What are your responsibilities?
I have to coordinate how I am taking care of my own patients and also how to coordinate what I am doing with my residents. We have entirely restructured our curriculum, removing residents from nonessential rotations so that now, all they are doing is telehealth visits or working in non-respiratory inpatient units. The reason is that we have to reserve all of the PPE [personal protective equipment], and if a resident sees a patient with a faculty member present, then 2 masks need to be worn, instead of one.
We have also restructured the inpatient rotation so that residents get 7 days off to rest and recover from the intense demands and also to decrease exposure.
How do you manage symptomatic patients?
We are trying to limit the patients who present to the emergency department. We try to manage any patient with symptoms such as cough or fever using telehealth, even if the patient has been exposed. We have very limited testing in the ED, and unless their symptoms are more serious, we prefer them to stay home and quarantine, rather than going to the hospital, where they can potentially be exposed to the virus and also expose others if they are infected. We also check in with them frequently to see if their symptoms have worsened and they may need to be admitted.
However, we are very proactive when we feel there is a serious risk. For example, one patient called who was coughing so badly she could barely speak and a relative had to explain her situation. We had instituted a new protocol, which I enacted for the first time. I instructed her to be driven to the ED but wait in the car. The ED personnel were given a description of the car, came out to the car, and immediately brought her into a private room so she did not have to wait in the main waiting area.
We are trying to arrange for a special floor for COVID-19 or suspected COVID-19 patients with acute respiratory distress so they can be isolated from other patients, but the process is still being worked out, but again, this is changing hour by hour.
Do you feel supported by your healthcare system?
I feel very fortunate to have a supportive system behind me. Two weeks ago, I was one of the first people to have high concerns about the increasing number of COVID-19 cases and their impact. I created backup schedules and restructuring and I’ll admit that some of my colleagues were mystified and wondered if I was overreacting. I even asked myself the same question. But fortunately, I was taken seriously by my immediate superior and by the end of that week, everything I thought was a crazy plan was implemented. I feel that my higher-ups are there to protect us, and I am grateful to be in a setting that is doing that.