16 First Responders Explain COVID-19 Cases In Their Cities

[emotional music]

I'm a physician,

I'm an ER doctor,

Physician assistant,

Emergency medicine physician,

Vascular surgeon, Primary care doctor.

[emotional music]

72 hours since our first corona patient.

[speaking in Spanish]

Three and a half weeks.

It's been about a month.

Four and a half weeks.

Five weeks ago.

This is the fifth week.

About five weeks ago.

Five weeks.

We saw our first case at Northwestern in early March.

It's been about six weeks ago.

Seven or eight weeks ago.

Eight weeks.

12 weeks.

[emotional music]

We have two positive cases at our facility currently.

[speaking in Spanish]

Now we have about 30.

There's around 30 positive cases.

In total we have 94 patients

in the whole country in the ICU.

For the whole of Washoe County,

I know there are around 360.

We have over 400 patient admitted in the hospital.

We have a minimum of 400 COVID cases in my facility today.

We've got basically a 400 bed hospital

on a day to day basis,

and it's virtually 100% COVID at this point.

Most of our folks are changing in the garage completely

and sanitizing themselves before they enter their homes.

I have wipes in my car

'cause I'm driving patient to patient

so I wipe down my car before and after every visit.

And then when I come home, I usually leave

my jacket and shoes outside of the house

at least overnight.

You change out of your clothes outside of the home,

you basically immediately shower at the hospital.

I have my protective equipment stashed in a place

that I know I'll be able to find it and

I take very close care of that protective equipment as well.

You know, disinfecting my shoes,

immediately my clothes, myself.

The surroundings, anything metal in my home,

anything metal in my car is disinfected.

Making sure that your phone is in like

a sealed plastic container,

your hair is in a hair net,

and all of the kind of usual precautions.

And then soon as your home,

making sure any clothes that you've been wearing,

even just at the hospital,

are kind of thrown into a high degree wash.

I take off everything before I go inside,

including my whites, bodysuit, I go out in everything

and I put it outside for fresh air to kill,

and then I, or put it in the oven,

70 degrees Celsius, for my masks.

And then I take off my, all my clothes,

strip completely down, put it into laundry,

and then take a shower, and let it run.

Takes about 30 to 45 minutes.

I have a dedicated footwear

to go back and forth to the hospital.

I usually shower at the hospital

but I leave my sneakers outside, I put Lysol on them.

I wash my cell phone with alcohol, my hands.

I take out all of my clothes,

I put them on a different basket on the laundry.

[emotional music]

Psychologically it's...

It is stressful.

Obviously I miss, being around my family a lot.

That's the hardest thing.

I am having nightmares at night

which I've never had before in my life.

[speaking in Spanish]

As the day passes, you learn how to

put on your gear, you shower like three times a day,

it becomes a routine.

With all of the new changes

and how protocols are switching from day to day,

are those things enough?

Or, you know, are we gonna find out that

we need to be doing more, or.

It is, you know, sad to see a lot of the patients,

you know, be unventilated and things like that.

You gotta be as professional as possible as well.

Broke down, three weeks ago, in the middle of a shift.

I never break down.

What's gonna happen to our mental health afterwards?

What's gonna happen to us afterwards?

You're gonna have a huge wave of survivor's guilt

after this pandemic is over.

I mean it's definitely been exhausting.

I wanna be really careful not to bring the virus

into someone's home.

I feel good because I know that I can do something

for my hospital and for my country and for the people,

which is, which is good, makes you feel good.

We're starting to see some real hope

for getting some of these people back to their families

and back to productivity.

[emotional music]

[speaking in Spanish]

I've had a patient who's 84 who I've seen once a month

for the last two years.

I've had to tell him that I cannot see him at home

because I don't even want to take the chance

that if I were to come into his home

and potentially give him the virus,

that would be extremely detrimental to his health, so.

I'm really his only social outlet at this point,

he really doesn't have a close family otherwise,

and it's been really tough for him to have to be

in isolation without proper care, you know,

with someone he's relied on for the last couple years.

