Kerry Kennedy Meltzer: I’m treating too many young people for the coronavirus
Every day, in our hastily assembled COVID-19 unit, I put on my gown, face shield, three sets of gloves, and N95 respirator mask, which stays on for the entirety of my 12-hour shift, save for one or two breaks for cold pizza and coffee. Before the pandemic, I would wear a new mask for every new patient. Not now. There are not enough to go around. The bridge of my nose is raw, chapped, and on the verge of bleeding. But I consider myself one of the lucky ones. My hospital still has a supply of masks—albeit a dwindling one—to protect me and my colleagues.
Many of my patients clearly haven’t received the message to stay home unless they’re in immediate need of professional medical assistance. Their fevers and coughs alone are not enough to even earn a test. I hand them discharge paperwork and a printout about how to prevent the spread of the coronavirus, tell them to self-isolate, and then I move on to the next person. If they didn’t have the coronavirus before coming to our hospital, they probably do now. So much for gatherings of 10 people or fewer.
Meanwhile, my colleagues tend to patients in the critical-care bay with dipping oxygen levels, patients who can barely speak and may need breathing tubes.
Earlier in the month, we were told that positive-pressure oxygen masks, such as CPAP machines, were risky, as they would aerosolize the virus, increasing health-care workers’ risk of getting infected. But in recent days, running dangerously low on ventilators, we have attempted using CPAP machines to stave off the need for medically induced comas.
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Still, the increasing frequency of intubations we need to perform is alarming. Our ventilators are almost all in use, and the ICUs are at capacity. Our hospital has already received extra vents here and there from other hospitals in the region that can spare them, but those few additions are merely a stopgap. Will we soon have patients sharing vents? We wouldn’t be the first hospital to attempt that unusual and suboptimal practice, which gained traction after the Las Vegas shooting, when scores of young trauma patients were vented in pairs. But these COVID-19 patients have delicate lungs, which makes vent-sharing far more dangerous. Nevertheless, we’ve already started studying the mechanics of how to make this happen, as a last-ditch effort.
By next week, we may simply have no choice. Those hundreds of relatively healthy patients we sent home may return to the hospital en masse in respiratory failure.
On Wednesday, I greeted a patient I had discharged only one week prior. When I saw his name pop up on the board, my heart sank. He is just shy of 50, with hardly any past medical history, and he had seemed fine. Now he was gasping for air. His chest X-ray was no relief—COVID-19 for sure. I needed to admit him to the hospital, and set him up with oxygen, heart monitoring, and a bed.