COVID-19
There's a very important lesson I have learned from church: in confrontations, it is less antagonistic to share personal experiences than to share doctrinal arguments. I'm going to apply that to COVID-19, because for illogical reasons, it is a controversial topic. Is it going to answer every question about SARS-CoV-2? No. Are my experiences representative of those of healthcare professions across the country? Probably not. But hey, this is a blog, not a medical journal.
Treatment
Since the second week of May, I've been working with the Infectious Disease (ID) division, primarily to help out with COVID-19 patients. In the first week or two, all we had for treatment was tocilizumab (to stop a 'cytokine storm', which is an overexcited immune system making things way too hard on the body). It doesn't affect the actual virus at all. And is only helpful if you actually have a cytokine storm. And ok, technically, we also had convalescent plasma (antibodies from the blood of someone who has recovered from COVID) for treatment, but we didn't have much of that to start with.
We eventually got the antiviral remdesivir--at first not much, but our supply improved after the first month. And then clinical trials opened with various treatment options (JAKi, CGRP, other awful acronyms...). If you didn't have acceptable lab values (it can be dangerous to get certain drugs if certain lab results show that you are, say, in kidney failure, or liver failure, indicating your body can't process the drug adequately), though, that limited options to 'supportive care', meaning basically oxygenation and blood pressure support. That can still save lives, though.
PPE
When we got notified of a positive COVID patient in-hospital, one person would go to assess the patient in person. Before going into a COVID room, I have to put on my respirator (we were allowed 1 per day. In case you're wondering, that is not an acceptable infection control method in the pre-COVID era), then cover the respirator with a surgical mask, then cover my eyes with goggles or a face shield, then put on a paper gown (covering the torso down to the knees, as well as the arms) and gloves (which were not paper). Then I could go in the room and try to get a patient history (for likely exposure sources) out of someone who is likely short of breath (making talking more difficult). It's a struggle to keep the masks from sliding up into my eyes, or the goggles from sliding up on my forehead, and I'm scared to readjust things when I'm already in the room.
I try to listen to heart and lung and bowel sounds with a plastic stethoscope, which I'm also scared of using because the stethoscope stays in the room with the patient, and is thus exposed to whatever viral particles they breathe out; so I try to wipe down the earpieces of the stethoscope with alcohol swabs and hope that nothing else touches my unprotected skin. I can't really hear much with those disposable stethoscopes because the quality is so low, but also because the hospital had to convert a bunch of patient rooms to 'negative-pressure rooms' (meaning the exhaust of the air from the room is directed outside instead of out on the unit) and accomplished that by sticking a giant fan in the room with a plastic tube that leads to a cut-out circle in the exterior window. That fan is loud, plus you get more outside noises because of that window cut-out, so the physical assessment of the patient is far from ideal.
Before leaving the room, I have to rip off the gown and invert the gloves so that the 'dirty' exterior does not contact me directly. Then I'm supposed to leave the room; on occasion, the patient will come up with more questions, or want something in their room moved, and I have to decide how far away I can safely stand in that room without that paper gown barrier. Once out of the room, I have to put on new gloves, wipe down the goggles/face shield, toss the surgical mask, and place my respirator in a bag for subsequent re-use. And after the first month, that re-used mask was re-used a lot more as the hospital sent used respirator masks to be sterilized and returned. So then I look for a respirator mask that doesn't have brittle elastic bands (from the sterilization process) and with as few sterilization cycles as possible.
To conserve PPE [personal protective equipment], subsequent checks on a COVID patient are usually done by looking in the room through a window (if available) and talking with the nurse.
At the end of the day, I change to street clothes and shoes, and stick my scrubs in a plastic bag to take home and dump straight in the washer.
Preventing COVID infection is a time-consuming process, but compared with possible death, I'll agree to the laborious process.
Disease Severity
One of the most confusing aspects of this viral infection is the range of type and severity of symptoms. Some patients may not have any breathing difficulty. Some may have gut problems with or without the lung problems. Other patients have severe blood clotting issues, but no other symptoms. Some will die within days of coming into the hospital. Others may linger and die in a week or two. A few will not really have any symptoms at all, and may not even believe they have COVID-19. Having no symptoms sounds great, but it comes with a major problem: people are more likely to infect others if they aren't aware they are sick (and thus don't self-isolate). And just because you had a mild course doesn't mean that your mother will have an easy time of it if you get her infected.
