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Streets in cities and towns across the country are eerily quiet. Car traffic has dropped so substantially air pollution is abating. In many places, people are hunkered down indoors, trying to avoid contracting Covid-19.

But the true battle against the SARS-CoV-2 virus, which causes the disease, is playing out in hospitals that are currently — or will soon be — engulfed in an onslaught of patients struggling to breathe.

The tsunami has crashed over Seattle, parts of California, New Orleans, and New York City. In Boston and other places along the eastern seaboard, the full force of the wave hasn’t yet hit, but it’s clear it is coming soon.

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Hospitals everywhere are surging their capacity, discharging any patients who can safely go home and attempting to conserve dwindling supplies of personal protective equipment, or PPE. Some are resorting to extraordinary measures — even going so far as to sanitize used N95 masks by baking them — to prevent health care workers from becoming Covid-19 patients themselves.

What does it look like to be on the front lines of that response — and what can we expect to happen in facilities across the country in the weeks to come?

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STAT spoke with three clinicians about what is happening in U.S. hospitals: Megan Ranney, an emergency physician at Lifespan Health Systems in Providence, R.I.; Lakshman Swamy, an intensive care doctor at Boston University Medical Center and the VA Boston; and Craig Spencer, an ER physician and director of global health in emergency medicine at NewYork-Presbyterian/Columbia University Medical Center. Spencer has firsthand experience with devastating infectious diseases: He contracted Ebola in West Africa in 2014.

Their comments, compiled here, have been lightly edited for clarity and length.

On the current situation in hospitals:

Ranney: In Rhode Island, just like in emergency departments across the nation, we are seeing the number of cases double, and double, and double again. And that’s even with very limited testing. We are not running out of space at this point. We are really proactively setting up alternative facilities like tents to help us to take care of the increased numbers of patients that are coming in with Covid-like illnesses.

Swamy: We’re not rationing care. But the terrifying thing is that we see it over the horizon. Because the patients keep coming. We’re in Boston, we’re not in New York. We’re hearing terrifying stories from New York. … It’s the same as what we hear in Italy, what we heard in China.

Ranney: What hospitals in my region are seeing is that most patients can be cared for at home. But that’s a tough judgment for people to make on their own. We are, as a state and as a hospital system, working to set up alternative triage mechanisms to help keep people home if they can stay home without ever having to come to the hospital. Like telehealth, like self-triage programs, things like that.

“We are in the storm, but the worst of it has not hit us yet. And we absolutely see it coming.”

Lakshman Swamy, intensive care doctor in Boston

Swamy: We are in the storm, but the worst of it has not hit us yet. And we absolutely see it coming.

Spencer: I didn’t see a single patient with chest pain. Not a single person with abdominal pain. I’m worried about where those patients are. Where are all the regular patients? Where did they go? What the heck is happening with them? And who’s going to be thinking about the non-Covid mortality, the impact of Covid on non-Covid patients?

On how the disease presents:

Ranney: Most people are going to be OK with this disease. Most people get a really bad cough and get some body aches, but go on to recover within seven to 14 days. But there is a portion of people, and it’s unpredictable who those people are, who get really, really sick.

Swamy: When we have a unit full of critically ill patients who are often on ventilators and have medications running, the kind of attention that requires is immense on a moment-to-moment scale. The reason is our interventions are sometimes as dangerous as the disease. The ventilator isn’t something you can just set and forget. Once someone’s on a ventilator, there’s no margin for error. Especially with Covid.

On shortages of PPE and medical equipment:

Ranney: Almost all of our personal protective equipment is meant to be disposable. Instead, we are wearing procedural masks, surgical masks as long as we can. A week. Or two weeks if possible. We are reusing those N95 respirators between patients. So we take them off, we put them in a paper bag, and then we reuse them. These, of course, are all things that the CDC has recommended, so we’re [doing] what has become standard protocol. But it is not the way that this equipment is meant to be used. This does not feel normal. It feels scary. And it feels that there is a potential for error.

Spencer: There are a lot of places that are quite short. So reusing your N95 when you’re not supposed to be or at least it’s not recommended. Trying to find different ways to reuse them. Baking them in the oven, UV light, etc. This is all kind of novel and certainly not ideal. But it’s always better than the latest CDC recommendation of last resort: bandanas and scarves.

Swamy: There are non-invasive ventilation strategies, which can provide some amount of support for breathing and oxygenation, without needing a ventilator or a breathing tube. But the problem is that all of those things have some elevated risk of aerosolizing virus. If we had unlimited supply of protective equipment and if we had a better understanding of what this virus actually does in terms of aerosolizing, and if we had more negative pressure rooms, then we would be able to use more of these things. But right now we just can’t — because the worst thing we could do is spread the virus to more people.

On the rapidly evolving response:

Ranney: It’s almost impossible to wrap our brains around the degree to which our daily practice of medicine is shifting, truly day by day. The number of patients changes day by day. The protocols change day by day. The CDC’s recommendations change day by day. The treatment options change day by day. So at the same time we’re facing uncertainty about our own risk of getting ill, we’re also facing uncertainty about what the best current protocols are for assessing and taking care of these patients. Because there’s so little scientific evidence. And the patient volume is increasing so quickly.

Spencer: We’re learning on the job. There’s not one single resource that says: “Are you taking care of Covid patients? These are the 78 things that you absolutely need to know.” There’s just so much information and it changes every single day. I remember looking last week at the number of journal articles that had already come out. It was like 12,200. Even if I had the abstracts for all of those, I wouldn’t be able to keep up.

