By Dr. Nicolle Block [March 22, 2020]
I am not someone that typically writes about my daily adventures but these days we all have a story to tell. I’m sharing this one because it is through the lens of a primary care provider in an outpatient practice as we enter a precarious time for our nation and world.
My story begins in early January when my amazingly smart and unlikely to panic brother-in-law started talking about this virus that was appearing in China. He told us this was the big one and don’t make any summer plans that were not refundable. He started sending me daily emails about this virus that the World Health Organization named COVID-19 later in the month. We watched this virus start decimating the Wuhan province of China and spread beyond there. We waited for the US government to start preparing for what we knew was a pandemic and NOTHING happened. Things started to get bad in China and the president still publicly denied this was going to become our problem. I am not an epidemiologist, but I read everything I could about this virus. Experts were in agreement that this was going to become a global pandemic and so I waited…
In mid-February, my family made sure to buy enough food and supplies for 2 weeks. We knew that my job as a healthcare provider, made us very likely to land up getting quarantined in the near future. When my husband went the shelves were fully stocked and no one was shopping in Costco. We continued to wait for a government response or acknowledgement of this storm that was brewing, but there was nothing. At work, I tried to mobilize my health system to get prepared for video visits, but this turned out to be a complicated technical problem. Again, I waited. Our office tried to order N-95 masks in January but the supplier canceled our order since they were directing all masks directly to hospitals.
It was early March when things started to change. My family went away for spring break, and the ski resort we stayed in seemed oblivious to what was going on. We were careful: we canceled our flight and drove instead; we avoided crowds; we used a ton of hand sanitizer; and we ate our meals in our condo. On our last night, the President FINALLY declared a state of emergency. We decided to drive home (900+ miles) without stopping overnight, to avoid risk of exposure. We started to see shifts in restaurants. There were no more water cups by the drink machine or trays at restaurants, and now there were long lines in bathrooms just to wash hands.
Last Monday, I went to work early. We had a quick provider meeting and decided that at this point we could no longer see sick patients. It was too much risk to other patients and our staff. We quickly had to devise a plan to keep everyone safe but still take care of our patients. The state of emergency allowed us to do televisits instead of physical visits. And so, my fabulous team made sure our patients were safe. We stationed someone in front of the clinic to screen patients before they walked into the clinic. If a patient was sick, then they were sent to their car and we did the visit on the phone. In one weekend we went from a normally operating clinic to our new reality. Every day we have faced new challenges and implement new changes.
We opened up a drive through testing center in a parking lot of a nearby clinic to run tests on high risk patients. These tests were developed by our lab. These tests were did not come from the CDC, since the CDC had none to give. After 48 hours, we had saturated the lab’s capacity with over 1,000 tests to run from all over Texas. For the past 2 days, we have had no COVID tests available. We had concerned patients in our system fill out an online questionnaire to screen for COVID, but the flood of inquiries was overwhelming. At one point this past week, we had a backlog over 5,000 questionnaires. My amazing urgent care team along with many other clinics in our system helped take on this daunting task and cleared these questionnaires by Friday afternoon. In addition to dealing COVID testing, we also discovered that insurance companies were not going to reimburse our practice for phone visits at the same rate as video visits. So, my fabulous husband reformatted some old iPads and bought them to the clinic for us to use on Friday. Somehow, through some amazing teamwork we all made it through the first week and took amazing care of lots of patients. I have been so impressed at how many “Thank You” messages I have gotten from patients and how grateful they were that we were there to listen. The leaders of our country should provide guidance and information to its citizens. It makes me feel really humbled to be able to help, but it shouldn’t have to be me or other primary care physicians that step in to fill this critical gaps.
