Stories from the Front Lines (✨COVID-19 Healthcare Workers only: posting rules imposed)

BenBagbag · Mar 30, 2020

With a little digging you can find videos of them lining bodybags in streets of New York. It's a hospital we transport to all the time.

The USNS docked but we don't have guidance about transport to there yet.

The son of my 90+ patient said she's doing fine on low concentration oxygen. It's an EMS members mother which is why I got follow up.

JPE.88305 · Mar 30, 2020

Pathologist.

I guess I don't have much to contribute from the front line / treatment perspective, but I think it still helps add to the overall perspective.

We're not doing posts on COVID patients, or anything "pulmonary" (fwiw autopsies comprise about 0.1% of most pathologist jobs, excluding forensics / medical examiners), so my involvement is pretty nil other than directing the microbiology lab (we're just now setting up in-house testing, sending to state lab until then, 30-50 tests/day). I'm at a ~1000 bed hospital in flyover country, we have several hundred cases but nothing like the coasts. 25-30% 18-40yo, 30% 41-60yo, 30% 61-80yo, ~5% >81. 15% hospitalized, 5% discharged and recovering, handful of deaths, the rest not hospitalized.

Going by this website from the University of Washington (http://www.healthdata.org/results/data-visualizations) our projected total deaths by mid August went from 800 over the weekend down to <1/4 of that...things can certainly change/fluctuate, but it's based on current numbers & trends. Just had an endobronchial ultrasound for a lung cancer staging case and chatted with the pulmonologist/ICU doc...we're obviously planning for worst case scenarios and getting our contingencies in order but from his stand point, there was optimism {which is on short supply nowadays}. Certainly our fear is overflow/influx from major population centers that are going to be hit harder, particularly if they peak sooner and social distancing/travel restrictions are lifted too early, but as of now, everything is shut down and limited social interaction seems to be doing its part: all bars, restaurants, non-essential businesses are closed...all non-emergent medical & dental practices closed; our volume is 50% what it was 2 weeks ago, only emergent cases and cancer-related procedures for the last 2 weeks. Yes it's flyover country so we're never at NYC levels of traffic, but our metro is maybe 3/4 million and roads are pretty empty, hospital parking lots fairly empty, downtown is empty, just big-box stores with people grocery / supply shopping.

Thank you to everyone on the front lines--I hope you all stay safe and healthy.
Cheers.

Wetworks · Mar 30, 2020

RN, ER (do we have to do this every time?)

Went to bed last night with a little irritation in my throat, up towards the palate, accompanied by some sinus pressure, so I took some Claritin-D (pollen is through the roof in NYC right now). Woke up today with hypersensitive skin and decreased strength, usually a sure sign a fever is imminent. Up to 102F, riding it out. Tried to get tested today, refused. I don't meet admission criteria, and DOH said they are "low on supplies." As a former 9/11 first responder, I can't help but feel we are being lied to again, ala "the air is safe." How do you not make testing ER personnel a priority?

BenBagbag · Mar 30, 2020

Wetworks
RN, ER (do we have to do this every time?)

Went to bed last night with a little irritation in my throat, up towards the palate, accompanied by some sinus pressure, so I took some Claritin-D (pollen is through the roof in NYC right now). Woke up today with hypersensitive skin and decreased strength, usually a sure sign a fever is imminent. Up to 102F, riding it out. Tried to get tested today, refused. I don't meet admission criteria, and DOH said they are "low on supplies." As a former 9/11 first responder, I can't help but feel we are being lied to again, ala "the air is safe." How do you not make testing ER personnel a priority?

This is insanity. We should get prioritized for testing. Any other symptoms? A lot of people here in NY are losing sense of taste. I have some guidance (which you probably have already) on how and when it's safe to return to work. Up here in upper NYC area we've had people who've returned to work. Truth is, as needs change they continue to shorten length of time needed to be symptom free.