On the personal risk of caring for Covid-19 patients:

Ranney: I have more than a dozen of my physician friends across the country, not in my own hospital but in Massachusetts, in New York, in Washington, in California, who’ve been diagnosed with Covid-19 at this point. So I know that I’m high risk.

Swamy: Every time I go to the ICU I basically hug my family and take a picture of my kids. They don’t know, but in my mind, if I have an exposure, I don’t know if I’ll come home. I don’t know if I should. I don’t know where I’ll go. There’s just a lot of fear about that.

Ranney: I have friends who are doing things like recording videos for their kids just in case they get sick. My colleagues are scared.

Spencer: For me it’s eerily reminiscent of the West Africa Ebola outbreak in 2014-2015, the mental anguish and anxiety of taking care of patients. I’m seeing a lot of my colleagues figuring out how to manage that. It’s really hard for physicians to kind of be vulnerable and we all need to be a little bit vulnerable right now.

Ranney: I have children, I have parents, I have a spouse. We’re having daily discussions about whether I quarantine from them because obviously I’m getting exposed to people constantly in the emergency department. I’m also distancing myself from my parents, which they’re not happy about. But I just can’t risk them getting sick.

Swamy: The tension is really high. I think the biggest fears I have are that my family will get sick, that I’ll make my family sick, that I’ll bring it home. That I’ll get sick. If I get infected, what am I going to do? How am I going to keep my family healthy? I don’t have somewhere to go to quarantine myself away.

Ranney: This pandemic is going to change a generation of health care providers. It is going to change generations of health care providers.

  • I retired from my ER doc position on March 31st and my only regret is that i am not in the Er with my fellow er docs nurses Np and pa and registrars and all the other staff members who i have worked with for the last 29 years.
    Stay safe my friends and i want to be with you.

  • My daughter is a doctor – with asthma, 2 young children and a fireman-husband. Colleagues of both these young parents are falling ill and isolating. She did her undergrad in Rhode Island, a beautiful state as impacted by the SARS-CoV-2 virus as so many others. And the worst is yet to come – everywhere. My daughter is an excellent diagnostician and clinician. Although I can fully feel her dilemma as highly conscientious Doctor, I hope that things like “hospital weeks” can be done next year. We will need to be open for the very difficult choice to spare doctors and all other health care staff who have underlying medical conditions that almost guarantee that they will get sick and that we might loose a whole contingent of health care workers, resulting in a dire shortage for the next 30 years. Inasmuch as the shortage of ventilators forces awful selection decisions, so also does the supply of doctors and nurses and all healthcare workers. I know I may get blasted for uttering these thoughts, but I do believe that they are more realistic by the day.

  • Living in a small, rural town in Qld, Australia, life here seems almost normal,yes, there are social distancing requirements in shops & some items no longer available in the stores, but, otherwise life here is as close to normal as possible, at present.
    But, I have friends that have family in the USA that are very anxious & concerned for their familiy’s welfare & the report’s coming put of USA, the number of deaths & escalating confirmed cases of Covid19 are truly staggering.
    I really feel for the medical staff in hospitals there, trying to cope with this horrific catastrophe & I feel for all the families that have lost loved ones, due to this deadly disease.

    China has truly given the world, the gift that keeps on giving, where & when will it end, who knows??

    • In very short time your continent too will realize that action like in Canada (and the US acted later) should have been taken sooner. Your life will change as it is changing on the American continents. Your leader clearly acts late – just like most others. I hope your nation looks sharply at the rest of the world as warning bells are ringing hard, and immediately starts preparing for the tremendous numbers of upcoming Covid-19 cases. Good luck to you.

  • Retired NYC Paramedic here. This resonates bc it brings back a lot of feelings, especially the sense of duty to go in even when there’s risk of picking something up or when you’d rather spend the holiday w family but are scheduled to work. In hindsight, those aspects of the job sucked but I’m still glad I did it for many years and somehow lived to tell the tale. I thank God every time I see an ambulance now. You know how we say God protects babies and drunks? He will protect you too. Thank you for being the people you are. You make the world a better place.

  • I’m a retired ER doc and I can only imagine the stress my former colleagues are going through. Hang in there guys.

  • Well the good thing about all this is that no matter how many hundreds of thousands of people die from this, it proves that we as a people are not so vengeful or non understanding to ever bother to look for those who created this virus, to forgive and forget is the very essence of humanity; and really, we really needed this to bring us all together, so really, no matter how many die, this has been a gift in disguise.

  • Not diagnosed but spoke to my pc PL pretty sure I had it in came out of it. Came down with a hacking cough and turned up the electric blanket And sweated it out like an Indian in a teepee for 5 hours. They cough stopped immediately. Totally weird how that worked. I’m 68 so I am well acquainted with flu virus

  • Awesome article, it gives you something to think about in this time of crisis. it’s time to pray and follow directions of those that know about infectious diseases.

  • If I were diagnosed with virus and was not hospitalized how would I treat it at home. Would they give me meds or would I treat with over the counter meds

    • Not diagnosed but spoke to my pc PL pretty sure I had it in came out of it. Came down with a hacking cough and turned up the electric blanket And sweated it out like an Indian in a teepee for 5 hours. They cough stopped immediately. Totally weird how that worked. I’m 68 so I am well acquainted with flu virus

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