

of communicate with people
what is the real need

Which is telling about isolation,

telling about protection,

and telling that this is the solution

A good hospital can save an
important number of lives

A proper isolation is going
to save millions of lives

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