I wholeheartedly agree with those experts who go beyond the World Health Organization and the Centers for Disease Control and Prevention and are now calling Covid-19 a pandemic. With evidence of sustained person-to-person transmission on multiple continents, it s time to stop focusing on containment and work instead to harden our domestic healthcare infrastructure.
As an emergency physician at an urban hospital in Washington, DC, this is personal. My colleagues and I will be on the front lines as American emergency agencies will soon likely experience a large and sustained surge of patients with Covid-19 concerns. The public should find comfort that health experts have been preparing for weeks. There is, however, still much work to be done.
I will likely become infected in the next few months. It s just simple math that I have accepted. But I became a physician knowing the job incurred risk and that I have a duty to patients and society. Based on what we know today, my risk of getting severely ill or dying from Covid-19 is low. I am fortunate to be relatively young and healthy, but that is not the case for other medical colleagues who are likely to become infected as well.
Protecting our workforce is critical. Healthcare workers who are infected or exposed without protective gear won t be able to work while contagious. Yet we need them to care for new Covid-19 cases as well as patients with all of the other diseases and traumatic injuries that will continue to occur. Heart attacks and strokes are not taking a break while the virus is here.
How can we be proactive about protecting our healthcare workers? To start, we need to consider protecting our older colleagues and those with certain preexisting medical conditions. We may even need to decide that only young and healthy doctors and nurses should be triaging and caring for these patients. I m in. But is this discriminatory or putting too much risk on the young? I m not sure.
As the novel coronavirus spreads, we can be certain that a number of medical staff will need to miss work because they or their families are ill. What we don t yet know is for how long. It is imperative that we fund research to determine how long the infected are contagious and when people can safely return to work so that we can keep our healthcare systems working and our economy from suffering.
Telemedicine can play a major role in this outbreak by allowing providers to avoid proximate risk of infection while electronically visiting large numbers of patients daily. Even infected or exposed doctors can "stay in the fight" by performing telemedicine visits while quarantined.
In addition to concerns about infection among the workforce, space in emergency departments will be an issue. Most urban emergency departments are already operating at maximum capacity every day.
As a disaster medicine specialist, my biggest concern is that ERs and clinics could become overwhelmed by the "worried well" and the minimally ill. Unnecessary visits by those with mild viral illness risks not only exposure to other ED patients, but also increases the risk of illness to the medical staff.
In addition, if our ambulances are busy transporting patients who are only worried or mildly ill, they will have slower response times to critically ill patients who truly need paramedic care. It is possible that people could die from health system disruption without ever having contracted the actual virus. An EMS delay of only a few minutes could mean that those having heart attacks, strokes, diabetic emergencies, opiate overdoses and trauma have a higher risk of death.
Because of these concerns, the public should expect to be asked in the coming weeks to avoid health system visits unless they have significant symptoms or risk factors. I suggest that healthcare facilities explore the creation of separate care areas for patients presenting with respiratory symptoms and possible Covid-19 in an effort to keep all those possibly contagious away from those being seen for other conditions.
We must ensure the public knows we are open and preventing spread from one patient to another. Don t be surprised if your local ED will need to add temporary structures such as a large outdoor tent to evaluate those concerned that they have been exposed to the coronavirus.
While healthcare workers and policymakers are currently laser-focused on Covid-19, the epidemic requires a coordinated response that extends beyond the healthcare system.
Elected and appointed leaders must communicate with the public clearly, honestly and often. Healthcare experts should be a key part of this communication. Meanwhile, employers large and small must enact public health measures, part of which should include requirements that sick employees stay home and guarantees that they will not be penalized for doing so.
Should people wear surgical masks when they go out? Yes, if you have even a mild cough. This will minimize infected droplets from your mouth and nose. Staying home if possible is preferable. Washing your hands often is essential.
But remember that masks offer minimal protection to the individual. Surgical masks (the "blue ones") are not designed to filter the air you breathe -- they are designed to catch droplets of the person wearing it, primarily to keep surgeons from contaminating a surgical site.
Even the special N-95 filter masks, designed to be true virus protection and now in short supply, are effective only if properly fitted and worn over clean-shaven faces. To those in healthcare -- get fit-tested immediately, shave your beards and resist the temptation to hoard the masks at home. Hospitals will need these masks on hand and must immediately enact measures to ensure that mask theft is eliminated.
I get asked several times per day, "Should I be worried?" The answer is yes, but only to an appropriate degree. This will get worse before it gets better. We don t know if it will go away when it gets warm (keep an eye on transmission in the tropics), nor do we know for sure if reinfection is possible.
One thing is certain: panic helps nobody. Heed the advice of medical professionals, not social media. Trust the US CDC recommendations and be confident in the fact that every physician, nurse, EMS worker and healthcare administrator is giving Covid-19 their fullest attention.
