As the COVID-19 pandemic continues to overwhelm communities across the United States, Rolling Stone reached out to a doctor specializing in neurocritical care at a Philadelphia hospital serving a low-income portion of the city. We discussed how the facility has struggled to prepare, how they see the coming weeks playing out, and what people across the country can do to help. They asked that we withhold their name and hospital affiliation, as they are concerned about retribution.
I’ve been worried for a while, but I would say I started to get really worried around three weeks ago. I started talking to other physicians, people in my department, and leadership at my hospital, saying things like, “Things are worrisome in Italy, I think that we’re headed in a similar direction. Are we going to be OK as far as protective equipment is concerned? Are we going to be OK as far as handling the number of patients?” Up until recently everyone I talked to was pretty much like, “No, it’s fine. We have plenty of equipment.” We got an email that said as long as everybody uses their PPE [Personal Protective Equipment] we’re going to have no problem whatsoever.
Then I got an email assigning me my singular mask. One. I was advised that if it gets dirty or anything happens to it, I can trade it in for another one. I have to bring it in, give them my soiled mask, and then get a new one. I was assigned a single N95 mask.
If anyone [at the hospital] has symptoms, they’ve been advised to quarantine for really no more than seven days past symptoms. They’re asking us to return to work and just wear a mask and practice good hand hygiene. That’s pretty frightening for all of us.
The single mask is also pretty frightening. I interact with ICU patients, I interact with COVID-positive patients. I interact with people in the EDU [Emergency Decisions Unit] that have unknown COVID status. They’re telling us that a surgical mask should be fine for us because we’re neurologists. I’ve been advising my residents, everyone that I can talk to, that this doesn’t seem like a good idea. Because you can’t know. A patient that one of my residents had seen tested positive, and I don’t know what mask she was wearing. I’m pretty sure it was a surgical mask, which doesn’t protect you. I’ve advised them all to wear their single N95.
But the anticipation is that everyone who can do critical care will be shunted over to that once it becomes necessary. So I anticipate that I will be doing critical care on COVID patients relatively soon, as soon as the staffing becomes stretched.
I feel like my experience is unique, because I’m at a hospital that is already on sort of the razor’s edge of resources at any given time, just before any of this happened. Right now I’m putting in a large order for KN95 masks, which is the Chinese nomenclature for N95. They’re not quite the same. They don’t have exactly the same protection, but they have the same filtration. I’m just using $1,500 of my own money to get them, so that I can protect as many people as I can. Because, it’s better than nothing. And to me I’m just like, “That’s fine. It’s worth the money if people will survive.” They’re not the right ones but I found this source site by network, like Instagram and Facebook. That’s really where I found out a lot of the information as things were happening. My feeling was just that my leadership [at the hospital] is not as savvy with it. They’re not of the same generation. They were days behind. They’re sending out updates with information that I had already heard about days before.
The only transparent thing I can see they’ve done to prepare is sending an email asking us to let them know what skills we have that are outside of our normal scope. People have said things like, “I can do ICU care. I can do this, I can do that.” But I haven’t heard anything about it since then. Everything that I’ve done as far as talking to people about advanced training before things get really bad has been met with, “That’s not necessary,” or, “We’re not doing that.”
What’s so scary to so many people is that we know we’re going to be doing it anyway. I really wanted to prepare. For example, in anesthesia people should be setting up simulations. We have dummies that people train on for intubation. I said, “Should we be training people who have some skill in this, but maybe haven’t done it in awhile and we could practice?” This was two weeks ago and I was told that that’s utterly unnecessary and that they have plenty of staffing and that the best possible person should be doing the basics, which is absolutely true. You wanted to have somebody who’s very skilled to be able to do it quickly so they’re not exposed. I totally agree with that, but isn’t there a possibility that that staffing will be stretched so thin that in order to save a life you might need somebody who maybe did it years ago?
We had no testing up until about a week ago, and it was extremely stringent, who we could test. They had to have symptoms. We couldn’t even test it on people who were just exposed. It changed every day. It became, “OK, maybe people who were exposed.” Now we have somewhat better testing, but the turnaround time is a week to 10 days. I have multiple patients right now who are just sitting there waiting for the test to come back.
We just got an email saying that the rapid tests were coming. Then we got an email saying that we’re not getting it unless we become a hot spot. Up until late last week we really couldn’t get any tests back. We were testing people, but we didn’t have any results. Now we’re getting them and we’re seeing upticks in cases.
I don’t think we have the capacity for it. Essentially everything is going to have to get set up as COVID care. Right now we haven’t exceeded that capacity, but we also don’t have the cases quite yet. We’re just sort of on the uptick. So we haven’t hit that wall today.
Our patient population is some of the sickest of the sick. We treat a poor, inner-city, predominantly African-American population. These are people who don’t have good health-care literacy, people who have poor health care access, people who don’t have good compliance, people who have multiple medical problems. Even before all this I had patients in their thirties and forties who are dying of diseases that should be in better control. It’s just a very unhealthy population.
What I’ve noticed driving back and forth to work is that in the neighborhoods around my hospital nothing seems to have changed. People are out. It doesn’t look like anyone’s social distancing at all. There is just no difference in behavior. Based on that and what I know about my patients, I anticipate a massive swell of very ill patients, and we’re just not going to have the resources to manage them appropriately. We barely have the resources to handle them on a good day. My speculation is that we will be similar to Elmhurst, in New York, which is completely destroyed. It makes me cry just thinking about what they’re going through.
I will say that I think the people I work with are amazing and that they want to do the best they can. I do. I really respect everyone around me. I think that everyone wants to do a good job. But I think that — and I think this is true at many hospitals and many places in the United States — the leadership has failed to prepare for this. As a result, I worry for my colleagues, especially the ones who are doing intubations and high-risk procedures. I worry for when it’s my turn.
People have been doing a lot to help. In Philadelphia there was a Good Samaritan who organized a Google doc for people who have gloves, masks, anything. You can just put it up, with your phone number and email. If somebody needs it they can go pick it up. I literally spent two hours today driving around the city picking things up. Somebody gave me three masks. Somebody else gave me a box of gloves. I just drove around picking up whatever people had. My friends have been reaching out, like I said, on Instagram, to try to find sources, or resources, or anything.
If people have masks they can donate them to any hospital or any health care provider. Almost every hospital I know has set up places that they can drop things off. Masks are really what we need. People should stop hoarding and bring that stuff to the hospital. They can keep enough for themselves, but they certainly don’t need boxes of them, and in all honesty health care workers are going to die because of it. But there has been a lot of help in the community, and everyone who helped has felt really good about it. Everyone feels so helpless, and I think that people can really feel good if they participate in the community, and try to help.
And unfortunately the sewn masks that people are making are great for regular folks, but they don’t work for us in the hospital. I think what people can really do is stay home. I’ve noticed people are so stir crazy that they’re all jogging, which is nuts because there’s way too many people out. You’ve got people huffing and puffing and sweating. You’ve got to keep your distance from them. People really just need to find a way to not go out.