Howdy FinD Brothers,
Today is my birthday and a nice break after spending the last seven days working as an Internal Medicine Hospitalist at Memorial Hermann Southwest. It’s been the most exciting and frightening week of my medical career.
The hospital is half empty, as all elective procedures have been canceled or postponed. There are no visitors allowed due to concern of spreading the virus–only employees and patients. The patients with suspected or confirmed COVID-19 are alone behind closed doors to minimize the spread of virus droplets to healthcare staff. There are few negative pressure airborne isolation rooms in any hospital. Everyone–patients, doctors, nurses, janitors–is wearing masks at all times.
Seven days ago, we had just a few confirmed COVID-19 patients in the ICU and one on the medical floor. Now, we are opening up new dedicated wards for these patients every few days. They are coming.
I saw my first confirmed COVID-19 patient four days ago, an elderly man with severe dementia. He and his wife, who is also hospitalized, don’t leave home much. One of their well sons, daughter-in-law, or grandchild who live with them probably gave them the infection. Since then, I have seen at least a half dozen or more. These patients present in a similar way with fever, shortness of breath, bilateral pneumonia on chest x-rays, and near-normal white blood cell counts.
We start all positive and highly suspicious patients on hydroxychloroquine plus or minus azithromycin. This drug combination causes QT prolongation, which means the heart muscle takes longer than normal to recharge between beats, predisposing the patient to cardiac death from ventricular arrhythmia and probably a little risky in patients with known cardiac disease. It may help them, but we don’t yet have good data on efficacy. The hospital has a limited supply of these medicines and all orders must be approved.
I feel sorry for these sick patients who are kept behind closed doors with no visitors. It’s a terrible illness to suffer alone. I see the fear in the eyes of the nursing staff attending these COVID-19 patients. More than 60 doctors in Italy have died treating COVID-19 patients. I, too, have to reassure myself too that I can face the danger of contracting illness with confidence in my protective equipment and measures as I have practiced for more than twenty years treating patients with contagious illnesses like the flu, tuberculosis, and AIDS.
Jesus is with me.
“Even though I walk through the darkest valley,
I will fear no evil, for you are with me;
your rod and your staff, they comfort me.” (NIV, Psalm 23:4).
After my work-week ends, I will live in isolation in my guest bedroom and office to avoid infecting my family. I left my shoes in the garage, tossed my scrubs in a bin, and showered immediately after work every day. For five days I will stay in quarantine away from my wife who fixes meals for me left outside my door. My interaction with my children is through bedtime stories via FaceTime and conversions across the hall. My dog is begging for me to take him for a walk, which I used to do every night but don’t now for concern of inadvertently spreading the virus to my family by touching him.
Every healthcare worker faces this tough decision on how to do their job and protect their family and come to a different solution for their situation. It’s a very tough time with full of uncertainty.
The COVID-19 wave of illness is here. Don’t let your guard down. Keep physically away from everyone and keep your guard up in grocery stores and essential places you go when you leave home. All hospital employees are required to wear surgical masks. I listened to an interview from a leading infectious disease doctor from South Korea where twenty percent of the positive COVID-19 patients (probably tested through contact tracing) had no symptoms. It’s these mildly sick or asymptotic people who may be spreading the virus in the community as I’m sure the sick are at home. He recommends wearing a mask in public. It helped during prior MERS epidemics in Asia in 2015 and is common practice in South Korea, China, Taiwan, and Japan.
Now the CDC is debating whether to change their recommendation to the public to wear masks. They don’t want people hoarding masks needed for healthcare workers. There is compelling data that we all should be wearing homemade masks as we venture into the grocery stores.
I pray that you keep continuing the message of staying connected but following social distancing and frequent hand washing to avoid overwhelming our local hospitals and emergency rooms. I watch videos of hospitals in New York City and hope Houston doesn’t get close to that degree of suffering and chaos.
I tell my mom, who worries about everything, that I made a choice a long time ago to become a doctor. Seeing sick patients is my job. It’s my duty to help them despite the hardships and risks.
Here is a little story that might encourage you in this dark time. As one of the nation’s top infectious disease experts, Dr. Anthony Fauci says he cannot make conclusions about the efficacy of a treatment based on anecdotal stories or small drug trials. The medical standard is large, blind, randomized studies with adequate control groups.
I have a hydroxychloroquine and azithromycin story of success. A lady in her early 60’s with numerous adverse comorbid medical conditions for COVID-19 came to the emergency room on Friday afternoon gasping for air with bilateral pneumonia and COVID-19 infection. She was sent to the ICU several hours later requiring 7 liters of oxygen support and was started on the combination of the above medications.
Yesterday, I sent her home on room air. She had no symptoms. Patients with COVID-19 are usually sick for 10-14 days. She was on her way to needing intubation on day one. I am certainly impressed and have hope for this and other promising treatments.
The French infectious disease expert who published the first study treating 20 patients with this drug combination just published his second study treating 80 patients with good results. There is hope for us all in this dark time to come. I have to go read about his new study. Take care of your family, brothers in Christ.
Joe Dang, MD