COVID-19: An Emergency Physician’s Perspective

If the last few weeks have shown me anything, it is that no one is immune to the big and small changes that COVID-19 brought to the world almost overnight. Where I live in Columbus, Ohio, and in many other states around the nation, public places like museums, zoos, and schools are all closed. This is almost everyone’s reality.

I feel this especially in my work as an emergency physician. Life right now consists of waking up in my guest room, where I’m social distancing from my family because I am exposed to coronavirus on a daily basis. Where I used to wear scrubs that I own, I now go to work in street clothes and change into hospital-issued scrubs. I work my shift, shower, and then come home.

I have seen multiple patients test positive for the coronavirus, and I have multiple patients who are still awaiting their test results. At the time of this writing, Ohio has around 4,500 positive cases and over 140 deaths. We’re not New York City; I have colleagues from there that I work with digitally, and the numbers are staggering. But even in Columbus, we are seeing a steady incline in both the number of people that we’re testing and in positive tests.

Current Issues with Testing

Unlike testing for influenza or other viral illnesses, the most widely used test we have used for coronavirus takes five to seven days to get a result. At the beginning of the pandemic, if a patient was admitted to the hospital, we could get a test back in three to four days because it’s done centrally, but if the patient is sent home, the test would go to another testing center, taking more time. On top of this test taking 5-7 days to get a result, it is only 70% sensitive (meaning one out of 3 patients with the disease may test negative).

There is now another, faster test that the FDA recently approved that seems promising. It has an eight- to twelve-hour turnaround time and seems to be more sensitive. Although we have this newer test here, it has not been widely been adopted and there are still a limited quantity of the rapid test available. Plus, when we order more tests than the daily capacity allows, we are stuck running the additional tests with the older (and longer) test. We have been told that we may have an increased capacity with the newer test over the upcoming weeks. When we are able to utilize the newer test, it does promise to be 80%–85% sensitive, so instead of having one out of every three patients with a false negative, that number would be reduced to one or two out of ten.

In general, when it comes to testing, we’re just trying to keep up at this point. People that are not in healthcare see the numbers rising exponentially in the US, but they have to realize that the numbers coming out reflect the situation as it was a few days ago. Again, it takes time to get those batches of tests back.

What Your Doctors Want You to Know

Monitor your symptoms. Most people are going to have symptoms similar to the common cold. People will experience a mild fever, a cough, and myalgias. It's going to be worse on days five through nine, and then it's going to taper off. If you start to have symptoms, isolate yourself. Don’t go to work or social gatherings, and maybe stay in a separate room from other people in the house that might not be affected.

In more severe cases, there's typically a 24- to 48-hour window to where you go from having a regular cough to being short of breath to being in the hospital on a respirator. Come to the hospital if you are experiencing shortness of breath. I know that is hard to gauge, and people with underlying disease are going to be more triggered to come early. That's okay. But until there is a shortness of breath, the average person who doesn't have medical problems should treat the symptoms with Motrin, Tylenol, and fluids, just like you would a cold or the flu.

Go for Balance

If you look at the data from China, people in their 60s with medical problems were high-risk patients. If you look at the Italy data, the age drops to the 50s. In the US, we've seen a number of young, healthy people pass away from coronavirus. It's hard to judge every situation exactly, but we should be moderate. Don't go see your grandma, don't go see your mom and dad. Be okay with digitally seeing people through FaceTime, Zoom meetings, or Google Hangouts. Wash your hands, cover your cough, and be a good steward of your own body. However, the prepper approach to this is not appropriate. While you're home with all of your stuff, there are people who have nothing at their house. It's important to have some balance.

There really isn't data that shows that public use of an N-95 respirator mask at the grocery store is beneficial unless you're going to be in close contact with people. If you're tempted to go buy this type of mask for your personal use, I would recommend that you don't right now. Healthcare in general is trying to buy all of those for the providers in close contact with patients. Although we're not currently having a shortage in Columbus, there are multiple cities that are having shortages because of the high volume of cases.

Most of your local leaders also have your best interests in mind. I don't think there's a governor in this country that isn't taking this seriously in terms of having people stay home and closing schools and public venues.

What HIT Vendors Can Do

I know that not all EMRs currently have the option to do telemedicine, but that is going to be a big technology need for providers and their patients in the coming months. Even when we reach the stage where we can start getting rid of certain restrictions and primary care offices can open again, telemedicine will still need to be a big part of moving forward and getting back to a new normal.

Right now, vendors can work on adding or improving telehealth technology as part of the EHR solution; they can create their own solution or sync with another company’s. A lot of healthcare companies have an opportunity to step in and make a difference in something that is definitely needed now.

How Anyone Can Help

If you know someone who works in healthcare, reach out to that person. My job is stressful by itself, but adding a global pandemic on top of that stress means that we all need some extra support. That support can be as simple as a text message asking how someone is or sending them a funny GIF or YouTube video. These little things go a long way. 

Andy Little, DO graduated from Ohio University Heritage College of Osteopathic Medicine in 2012 and from the Doctors Hospital Emergency Medicine Residency in 2016. He currently serves as Core Faculty at the Doctors Hospital Emergency Medicine Residency serving in the roles of research director and curriculum director. Outside of his roles in education, he also serves as a co-founder and host for the EM Over-Easy Podcast.

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