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Back on the Front Line: Some Doctors Face COVID-19 a Second Time

  • During the first COVID-19 peak in April, many healthcare providers traveled to New York City to help.
  • Now some of these providers are seeing a second COVID-19 peak back home.
  • We talked to physicians about the strain of going through two COVID-19 peaks and what they learned in New York.

When the first COVID-19 wave came to the United States in March, hospitals in hard-hit areas like New York City started to buckle under the impact.

Waiting rooms overflowed. Supplies of personal protective equipment (PPE), ventilators, and other medical equipment dwindled. And doctors scrambled to control this new, strange disease, while watching patient after patient die alone.

The need for healthcare providers was so dire that physicians, nurses, and other medical providers volunteered to travel to New York to help.

“The hospitals were completely bursting at the seams,” said Dr. Stephanie Loe, an emergency medicine physician at Riverside University Health System in Southern California, who spent 4 weeks treating COVID-19 patients in New York City hospitals this past spring.

When Loe returned home, the virus was waning in New York. But then cases started to surge in Southern California.

Like many physicians who traveled to COVID-19 hot spots in the spring, she was now back on the front lines of the pandemic.

There’s no doubt that doctors who have dealt with the first round of cases are, in many ways, better equipped to deal with a second wave. But a fresh set of problems is making the new surge even more challenging.

Here’s what doctors who are back on the front lines are seeing.

Learning on the front line

“At the beginning we really didn’t know what to expect, but we’ve learned that it’s not just a respiratory disease. COVID-19 can turn into multi-organ failure,” Loe said.

Loe learned in New York that the standard procedure of putting patients with respiratory failure on ventilators doesn’t always lead to great outcomes.

Instead, she now tries all other treatment options, such as putting patients flat on their bellies in the prone position, before doing something more invasive.

“Even if the patient’s stats aren’t where you want them, you have to be OK with that. We also realized that patients wouldn’t be in respiratory distress for a little while — it would be for several weeks,” she said.

Doctors have also learned that with COVID-19 patients, things often get worse before they get better — especially in the intensive care unit (ICU).

“When you treat many patients in the ICU, even those with significant lung damage, either you can save the patient and get them out relatively quickly, or they die in a relatively short period, but that’s not the case with COVID,” said Dr. Gretchen Winter, a pulmonary and critical care physician at the University of Alabama at Birmingham and member of the American Thoracic Society.

“There’s now an expectation that you’re in a long game, and it’s often two steps forward, three steps back with COVID patients,” added Winter, who helped with the surge in New York City for 5 weeks.

Staff and supply shortages

The widespread scarcity of PPE continues to hurt some hospitals amid this second surge. Limited stock of N95 masks, which help protect the wearer from the new coronavirus, force doctors to use them longer than intended, says Winter.

“We’ve also had persistent issues with getting enough supplies of medications, largely with sedative medication for people on ventilators. There’s a real possibility of running out of medicine and ventilators in the future,” she said.

Another area of concern is staffing. The first surge in hospitalizations saw doctors, nurses, and other hospital workers stepping in to help in the ICU, even if it wasn’t their area of expertise, says Winter.

“We mostly thought about where we’re going to put beds, but we realize we have to prepare staffing early as well,” Loe added. “Some people may need to adapt and work in areas they aren’t used to.”

Staffing shortages may continue to worsen in the second surge.

The pandemic is expected to lead to more than $323 billion in total losses this year at U.S. hospitals and health systems, according to the American Hospital Association.

To cut costs, at least a dozen hospitals have announced layoffs since June 1, and hundreds have furloughed workers.

“I’m not sure we have enough availability and energy left in healthcare providers across the country to assist where they’re needed and answer the call to help with surges in the South the way they did in New York,” Winter said.

The battle against misinformation

Over the past few months, inaccurate information about the new coronavirus shared through social media and mixed messages from the government have created an “infodemic.”

Doctors say that the misinformation is eroding trust in the healthcare system and making the second surge more complicated.

“When I knew people were starting to take this less seriously and going about their business not caring about masks, I felt like all of this hard work was for nothing,” Loe said. “If you can’t gain the trust of patients, you don’t have anything. You feel completely helpless.”

Myths about proven methods to flatten the curve, such as wearing masks, are making it more difficult to slow the spread of infections this time, which may further overload hospitals.

Emotional highs and lows

The first surge presented doctors and hospital staff with a slew of new on-the-job stresses, from shortages of equipment to the heartbreak of seeing patients struggle with the disease.

That stress has left many once-energized healthcare professionals exhausted as they return to the front lines.

“There are a million emotions. I feel angry, I’m very sad, and I’m hopeless, in a way,” Winter said. “We don’t see any foreseeable end in the future, and we’re going to continue to be overwhelmed and exhausted watching people get sick and die.”

The risk that they, too, could contract the virus while treating patients, as well as the preventive measures they must take to avoid the virus, also adds to medical workers’ stress.

“We [anesthesiologists] are at very high risk because we intubate patients right in their airway. It takes a lot of focus and mental aptitude to not get contaminated and remember all the steps to complete the procedure,” said Dr. Alicia Warlick, an anesthesiologist at UNC Rex Healthcare, American Anesthesiology, in Raleigh, North Carolina.

“It takes a mental toll on you when you’re working 14 hours a day or more. It’s very taxing. I have the constant worry when I get home as I decontaminate myself every day,” she said.

Warlick adds that overall, she’s doing well and that the pandemic has breathed new meaning into her work — a sentiment echoed by other doctors.

The patients they treat and the lives they save serve as a daily reminder of why they went into the field, and motivates them to keep going through this surge.

“There’s an excitement to being part of something bigger than me. This is everything I’ve wanted to do in my life,” Loe said.

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