COVID-19 updates: Cases skyrocket as Americans continue to self-isolate

The DO speaks with an emergency physician on the frontlines of the pandemic.

Cases of the novel coronavirus disease (COVID-19) continue to increase rapidly across the U.S. In response, officials across the country have shut down most major metropolitan areas with the exception of essential businesses. Here’s the latest as of 9 a.m. CT on Thursday:

Number of cases in the U.S.: Across all 50 states, three U.S. territories and Washington, DC, the CDC is reporting 54,453 COVID-19 cases and 737 deaths. The CDC is reporting confirmed and presumptive positive cases of COVID-19 reported to CDC or tested at CDC since Jan. 21, 2020. The New York Times is reporting at least 68,534 cases and 990 deaths in the U.S.

Global cases: There have been 413,467 confirmed cases worldwide and 18,433 deaths, according to the WHO.

Record unemployment claims: On Thursday morning, the Labor Department released unemployment claims. More than three million people filed for unemployment benefits last week, a record high number for initial claims.

$2 trillion stimulus deal: On Wednesday, the Senate passed the biggest economic stimulus package in modern American history. The House is expected to pass the bill shortly, and President Donald Trump is expected to sign it into law. If enacted, the stimulus will include direct payments and jobless benefits for individuals, additional funding for states and bailout funds for businesses.

Vice President Mike Pence says patients can now swab themselves for COVID-19: Vice President Pence said on Monday that the FDA has approved self-collected samples for COVID-19 testing, in an effort to reduce the strain on proper protective equipment (PPE) use.

2020 Summer Olympics postponed: On Tuesday, the International Olympic Committee announced that the 2020 Summer Olympics, previously scheduled to start July 24 in Tokyo, have been postponed to summer 2021 at the latest, as a precaution against the spread of COVID-19.

Q&A: An emergency physician in the Philadelphia area provides insight from the frontlines

Chris Giesa, DO, an emergency physician at Delaware County Memorial Hospital outside of Philadelphia and past president of the American College of Osteopathic Emergency Physicians (ACOEP), has yet to see an influx of COVID-19 cases where she works. But her hospital is nonetheless already taking every precaution to protect its patients and staff using PPE. The issue the hospital may soon face, however, is a shortage of PPE, which many hospitals around the country are already dealing with.

In this edited interview, Dr. Giesa discusses how COVID-19 has changed everyday life in her hospital, what steps they are taking to stem the spread of the virus and how she is coping with the ongoing crisis.

What has changed procedurally for you at work in response to COVID-19?

I can no longer immediately walk into a room to see a patient. I stop at the doorway and introduce myself before I go in, regardless of their chief complaint. I ask if they have any coughing, shortness of breath or any known contacts with somebody who has tested positive for COVID-19 (or contact with anybody else who has had known contact). I don’t ask about their travel history, but that’s screened in triage.

If they say yes to anything, or they have any upper respiratory tract symptoms, I go and put on my mask, gloves and goggles before I see them. It’s not unusual to gown up, go in and see a patient and realize I don’t need to be gowned up, but, better safe than sorry.

What precautions is your hospital taking in terms of both designated spaces for patients, and PPE?

At our major medical center, they’re setting up a space off of the emergency department. That was an area we had given to the hospitalists that we’re now taking back, and it’s where anyone who needs to be screened for COVID-19 will go. They will not come through our main department here at the medical center. In the next few days, that will be fully active. It’ll help us save on our PPE equipment, masks and goggles.

Right now, both physicians and patients are using paper masks. We’re saving N95 respirators for patients who are really coughing and spewing secretions, or are undergoing procedures that have a high risk of spreading the virus, like intubations, or if they’re in respiratory distress and on nebulized bronchodilators. In those cases we’re wearing N95 masks, but otherwise we’re keeping those in reserve.

Are you concerned about eventually running low on necessary PPE?

I have real concerns about running low. I have friends from ACOEP across the country who have been in the thick of things longer than we have been here, and they’re running low. Here, if I want an N95 mask, I specifically have to request it.

We have a ‘COVID cart’ with all the equipment on it, and a ‘COVID nurse’ who goes around and does all the swabs during peak hours of our day shift. But they only allocate so many N95 and surgical masks to be put on that cart. They replenish them every shift. And I think twice about wasting a mask, but I never want to second guess if I need it. If I think I need it, I put it on.

Everyone’s concerned. We’re the ER docs, we’re the frontline. What I think the public doesn’t realize is that not only are the ER docs putting their lives on the front line, and their welfare, our families are standing there with us. That’s a pretty tough pill to swallow. At least with Ebola, you didn’t have to worry about respiratory contact, it was secretions. As scary as that was, it was very easy to protect yourself from. Now it’s just plain old scary.

What can people do to help hospitals get ahead of the impending equipment shortage?

If you have a supply of masks, please donate them to your department of health, or local hospital. You might not even know you have them. For instance, I was looking around in my basement recently, and I found a bag of 10 unused N95 masks from a pack my husband had once used for woodwork. So I’m holding those in reserve, and keeping one in my car for emergencies. I don’t think it’s going to get so bad that I have to bring all the masks in from home but if I see that we’re getting low enough, I’ll bring them in and share.

What are your thoughts on social distancing?

I’m hoping that it will help prevent the virus from spreading too quickly. It’s going to be widespread, but we don’t want it widespread all at once. We can’t start off with a huge surge. We’ll lose medical staff that won’t be able to practice, and we’ll run through our supplies. What I’m hoping is that in three months’ time, this is going to be a thing of the past. We’ll see rare cases after that, but we won’t be living the way we are now.

I am big on wellness and personal well-being, which is obviously tested during this time. With young physicians in my transitional residency program, this is their first year of practice, they’re pretty anxious and scared. But we all have to stand on the frontline. So I’ve been telling them to maintain their social contacts, because isolation can make you a little anxious and edgy. Texting isn’t enough. Use video chats and get creative, play board games on Google Hangouts. Or just sit and talk, and be social, that’s the best thing anybody can do right now.

Related reading:

Online CME and learning resources for DOs and osteopathic medical students

COVID-19: DOs and medical students share their experiences

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