Doctors forced to learn lessons on the fly during coronavirus pandemic

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Almost two months after the first case of coronavirus was reported in the United States, healthcare professionals across the country were pondering what they would have liked to know at the start of the epidemic: how quickly it would spread in their communities, how devastating the emotional toll would be, how unprepared they and their health care systems were to treat a disease they had never seen before.

New York emergency room doctor Dr. Stefan Flores said he had a new appreciation for the value of masks and gloves as hospitals were forced to ration life saving tools.

“Before this pandemic, I would throw on gloves and never consider how rare the N-95s would be and how crucial they would be to my life,” said Flores, who works at NewYork-Presbyterian / Columbia University Medical Center.

“I wish we had adopted earlier quarantines and social distancing and that we really took this seriously before it hit our nation’s coasts,” he said.

A medical worker walks outside a coronavirus special admission area at the Maimonides Medical Center April 10 in Brooklyn, New York.Spencer Platt / Getty Images

Dr. Jeff Le, who works at Maimonides Medical Center in New York, said he wished he had known things would change quickly and that the hospital would be limited to beds, personal protective equipment and ventilators.

“I don’t think our country or our government is ready,” he said. “We did not have the supplies to accommodate the influx of very sick patients. “

Dr. Tarak Trivedi, an emergency room doctor in Los Angeles, said there were many unknowns about how quickly the virus could spread and how.

“Initially, we did not know there was as much transmission or that there was the possibility of transmission between asymptomatic people,” he said.

“I have friends here, even in Los Angeles, who are doctors and nurses who got the coronavirus,” he added. “I think if you asked them, I think they’d probably tell you that they wanted to recognize what a really dangerous environment is.”

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Anthony Ciampa, a registered nurse in New York City, said, “If I could have gone far enough, I would have done more to just sound the alarm and say,” Hey, we have to stay healthy so we can take care of our patients. ”

Dr. Chloe Bryson-Cahn, who works at the Harborview Medical Center in Seattle, where the coronavirus was first reported in the United States, said that “at first it was like juggling a ton of different things “

“How are we going to get people to the hospital safely?” How are we going to operationalize the tests? Who are we going to test? ” she says.

“You know, I don’t know we could have been here a month ago,” she added. “I think we had to do a month of this work, learn how we can get people safely through our front doors to the emergency department.”

Medical workers respond to the Maimonides Medical Center during the epidemic of coronavirus disease (COVID19) in Brooklyn, New York, April 16, 2020.Caitlin Ochs / Reuters

The doctors also said they would have liked to know how to manage the mental and physical balance of treatment for the disease; more about potential treatments; and when it is better to take measures such as patient intubation.

Le, from New York, said he wished he had known “how quickly patients can decompensate” or get worse.

“I would have liked to know how closely I should monitor these patients,” he said.

He added that he had no idea “the kind of emotional havoc it would cause on my life, the lives of my colleagues and my patients.”

Dr. Prakash Gatta, a surgeon at Multicare Tacoma General Hospital in Washington State, said, “I wish I could understand why some patients are doing well and why some are not surviving. “

Trivedi said that at the start of the intubation was “kind of a par for the course for patients with these types of oxygen saturation numbers. “

When the first wave of coronavirus cases hit New York, “like everyone else, we intubated these patients very early and we intubated a ton of these patients,” said Dr. Reuben Strayer, who also works at Maimonides Medical Center in New York.

Next, short and long term data from China and Italy showed that “people who have been intubated for COVID have had very poor results,” said Strayer. “And it made sense to us at that time that we should limit intubation and only perform intubation on patients who have unequivocally demonstrated that they really need it. ”

Flores, the New York emergency room doctor, regretted not considering end-of-life care for his patients sooner.

“I wish I had told patients from the start to consider making a will,” he said.

Despite all the dark and difficult times, health care professionals said they felt united as a community and spoke about their work with pride.

Bryson-Cahn, of Washington, said that what was most important “is just to have a practice of gratitude every day, from our guards to our nurses, to our respiratory therapists, to the people at the door who do the screening patients. “

Amy Pacholk, a surgical trauma nurse at Stony Brook University Hospital in New York, said she was not emotionally ready to see patients recover from intensive care.

“The things I see that make me happy, and I wouldn’t necessarily expect a month ago, is that hearing someone’s voice after their extubation and talking to their family, it’s amazing, ”she said.

“Today, we extubated a patient, my patient, and it’s a little exhilarating when we do it,” said Pahcolk. “It’s happy. “

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