So the decision as to when you intubate somebody

is a particularly weighty one with coronavirus

because the data that we have at our disposal shows

that it's difficult for many of these folks

and a majority of these folks really

to get off of the ventilator.

So making that decision has become,

it's already a complicated decision.

So there have been a lot of difficult discussions

over telephone with devastated family members

who had their relatives dying in hospital

with nobody around,

and that was very, very difficult,

those conversations over telephone

when you can't even really build the rapport

that you'd like to because the telephone,

you can't see people's emotions, you can just hear crying.

And unfortunately there are times when the virus wins

and we have to decide that we've done all that we can

for that particular individual.

And nobody likes to give up.

This patient we treated on Tuesday,

she had been with internalized catheter for 15 years.

And she had no access.

So we were trying to get some venous access

so she could get dialysis

because she could not be dialyzed for 10 days.

And she coded on the angio suite.

and our decision was to, what do we do?

We don't have a lot of ventilators.

She's more than 70 years old.

What's going to happen?

But at the end we did cardiopulmonary resuscitation

and the patient is currently on ventilation.

She got one dialysis but, being unstable,

you, sometimes you cannot do the whole dialysis,

but you always think that,

Okay, this elder patient, she's going to get a ventilator,

then you could get two younger patients,

and at the end, well she was not a COVID patient so,

we decided to intubate her

and give her all of the maneuvers that we could.

I will say, it is incredibly difficult

from an emotional standpoint to,

to interact with patients and their family members.

We don't let visitors into our hospitals

and there are no hospitals

around this country that do, right?

Our whole workflow around that is different now,

and so it's crazy to tell someone,

Hey, you know your family member's critically ill

but you can't come in here right now.

One of the things that's really been

unusual for us is that we are limiting

the aerosolized medications,

so the medications that we give for people with

exacerbations of asthma or wheezing

or exacerbations of their COPD,

they are really concerned of our aerosilizing

and causing more spread of infection.

So whereas normally when a person had wheezing

we would just put on a mask and a nebulizer treatment,

not even think of it,

now we really have to make decisions,

is the risk to the patient and the crew

of having this aerosolized medication

compared to the benefit that they're gonna receive

from having that wheezing or shortness of breath relieved?

So two days ago I had a patient who was sick,

I don't know yet if they were COVID

but they were definitely in respiratory distress.

I went ahead and gave the albuterol treatment

with the HEPA filter on and then stopped it

before we made it to the hospital

and it did seem to improve them,

so I feel like it was the right thing to do

but all the time I was wondering, you know,

is this one really sick enough for us to do that way?

Or should I wait until they can have a different way

of delivering the medication?

Fortunately it worked out but,

you know, never had to think about it twice before.

I think the hardest decisions

that we're having to make right now

in the US and around the world

are in terms of resource allocation.

And so continuing to have to triage people

and make educated guesses about who most needs to be tested

and who's most likely to be infected

continues to be a struggle.

I think the hardest decisions still come,

comes back to when do you need to order tests

for your patient?

Ideally, it would be good if we can do tests for everyone

but realistically, they just not the resource to do that.

I think, you know, treating patients with corona

is the patient that asymptomatic.

I have subsets of patients that

one is symptomatic and one is not.

Who do we test, who do we not?

It'd be nice to have a retrospective scope

and say we could have done anything better, right.

The issue's that none of us,

human beings have been notoriously bad at predicting things

all the time.

So otherwise we would be prepared for this pandemic.

And if anything we could do better is really to

asking humanity to change human nature.

[emotional music]

This has taken a very big emotional toll on me.

I miss my children, I miss my grandchildren,

and yes, it has taken a very big toll.

I haven't cried yet, but I've definitely

been on the brink a couple times.

[Interviewer] When was the last time you cried?

Right before this interview [laughs].

I'm sure my partner would say

that I've been emotionally burned out,

and that I've been horrendously moody, hungry,

and tired all the time.

I've got patients with, you know,

really life-threatening and serious problems

and me being away from home

pales in comparison to all those.

