As an emergency room physician at Barnes-Jewish Hospital, Evan Schwarz is used to working under pressure.
But when he and his team connect a COVID-19 patient to a ventilator, it’s hard not to worry.
To connect a patient to the equipment, the team must first insert a tube down a person’s trachea — one of the riskiest procedures for medical workers when treating a coronavirus patient. As the tube is inserted, potentially deadly virus droplets spray into the air.
Medical workers are wearing masks, gowns, gloves and face protection. They place a large, plexiglass-like cube with arm holes over patients to contain the spray. But Schwarz still fears getting sick.
“I worry about the staff, the nurses, the techs, the other physicians,” he said. "What happens if they get sick and get exposed?”
Emergency room doctors are used to treating the most seriously ill or injured patients and seeing death each day. But COVID-19 is different. It puts them, their co-workers and their families at risk.
The procedure weighs on Schwarz’s mind.
“We know that people who have gotten intubated, at least in some places, their mortality is just incredibly incredibly high,” he said. “Have we given them a chance to talk to their families in case they succumb to the disease?”
Before doctors intubate someone, they try to set up a phone call with their loved ones or ask if patients want to write a letter in case they never wake up.
“We know they’re scared,” Schwarz said. “We know they don’t know what’s going to happen.”
Impossible decisions
Some doctors at hospitals in New York have started connecting multiple patients to a single ventilator because the machines are in short supply. Physicians in Italy have had to make tough decisions about whom to treat when there are more sick patients than life-saving equipment.
Schwarz and other doctors are worried that could happen in the St. Louis region.
“I worry about having to potentially have very difficult conversations with patients if we don’t have enough resources to take care of them,” he said.
Local health officials say that isn’t likely to happen in St. Louis. Before the majority of COVID-19 cases hit the region, hospitals cleared out elective patients and visitors, said Dr. Jeffrey Siegler, who also works at Barnes-Jewish Hospital and in three other regional emergency rooms.
Epidemiologists predict COVID-related hospital visits to hit their peak in late April. In the meantime, “I feel so alone in this big hospital,” Siegler said.
Hours in a mask
Every shift, Siegler puts on all his protective equipment. When he treats patients who might have COVID-19, he could wear the cumbersome gear all day.
The Centers for Disease Control and Prevention originally said only people with symptoms transmitted the disease. But the agency now warns even people who don’t look or feel sick can spread COVID-19.
Asymptomatic spread is a constant worry for doctors — even when they see patients with something as simple as a broken bone.
“I’m trying to figure out: Does this person with a broken leg also have Covid?” Siegler said. “We’ve seen reports where they come in with something totally unrelated and yeah, by the way, they happen to have COVID on their X-ray or their swab, and they didn’t have symptoms.”
He said if hospital workers aren’t wearing a lot of protective equipment — or if they’re wearing it incorrectly — they could be exposed.
The protective equipment itself can make the coolest hospital workers claustrophobic, said Mark Levine, another Barnes ER physician. Usually doctors wear a mask, gown and other gear for a few minutes at a time, depending on the patient. They’re not used to wearing it for hours.
‘Mental exhaustion’
Physicians are used to leaving stress at the hospital when they go home at the end of the day, Levine said. But in recent week, COVID-19 has constantly been on their minds.
“There’s increased stress at home, they’re more on edge or depressed,” he said, “They assume, ‘Oh, I’m going to wind up getting this disease, someone I know is going to die.’ It’s a mental exhaustion.”
That makes doctors scared they could spread the disease to their families. So when Siegel’s shift is over, his other job — decontaminating himself — begins.
“I do as much of a decon on myself as possible in the [emergency department] before I leave,” Siegel said. “Then, at my car I change into gym clothes, and then when I get home, I change out of those gym clothes, put the scrubs in a trash bag to wash later.”
After that, he showers and then wipes down the inside of his car with Lysol.
“The idea of bringing something home that’s going to hurt my family, and that has this level of transmissibility, that’s a new experience for me,” said Howie Mell, an ER doctor at St. Elizabeth's Hospital in O’Fallon, Illinois.
Mell is a former firefighter and is used to having a scary job. But for the first time in his life, he’s scared for his wife’s safety.
“Fires don't chase firemen home,” he said. “But this bug chases lots of folks home, and that's a new reality.”
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