Take your temperature twice a day and keep track. I have a feeling the more data we save the more we'll know after the fact. At times I wonder: Have we learnt nothing from China? Everything out of NY seems like we're reinventing the wheel...

sah · Mar 30, 2020

Wetworks
RN, ER (do we have to do this every time?)

Went to bed last night with a little irritation in my throat, up towards the palate, accompanied by some sinus pressure, so I took some Claritin-D (pollen is through the roof in NYC right now). Woke up today with hypersensitive skin and decreased strength, usually a sure sign a fever is imminent. Up to 102F, riding it out. Tried to get tested today, refused. I don't meet admission criteria, and DOH said they are "low on supplies." As a former 9/11 first responder, I can't help but feel we are being lied to again, ala "the air is safe." How do you not make testing ER personnel a priority?

Sorry to hear this, and sincerely hope you do well with this. Having said that, doesn’t your hospital need to have you tested to determine when you would be able to return to work? Now, in California, the testing is limited to those admitted to the hospital or healthcare workers.

Wetworks · Mar 30, 2020

BenBagbag
This is insanity. We should get prioritized for testing. Any other symptoms? A lot of people here in NY are losing sense of taste. I have some guidance (which you probably have already) on how and when it's safe to return to work. Up here in upper NYC area we've had people who've returned to work. Truth is, as needs change they continue to shorten length of time needed to be symptom free.

Take your temperature twice a day and keep track. I have a feeling the more data we save the more we'll know after the fact. At times I wonder: Have we learnt nothing from China? Everything out of NY seems like we're reinventing the wheel...

Yea, I heard about that, it's zinc depletion from what I understand. I made it part of my triage assessment.

Only twice a day?!?! I'm taking that shit like 10 lol!!!

DaveK
One of the symptoms of Covid-19 is excessive snacking

Who are you telling?!?!😁

sah
Sorry to hear this, and sincerely hope you do well with this. Having said that, doesn’t your hospital need to have you tested to determine when you would be able to return to work. Now, in California, the testing is limited to those admitted to the hospital or healthcare workers.

Admission criteria is the driving force here, too. I heard we might have the rapid test this week, hopefully.

BenBagbag · Mar 31, 2020

Anyone with above average knowledge of different forms of PPE who could PM me? (Not sourcing, more about which products do what etc...)

Perhaps there are others on the forum who aren't Healthcare workers but have experience with PPE in their lines of work who can reach out?

Much appreciated!

Jwit · Mar 31, 2020

BenBagbag
@Jwit

I just stumbled on numbers out of Eerie and it is around 400 now. How's it going up there by you?

Best,
Ben

We are doing okay so far. Have a decent system for transfers to two COVID-only hospitals. But we are bringing patients in faster than they are being discharged(or dying). We are also way behind on testing. Up until about a week ago we only had about ~500 tests done in across the county. The community has been incredibly supportive. Food and coffee deliveries from anonymous donors to the EMS break rooms a the hospitals or outlying quarters. Everyone is starting to hold onto their masks and gloves a little tighter now too. You can feel the anticipation in the air.

STANDY · Apr 1, 2020

BenBagbag
Anyone with above average knowledge of different forms of PPE who could PM me? (Not sourcing, more about which products do what etc...)

Perhaps there are others on the forum who aren't Healthcare workers but have experience with PPE in their lines of work who can reach out?

Much appreciated!

PM me questions if you want. Quarantine, so know a fair bit about PPE for infectious substances

Wetworks · Apr 1, 2020

Still unable to get tested. No appointment received from DOH yet. Really shameful that frontline healthcare workers, especially those who work in ERs, can't get priority. No professional courtesy afforded, and that's with a badge and hospital ID. But hey, Chris Cuomo found out he's positive, so there's that!!!🤬

BenBagbag · Apr 1, 2020

EMT, NYC

One of our non-COVID patients from a week or two ago is a community family medicine doctor (I may have mentioned that doctor here) who is above 65 and has preexisting conditions. He still needs to work. He has a small practice and can't even get a hold of a supplier for PPE. Yesterday a community member here reached out to me and said he had a few extra N95 masks from construction they did a few months back and asked if I wanted. I literally told this community member that we have enough PPE for the next little bit but this doctor doesn't have enough N95's and have been reusing day after day. I told the community member to drop the masks off by the doctor's office. Hopefully prevents this doctor from becoming our patient again. I've told the doctor to be in touch if and when he needs PPE and we can help him with his supply chain (our EMS crew has a great network of suppliers though cost is still an issue).