But it's certainly an experience that none of us

will ever forget as long as we're, as long as we're around.

Like, okay I'm doing this pretty good thing

for my country, but what if I get infected,

what if I infect my family?

I cannot see my family.

And also, it's not, it's not easy for anyone,

but you have to stay positive.

If you start thinking about how, like,

all the possible scenarios, you cannot win,

because you are going to be scared the whole time

and sad the whole time.

I can't remember the last time I cried

but it's definitely very emotional, I mean.

It's all been pretty hard to be honest with you.

Not being able to hold my daughter or my newborn daughter.

The tears haven't been shed yet

because I wanna make sure that I'm a rock for other people.

But this crisis team, we've actually all check in,

we have our own internal crisis team for the hospital

and every week, they're rotating through

and making sure that we've got time together,

that we're having those debriefings when they're warranted.

And in of the fact, one of the nurses who sits

on this team actually stopped me in the ER

the other day as I was running,

like racing by and grabbed my arm and said,

How are you?

And I'm, I'm good.

She says, No, really, like how are you.

And really just kind of nailed that home,

like, I'm checking in with you, sister, you know and--

When I was in the hospital, there was so many,

everyday you had an opportunity of realizing that

crying would have been a good way of, you know,

releasing some tension.

Never cried for fear.

Cried for patients, for situation, for friends.

[speaking in Spanish]

[emotional music]

I think right now where we are in northern Nevada,

is just at the beginning.

We're going to be seeing a flux of patients

but I can see that it's creeping up

and that we are probably just getting into

the really high volumes that other more urban areas

have been receiving already.

Our whole facility just does not

have the capacity to handle the bandwidth

for large volumes of patients.

We're exceptionally lucky in Ireland

that a lot of the social distancing

and government precautions and sentences put in place

have minimized a lot of patients being exposed.

So right now in southern California,

I think there's a glimmer of hope

that social distancing is working.

And I think that we're gonna start to see

more regional differences in terms of caseload.

Kind of the attention span, I worry,

of folks has been used up, meaning that we have been

under shelter-in-place or stay-at-home orders

for several weeks now,

and we are beginning to see

some of the messaging on the news

that the numbers, even in the worse hit areas,

are beginning to get somewhat better.

This, in my view, is actually the most critical portion

of time where you have to double if not triple down

on all the preventative measures

that we're taking as a society.

It also depends on whether people get frustrated

and they, the weather's really nice,

and they go outside, they take that risk.

Because all it takes is one person

to encourage others to go outside, to encourage others.

And New York City's back outside

and we're spreading to one another.

You know, it's a critical mass,

then we're gonna be back into where we were three weeks ago.

I think if people don't, don't stay at home,

this will get a lot, a lot worse.

It appears that in certain areas,

things are starting to improve,

and once we get testing more readily available

I think that will make a big difference.

We're seeing that to some degree at Woodhull.

And we are hopeful that we're at or perhaps just past

the apex of things.

Guarded optimism would be a good way to put it.

Hoping that we will see a trend down,

but that trend down will take a long time,

it's not gonna be one week or two weeks.

And it's day by day.

My outlook is

cautiously optimistic about the efforts we've done

for curve flattening.

I don't see the virus going away after this surge.

I don't see it going away entirely,

and I expect there to be secondary peaks

because of the activities we've done so far.

[emotional music]

At the end of the day,

we're all gonna get through this together.

The courage that I've personally seen

has been awe-inspiring.

I will sure we want to be safe.

We will look out for each other,

we will work for the same cause.

You're not alone.

Remember you're doing important work.

This will pass too and we are going to make it through it.

I'm proud of you guys.

We could all learn from those experiences.

You will never be prouder than you will be

looking back on what you did during this time.

Stay in touch with your love ones.

Thank you.

God bless you and appreciate you.

[speaking in Spanish]

Never ever lose the strength and the willingness

of communicate with people what is the real need.

Which is telling about isolation,

telling about protection,

and telling that this is the solution.

A good hospital can save an important number of lives.

A proper isolation is going to save millions of lives.