SARS-CoV-2 is a tricky little microorganism. Do not treat this thing lightly. It is not something you want to find out for yourself.
Treatment
Since the second week of May, I've been working with the Infectious Disease (ID) division, primarily to help out with COVID-19 patients. In the first week or two, all we had for treatment was tocilizumab (to stop a 'cytokine storm', which is an overexcited immune system making things way too hard on the body). It doesn't affect the actual virus at all. And is only helpful if you actually have a cytokine storm. And ok, technically, we also had convalescent plasma (antibodies from the blood of someone who has recovered from COVID) for treatment, but we didn't have much of that to start with.
We eventually got the antiviral remdesivir--at first not much, but our supply improved after the first month. And then clinical trials opened with various treatment options (JAKi, CGRP, other awful acronyms...). If you didn't have acceptable lab values (it can be dangerous to get certain drugs if certain lab results show that you are, say, in kidney failure, or liver failure, indicating your body can't process the drug adequately), though, that limited options to 'supportive care', meaning basically oxygenation and blood pressure support. That can still save lives, though.
PPE
When we got notified of a positive COVID patient in-hospital, one person would go to assess the patient in person. Before going into a COVID room, I have to put on my respirator (we were allowed 1 per day. In case you're wondering, that is not an acceptable infection control method in the pre-COVID era), then cover the respirator with a surgical mask, then cover my eyes with goggles or a face shield, then put on a paper gown (covering the torso down to the knees, as well as the arms) and gloves (which were not paper). Then I could go in the room and try to get a patient history (for likely exposure sources) out of someone who is likely short of breath (making talking more difficult). It's a struggle to keep the masks from sliding up into my eyes, or the goggles from sliding up on my forehead, and I'm scared to readjust things when I'm already in the room.
I try to listen to heart and lung and bowel sounds with a plastic stethoscope, which I'm also scared of using because the stethoscope stays in the room with the patient, and is thus exposed to whatever viral particles they breathe out; so I try to wipe down the earpieces of the stethoscope with alcohol swabs and hope that nothing else touches my unprotected skin. I can't really hear much with those disposable stethoscopes because the quality is so low, but also because the hospital had to convert a bunch of patient rooms to 'negative-pressure rooms' (meaning the exhaust of the air from the room is directed outside instead of out on the unit) and accomplished that by sticking a giant fan in the room with a plastic tube that leads to a cut-out circle in the exterior window. That fan is loud, plus you get more outside noises because of that window cut-out, so the physical assessment of the patient is far from ideal.
Before leaving the room, I have to rip off the gown and invert the gloves so that the 'dirty' exterior does not contact me directly. Then I'm supposed to leave the room; on occasion, the patient will come up with more questions, or want something in their room moved, and I have to decide how far away I can safely stand in that room without that paper gown barrier. Once out of the room, I have to put on new gloves, wipe down the goggles/face shield, toss the surgical mask, and place my respirator in a bag for subsequent re-use. And after the first month, that re-used mask was re-used a lot more as the hospital sent used respirator masks to be sterilized and returned. So then I look for a respirator mask that doesn't have brittle elastic bands (from the sterilization process) and with as few sterilization cycles as possible.
To conserve PPE [personal protective equipment], subsequent checks on a COVID patient are usually done by looking in the room through a window (if available) and talking with the nurse.
At the end of the day, I change to street clothes and shoes, and stick my scrubs in a plastic bag to take home and dump straight in the washer.
Preventing COVID infection is a time-consuming process, but compared with possible death, I'll agree to the laborious process.
Disease Severity
One of the most confusing aspects of this viral infection is the range of type and severity of symptoms. Some patients may not have any breathing difficulty. Some may have gut problems with or without the lung problems. Other patients have severe blood clotting issues, but no other symptoms. Some will die within days of coming into the hospital. Others may linger and die in a week or two. A few will not really have any symptoms at all, and may not even believe they have COVID-19. Having no symptoms sounds great, but it comes with a major problem: people are more likely to infect others if they aren't aware they are sick (and thus don't self-isolate). And just because you had a mild course doesn't mean that your mother will have an easy time of it if you get her infected.
SARS-CoV-2 is a tricky little microorganism. Do not treat this thing lightly. It is not something you want to find out for yourself.
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