Hoping the Amazon promotion for PPE really begins to change things.

But in general PPE has been better around NY from what I hear. What are other's experiences?

WatchCor · Apr 1, 2020

@BenBagbag have you noticed any empyemas due to secondary bacterial pneumonias on Covid-patients in your area(NYC?)?

We're still not hit very hard here so no experience on if this has been an issue anywhere.

...and what about pneumothoraxes due to prolonged vent/intubation times with high PEEP values (15-25)?

This has been an issue in our hospital on the few ICU Covid patients with COPD. Although this issue is probably related more to the emphysema/COPD in general and not per se to Covid.

BenBagbag · Apr 1, 2020

WatchCor
@BenBagbag have you noticed any empyemas due to secondary bacterial pneumonias on Covid-patients in your area(NYC?)?

We're still not hit very hard here so no experience on if this has been an issue anywhere.

...and what about pneumothoraxes due to prolonged vent/intubation times with high PEEP values (15-25)?

This has been an issue in our hospital on the few ICU Covid patients with COPD. Although this issue is probably related more to the emphysema/COPD in general and not per se to Covid.

Above my pay grade. All I can say is that for a week I thought my stethoscope was broken because every COVID+ patient has clear lungs but diminished lung sounds. So it just sounded faint. Was taking off my scope and tapping it a few times.

Again, we have very short interactions with patients out in the field without equipment like that. I'm staying in my lane. haha

BenBagbag · Apr 1, 2020

Wetworks
Still unable to get tested. No appointment received from DOH yet. Really shameful that frontline healthcare workers, especially those who work in ERs, can't get priority. No professional courtesy afforded, and that's with a badge and hospital ID. But hey, Chris Cuomo found out he's positive, so there's that!!!🤬

@Wetworks saw this article from politico (exerpt below). When do you expect them to ask/plead/demand that you come back?

The Montefiore health system broke from city guidance last week to allow staff showing a fever to get tested for the coronavirus. More than a dozen medical professionals employed at systems across New York City told POLITICO that positive tests keep people from working and create staffing shortages - a scenario the state is bracing for.

“It’s like hear no evil, see no evil,” said one hospital staffer based in New York City, who requested anonymity for fear of retaliation. “[The hospitals are] banking on not everyone contracting a severe case. I think that’s why they’re implementing these protocols with PPE because they’re treating everyone as if they are positive.”

She added: “Everyone is sick. Everyone is sick. I’ve never, ever, ever seen anything like this. It’s really bad.”

Wetworks · Apr 1, 2020

BenBagbag
@Wetworks saw this article from politico (exerpt below). When do you expect them to ask/plead/demand that you come back?

I just got a call from employee health/HR asking what my symptoms are, when they began, and if I can to call back every other day to give them an update. And oh yea, "feel better." It's a joke. Like I said, having been a 9/11 first responder I find the current climate surrounding healthcare worker and patient safety vs management's CYA attitude appalling. We already know this ends badly.

BenBagbag · Apr 1, 2020

Wetworks
I just got a call from employee health/HR asking what my symptoms are, when they began, and if I can to call back every other day to give them an update. And oh yea, "feel better." It's a joke. Like I said, having been a 9/11 first responder I find the current climate surrounding healthcare worker and patient safety vs management's CYA attitude appalling. We already know this ends badly.

