As emergency departments around the country await a surge of COVID-19 cases that in some places has yet to start, Alexis Cates, DO, describes the mood in her hospital as “eerie.”
“A week ago, we were saying the same things, like ‘maybe it’s next week, let’s plan for the surge,'” she says. “Now it’s that calm before the inevitable storm. It’s a really high-anxiety time. The vibe in the ED is definitely different than I’ve ever experienced.”
Over the last few weeks, The DO has been speaking with osteopathic physicians on the front lines of the pandemic, including an infectious disease-focused family physician in Connecticut, an infectious disease specialist in Oregon, and an emergency physician outside Philadelphia.
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This week we continue with Dr. Cates, a fellow in medical toxicology and an emergency medicine physician in the Albert Einstein Healthcare Network in Philadelphia.
In this edited Q&A, Dr. Cates discusses her hospital’s preparations and some of the unintended medical consequences of social distancing.
What has it been like in your emergency department recently?
We have twice-weekly meetings with faculty to go over what’s changing, since things are changing every day, sometimes even twice in the same day. Those meetings involve who we’re able to screen for specific COVID symptoms, where the screening tests go, what the PPE situation is for that particular day, how many masks we are getting, and what kind of PPE we should be wearing in particular patients’ rooms.
The most recent thing that we’ve been hashing out is how to manage our volume of COVID patients increasing while our general patient volume is lower. We’re assigning a specific team to handle COVID cases, splitting up departments and changing our staffing so not too many personnel are exposed at one time. We’re also figuring out how to involve the residents in preparation for this peak. At least in Philadelphia, we don’t believe that we’ve met the peak yet.
How have the teaching responsibilities of your fellowship changed?
The teaching for our resident rotators has had to move online since they’ve all been sent home from bedside care, which has its challenges. Everybody has different devices, and then there’s coordinating audio connecting and sharing screens, on top of making sure you have adequate curriculum.
Education doesn’t stop with this pandemic. We have to keep going and make sure we’re meeting requirements. We’ve just had to adjust everything on a day-to-day basis. They get the education they’re hoping to get with a toxicology rotation, but unfortunately without the bedside service, so it’s kind of difficult.
Nothing replaces that bedside evaluation of the patient. We’re all trying to make the best of it. We’re going over specific patient cases with our rotators as well, just to give them a simulation, but virtually. We’re trying to mimic, as much as we can, what a bedside consult would look like.
How about the patient care side of the fellowship?
We’ve converted to telemedicine consults, which means we’re not directly seeing patients, and that has been a little difficult. Mostly we’re on the phone with physicians, whether they are in the emergency department or the ICU or elsewhere in the hospital, discussing patients’ presentations.
If we don’t have to be at bedside, we don’t have to go through any PPE. Doing it this way also prevents having unnecessary people walking in and out of a room, regardless of if a patient is a suspected COVID case.
What are some of the unanticipated ramifications you’ve seen as a result of social distancing?
In Pennsylvania, liquor stores are the only place you can buy liquor. Many people with alcohol use disorder prefer liquor because it has a higher concentration of alcohol. With those stores being deemed non-essential and closing for the time being, people are at risk of undergoing alcohol withdrawal if they don’t get the amount of liquor they normally take in.
We are seeing an uptick in patients like that, and a lot of times they can be quite ill, which puts a further strain on our health care system. So if they need an ICU bed, or need to be intubated or put on a ventilator, that’s another patient using resources needed to treat patients with COVID-19 who maybe wouldn’t be using them otherwise.
There are tons of dominos falling here. I saw one patient with dementia who was really dehydrated and had a really high sodium level. He’s not getting enough food because nobody’s able to sit with him and make sure he’s eating.
There are a lot of unintended consequences we’re experiencing. It’s tough to find the balance. Social distancing is the right thing to do, but we’re seeing some harm in a way. It’s tough all around.