-Coronavirus is gonna cause a viral pneumonia,
and the severity of that pneumonia
can range from pretty mild
all the way up to fulminant respiratory failure
and severe problems.
When people develop acute respiratory distress syndrome,
which can happen for a whole variety of reasons
besides just COVID-19,
the average mortality is about 25% to 30% in all comers.
What we've seen in this outbreak of the virus, however,
is that for people who get severe distress,
the mortality seems to be much, much higher,
and for many people, spending long periods of time
on the ventilator, many of them will not survive.
We've had cases down here
as young as 31 years of age at our hospital,
and the people who are getting this at younger ages --
in their 30s and their 40s --
are getting just as severe disease in some cases
as the older individuals who have co-morbidities.
So I don't think this virus is sparing the young.
-We talked about potentially turning him last night.
However, after calling his family,
they were concerned that he's very sick
and will not make it out of the hospital,
so they are still sort of processing that.
So we've held off.
-The hospital has done a lot of planning
to get ready for a surge of patients.
We've created a dedicated ICU
for caring for patients with COVID-19,
as well as for patients
who need to be ruled out for that when they come out
and there's a high suspicion that they're infected.
Once we have over a certain number
of COVID-positive patients in our COVID ICU,
we activate a second attending physician,
who works primarily in that unit along with the residents
from the regular medical ICU team.
But the team has to share the work,
and you can imagine that their disruption in workflow
is pretty significant.
It adds a lot of time to the day.
And then just the care of patients with COVID-19
or even who are just being ruled out for COVID-19
is much more time consuming than it would be
for the care of other patients.
Simply going in and out of the room takes more time
because of the donning and the doffing
of the personal protective equipment
in order to keep yourself as well as the other staff safe.
-And the one thing I would add, if he does decompensate --
One of the things I actually find under normal circumstances
that's the most rewarding aspect of this job
is the interactions with the patients and their families,
and that's been completely overturned
in the current pandemic.
We spend as little time in the room as possible
to decrease the risk of exposure to the virus
and help preserve personal protective equipment.
So even for patients who are not intubated and are able to talk,
we don't have as much of a face-to-face
interaction with them.
And for families, it's been particularly challenging.
The hospital has significantly restricted family member
or friend access
in order to decrease the risk of spread of the virus.
So we are forced to have all conversations over the phone
with the family.
-70% is rated, 12 is where I had it.
Over night, he got -- I think one of the nurses turned him up,
and he's on 100% right now.
-The people who really deserve everyone's thanks these days
are the nurses and the respiratory therapists
and the other staff that are working in the hospital
because while we're spending a lot of time in the ICU,
it's the nurses who spend a huge amount of time
at the patient's bedside.
They're the ones that are facing the greatest risk.
Alright, orders and plan.
I think the federal response has been terrible.
It's been haphazard.
The communication's been poor.
Everyone knows about the delays in kind of
recognizing the severity of the situation.
Concerns that they actually knew earlier on that things
were gonna be severe but didn't act on that
and take any measures
to help protect the country in its situation,
and then everything that's transpired since that time,
I think, has just not been conducted very well.
I think if it wasn't really for the actions of the state
and local leaders,
not just in Washington, but elsewhere in this country,
I think this pandemic would be a lot worse.
And I'd say, in the last week or two,
we've seen kind of a slow,
steady rise in the number of patients,
which kind of seems to be a little bit of a harbinger
of what's to come as we go into the next couple of weeks.
I really fear that we'll see a significant increase
in the number of cases in this area
that will put a similar stress on the system
and impair our ability to not only take care of the patients
but safely take care of ourselves.
I haven't had to make a decision about working
in the absence of PPE.
It's definitely in the back of everyone's mind,
and we, you know, we know that they're working very hard
to maintain the supply of PPE for us
so we can continue to deliver care in a safe manner.
But I think I'd be lying if I told you
that the staff weren't worried about a shortage of that
and what implications it will have on our ability
to keep ourselves healthy.
One of the things I've experienced
that I think all of my colleagues are experiencing now,
there's so much fear of contracting the virus.
Every time you have the slightest
little physical symptom,
so there's a little scratch in my throat
or my nose ran a little bit today
and I just had to pull out a piece of Kleenex,
there's a spot that, you know,
"This is it, this is the COVID-19,
and now everything's gonna go downhill from here,"
and you have to just be willing to take a deep breath
and move forward and accept the risk.
Otherwise, you won't be able to do the things
that you need to do for the sake of the patients.