I hope you are healthy and young enough to not be in that worrying demographic. But I'm nervous for those first responders who are in the older/comorbidity category and those who are young but now live with parents or others at risk. I know a few other crew members who moved out of their parents' homes for time being to continue to be on the front lines but not kill their loved ones in the process.

Update on that nursing home I visited on Thursday: We noticed 8 ambulances outside there at once today. And it's been a revolving door of ambulances. They usually have one out there every so often (PRE-COVID19), I don't recall ever seeing two. So not good news.

larryganz · Apr 1, 2020

Wetworks
I heard Elmhurst is a war zone.

Today was MUCH worse. Emergently intubated 8 people. I don't care what the one case study paper says about inability to determine ACE/ARB relationships to worsening presentations of C19; I'm seeing it. And not only that, I am seeing ACEi pts presenting relatively calm, no real respiratory distress even when evidently hypoxic with sats in the 60s. My small sample size shows VBGs with low pCO2, despite no apparent hyperventilation, which to my non-doc mind is weird. Conversely, pts on ARBs are also hypoxic, but retracting and extremely distressed (and expected). ALL of them have white sheets for chest XRs.

The RRTs are usually pretty non-aggressive where I work, I'm not. I "suggested" increasing PEEP on one pt beyond the typical 5-7, bumped them up to 12, sats finally started to bounce, really came up well after being at 15, to the point that the sedation needed to be increased due to higher level of consciousness presumably because of better overall oygenation.

Going to enjoy the next few days off with some scotch.

Speaking of ACE/ARB and/or Hi-BP. My Savella (SSRI/NERI) for my fibromyalgia has been bumping my blood pressure since last year, and I had to drop from 75mg a day to 50mg a day last year (25 bid). That helped me avoid antihypertensives for persistent HTN.

Well for the past 6 weeks my BP has been back up, mostly due to the constant anxiety and stress from the pandemic that I saw coming as early as middle of February. At my doctor's office two weeks ago it was 190/102 (doubled checked at end of visit and home). Rather than accept being on something like a an ACE/ARB (RAAS inhibitor) I elected to lower my dose of Savella even further, and cut it down to 12.5mg bid while trying to lose weight. I'm down from 243 lbs to 238 lbs today.

Last week it was down to 180/90, but last night I was down to 160/82. I'm going to stay on 12.5mg BID and try to lose 20 lbs now, and get more active to deal with the increased onslaught of pain from the lower dosage. I've been avoiding NSAIDS for my chronic pain (Relafen or Naproxen) because of CoVid as well, so all I have left is Tylenol arthritis strength.

Now, some articles suggest that it may be more harmful to stop the ACE/ARB (RAAS inhibitors) in certain CoVid-19 patients until we know more. This one explains the relationship with the ACE receptors and CoVid-19.

https://www.nejm.org/doi/full/10.1056/NEJMsr2005760

Quote From the Article Summary:

"KEY POINTS RELATED TO THE INTERPLAY BETWEEN COVID-19 AND THE RENIN–ANGIOTENSIN–ALDOSTERONE SYSTEM

• ACE2, an enzyme that physiologically counters RAAS activation, is the functional receptor to SARS-CoV-2, the virus responsible for the Covid-19 pandemic
• Select preclinical studies have suggested that RAAS inhibitors may increase ACE2 expression, raising concerns regarding their safety in patients with Covid-19
• Insufficient data are available to determine whether these observations readily translate to humans, and no studies have evaluated the effects of RAAS inhibitors in Covid-19
• Clinical trials are under way to test the safety and efficacy of RAAS modulators, including recombinant human ACE2 and the ARB losartan in Covid-19
• Abrupt withdrawal of RAAS inhibitors in high-risk patients, including those who have heart failure or have had myocardial infarction, may result in clinical instability and adverse health outcomes
• Until further data are available, we think that RAAS inhibitors should be continued in patients in otherwise stable condition who are at risk for, being evaluated for, or with Covid-19"

sah · Apr 1, 2020

larryganz
Speaking of ACE/ARB and/or Hi-BP. My Savella (SSRI/NERI) for my fibromyalgia has been bumping my blood pressure since last year, and I had to drop from 75mg a day to 50mg a day last year (25 bid). That helped me avoid antihypertensives for persistent HTN.