We are trying to limit the patients in our office. When a non-sick patient needs to be seen we are doing this visit with surgical masks masks/face shields/gloves. We only have surgical masks in our clinic, these are the thin loose-fitting masks that help protect you from splashes and large particles but do not protect you completely from small particles, like viruses. We do not have any N-95 mask, these masks are fitted and provide an efficient filtration of airborne particles.These were the mainstay of our care of patients with respiratory diseases prior to the COVID-19 pandemic but there are so few right now, that they are locked up in the hospital for the most invasive procedures like intubation. Currently we have limited surgical masks (we only have a few boxes for a clinic with 14 providers) and only each have one face shield that we have to clean. We are cleaning every surface after the visit. We are all wearing scrubs and as soon as I get home I have to strip down in the garage and take a decontamination shower. These are our new realities. I am lucky that my days end after 9-10 hours, I know for many of my co-workers in the hospitals in other states working endless days without much rest at all. I fear that may become the reality for all of us primary care doctors as well
We are just at the beginning of what is going to be a very long and hard few months of uncertainty. I do not believe schools will go back in session this school year. We are probably going to fill our ICUs and hospitals and then have to fill up waiting rooms and conference rooms beds with COVID-19 patients. We are likely going to be ordered to shelter in place all over the country over the next few weeks for local or the federal government. For more detailed information, how sheltering in place will help us, please look at https://www.covidactnow.org/state/TX (this is for Texas but you can look at your specific state). I have talked to so many people over the last few weeks and continued to read as much as I can. I have a few pieces of advice:
Continue to wash your hands and practice social distancing. This does not mean you need to be a hermit and stay isolated in your house. Go on walks/bike rides/runs. Right now, human interaction while social distancing or using electronic means is crucial part of dealing with all the changes.
Please thank everyone that helps you over the next few months. I have tried to thank every grocery store worker, co-worker, or family member/friend I have talked to. Everyone who is out there working is as scared and overwhelmed as you are. A few words of thanks go a long way.
Please do not post articles online from non-reputable sources. There is so much fake science going on. If something is not from a source you recognize, don’t post it. I will be happy to review it for you to let you know if its credible. The CDC (https://www.cdc.gov/coronavirus/2019-ncov/index.html) and the World Health Organization (https://www.who.int/emergencies/diseases/novel-coronavirus-2019) have wonderful websites.
Please do not hoard supplies. It is OK to be prepared with a few weeks of regular supplies but there is no lack of food/regular supplies right now if everyone takes what they need. Also please do not try and hoard medications, the current hoarding of hydroxychloroquine (an antimalarial medication that is also used in rheumatoid arthritis and other autoimmune conditions) is wrong. There may be some evidence that it works but save the drug for the sick and hospitalized patients or patients with autoimmune conditions that regularly rely on this medication. If you are hoarding masks, especially N-95 masks, please donate them to your local ER or clinic. I saw someone at the grocery store yesterday with a N-95 mask, while we have none in my clinic.
COVID-19 typically causes cough, fever, and shortness of breath. If you start having these symptoms, please do not panic. I know there is a lot of scary stories out there but more than 80% of people will have a mild illness. At first, self-quarantine and treat your symptoms with over the counter cold medications and rest. If your symptoms get worse, call your doctor. DO NOT go to any primary care providers office without calling. If your symptoms are severe and you have difficulty breathing go to the ER.
Give blood. Our blood banks desperately need it.
Be ready for change. The next few months are going to test us and we have to adapt.
Make sure to eat regular meals, sleep, and get exercise. This last line is to remind me and other healthcare workers that if we stop taking care of ourselves, we are more susceptible illnesses, including COVID-19.
There are going to be many beautiful moments over the next few months, as we adapt to new less cluttered life. Please savor this moment.
I want to end this post by delving little into politics. This crisis is so intertwined with the political situation that I am obligated to mention it. When the dust settles from all of this, please vote for someone that will bring science back into the White House. The Trump administration eliminated the office tasked with preparing for pandemics (for more details read this article from my brother in law’s boss. Without a senior leader coordinating national preparedness we lost 3 months of time planning our national response. That was time we could have been manufacturing masks and ventilators. We could have started expanding the number of ICU beds. We could have given schools ample time to prepare a “take home” curriculum. We could have passed laws to ease the foreseeable economic collapse. We have no control over viruses, but we can be prepared for them. We do not have enough tests. We do not have enough personal protective equipment. We do not have enough ventilators. This lack of preparation means that many more people will die from this virus. Unfortunately, many of these avoidable deaths will be healthcare workers. This is an unacceptable loss for the wealthiest nation in the world.
I appreciate all of you for reading this long post. Please send me a message if you have questions/concerns I can help with.
Nicolle Block, MD is a primary care physician at Baylor Scott & White Medical Center in McKinney, TX. Cheryl and I both go to her. We love her. We find her exceedingly competent and compassionate.