Well for the past 6 weeks my BP has been back up, mostly due to the constant anxiety and stress from the pandemic that I saw coming as early as middle of February. At my doctor's office two weeks ago it was 190/102 (doubled checked at end of visit and home). Rather than accept being on something like a an ACE/ARB (RAAS inhibitor) I elected to lower my dose of Savella even further, and cut it down to 12.5mg bid while trying to lose weight. I'm down from 243 lbs to 238 lbs today.

Last week it was down to 180/90, but last night I was down to 160/82. I'm going to stay on 12.5mg BID and try to lose 20 lbs now, and get more active to deal with the increased onslaught of pain from the lower dosage. I've been avoiding NSAIDS for my chronic pain (Relafen or Naproxen) because of CoVid as well, so all I have left is Tylenol arthritis strength.

Now, some articles suggest that it may be more harmful to stop the ACE/ARB (RAAS inhibitors) in certain CoVid-19 patients until we know more. This one explains the relationship with the ACE receptors and CoVid-19.

https://www.nejm.org/doi/full/10.1056/NEJMsr2005760

Quote From the Article Summary:

"KEY POINTS RELATED TO THE INTERPLAY BETWEEN COVID-19 AND THE RENIN–ANGIOTENSIN–ALDOSTERONE SYSTEM

• ACE2, an enzyme that physiologically counters RAAS activation, is the functional receptor to SARS-CoV-2, the virus responsible for the Covid-19 pandemic

• Select preclinical studies have suggested that RAAS inhibitors may increase ACE2 expression, raising concerns regarding their safety in patients with Covid-19

• Insufficient data are available to determine whether these observations readily translate to humans, and no studies have evaluated the effects of RAAS inhibitors in Covid-19

• Clinical trials are under way to test the safety and efficacy of RAAS modulators, including recombinant human ACE2 and the ARB losartan in Covid-19

• Abrupt withdrawal of RAAS inhibitors in high-risk patients, including those who have heart failure or have had myocardial infarction, may result in clinical instability and adverse health outcomes

• Until further data are available, we think that RAAS inhibitors should be continued in patients in otherwise stable condition who are at risk for, being evaluated for, or with Covid-19"

MD Internal Medicine
Even though the strong evidence is pending, I am doing pretty much like you Larry. I've lost 5 pounds, eating a new "anti inflammatory" diet to combat the potential cytokine storm in my body (sounds like quack medicine). Modifying my BP meds. Fingers crossed for hydroxychloroquine to show strong randomized trial data soon.
I suspect my personal exposure to Covid will increase soon in my small hospital. Trying to optimize what risk factors I can control.

larryganz · Apr 1, 2020

sah
Even though the strong evidence is pending, I am doing pretty much like you Larry. I've lost 5 pounds, eating a new "anti inflammatory" diet to combat the potential cytokine storm in my body (sounds like quack medicine). Modifying my BP meds. Fingers crossed for hydroxychloroquine to show strong randomized trial data soon.
I suspect my personal exposure to Covid will increase soon in my small hospital. Trying to optimize what risk factors I can control.

MD Pediatrician.

I used to be on Hydroxychloroquine (Plaquenil) for my Rheumatological problems, but my fibrosing Medicstinitis flared up in 2013 and they thought I'd need my left lung removed (see previous story), so they took me off the Plaquenil in case of cardiac toxicity - even though I'd been using it for 11 years and tolerated it well. Now I wish I was still on it.

Wetworks · Apr 5, 2020

Got my result today, positive, no surprise there. Still dealing with a fever over a week later, cough is slightly worse, no SOB. Fatigue is becoming an issue as I don't have an appetite and I am seemingly never normothermic. Would not recommend.