For one emergency room doctor who works at a Denver area hospital chain, a projected onslaught of COVID-19 patients has meant alternating between urgently posting on Facebook and Nextdoor in search of extra protective face masks to practicing peaceful meditative techniques to calm himself when he thinks of what’s to come.
Dr. Aaron Wolfe, 35, an employee of CarePoint Health, an emergency room staffing firm, has always relied on research to put order to his life and his profession. He’s put that trait to work again as he prepares for what COVID-19 will mean for the emergency room of the Aurora hospital where he primarily works.
“I’m borderline obsessive on finding new information about the virus and what the world is doing,” he said.
“I’m just trying to get my head around what people are doing to treat this and how to prepare for the side effects,” Wolfe said. “I’m trying to get clinical information. I’m trying to find information on what it’s like to be quarantined and isolated and what it’s like to be in what they are calling a war zone.”
This time that research isn’t allowing him to come up with comforting solutions. Instead, he’s found a grim future is likely on the way — one where he’s predicting doctors like him likely will have to make difficult, less than ideal choices in a chaotic, exhausting environment.
Last week, he girded himself by watching the podcast of a doctor in Italy who described working 14 hours a day for 21 days straight. The podcast wasn’t reassuring. It warned of tiring and emotionally draining days that worsen when colleagues begin to succumb to the virus and die.
“He said he was crying every day now,” Wolfe recalled of that podcast. “Hearing that is depressing.”
Wolfe said he’s expecting his hospital, which he asked not to be identified for the article, to eventually see its capacity breached.
“I’m 99 percent certain we will see a ventilator shortage in this country, and that will probably occur in three to four weeks,” he said. “That’s the most aggressive timeline. It might be one to two months.”
For those COVID-19 patients who go into acute respiratory distress, a ventilator could be the difference between life or death. And they typically will need to remain on a ventilator for anywhere from two to eight weeks, what Wolfe described as an “abnormally long course” compared to what he’s seen with other viruses.
So he’s researching how to use one ventilator to provide oxygen to two patients at the same time even though ventilators aren’t designed to work that way. He knows an emergency room doctor dealing with the aftermath of the 2017 Las Vegas shooting massacre that left 58 dead and another 413 wounded by gunfire had some success in MacGyvering the breathing tubes of ventilators so two people could receive respiration from the same ventilator at once.
His research shows that if he’s forced to do the same he needs to make sure the two patients have similar-sized lungs.
“This might save people,” he said. “And in theory it should work.”
He’s not used to working on theories when he’s in the emergency room, though. He’s used to comforting protocols. But things already are changing, and he doesn’t think the public is grasping the gravity of the situation, which he fears only makes a surge of patients all the more likely.
“There’s too many people not understanding how serious this is,” Wolfe said. “We don’t have a vaccine for this. We don’t have immunity exposure to it.”.
Other hospitals in the hospital chain have begun delivering extra respirators to his hospital, which has been classified as a catchment area for COVID-19 patients. The hope is that keeping COVID-19 patients in separate wards and set apart as much as possible in bigger hospitals will reduce the spread of the virus. Doing so would allow patients with other issues, such as heart attacks and strokes, to be treated elsewhere without risk of infection, he said.
On Monday, a mobile van was set up outside the emergency room where Wolfe works. The van allows the hospital to diagnose patients that need to be admitted for COVID-19 vs. those that don’t without exposing the lobby waiting room inside the hospital to potential contamination.
Not everyone is getting tested even if they’re showing COVOID-19 symptoms, Wolfe said. Those that have the symptoms but aren’t in a state of emergency and don’t need to be admitted to the hospital are sent home without a test and told to quarantine themselves, he said. Only those who get admitted and are symptomatic are tested for COVID-19.
The hospital used to adhere to a strict schedule, but now all emergency room doctors are on call. Wolfe is able to forgo offers from coworkers for childcare because his wife has been working from home now and is able to care for their two children.
He considers himself lucky because a friend lent him a face mask with a respirator. The addition of the respirator adds an extra level of protection beyond the normal surgical face masks he typically uses in the emergency room, and it’s also easier to disinfect the rubber fittings. Bleach should do the trick there, according to his research. Still, he’s looked for replacement cartridge filters for the respirator so he won’t have to recycle the one it came with. He can’t find the cartridges at any stores or for sale online.
He said that other workers at the hospital are relying on regular face masks, and there’s likely to be a shortage of those, which is problematic because they’re harder to disinfect after use. He said colleagues are studying how to improvise with cloth and bandanas.
Wolfe also is researching the best way to disinfect face masks that already have been exposed to COVID-19 and whether baking them in the oven will work or blasting them with a hairdryer.
His call on Facebook and Nextdoor for donations of protective face masks netted 15 from five individuals. On Monday, one of the hospitals in the hospital chain where he works predicted in an email to physicians that its face mask supply would last for two weeks.
“We’re at a point where we’re having to come up with solutions to reuse things that are not designed to be reused,” he said.
Face mask protective gear is crucial, he explained, because intubating a patient, which involves placing a plastic tube down a patient’s trachea to maintain an open airway and for administering drugs, sprays aerosol and potential virus particles all over. Placing someone on ventilation also is a high-risk procedure for potential contamination.
“Those procedures increase the exposure to health care professionals,” Wolfe said.
He’s most worried limits in capacity will mean hospital workers having to make the call of which patients to continue trying to save vs. those who should be sent home to die because of a lower likelihood of survival due to being older with two chronic conditions or diseases.
“There needs to be some uniform decision developed,” he said. “It can’t just be a conversation had bedside in real time. You have to set expectations. You can’t have families yelling at you and arguing who gets vents. There needs to be a policy that’s been set that we’re following.”
Last week, the hospital had about five confirmed COVID-19 patients on ventilators, he said. Another eight were on ventilators diagnosed with COVID-19 awaiting test results. One of the patients had originally been sent home for self-quarantine but had returned for placement on a breathing machine because that patient’s conditions suddenly worsened.
“We’re kind of like in the very beginning,” Wolfe said. “It’s the calm before the storm. We’re starting to see the pickup in numbers and increases in the severity of the illness, but we’re not where the peak will be. This is definitely the beginning. This is a marathon. It will go on for months. We’re trying to wrap our heads around that.”
And so he prepares for the worst as COVID-19 keeps coming.
He’s taken to jogging and taking long walks and ensuring he’s eating right and getting regular sleep to prepare for the endurance he’s sure he’ll have to go through. The basketball games with friends at the gym that used to provide stress relief and exercise aren’t occurring anymore in the era of social distancing.
He meditates briefly when worry sets in, breathing and practicing mindfulness to keep himself stabilized. And he continues his research, the research he says has him preparing for difficult times.
“The world will look like a totally different place in a month than it does right now,” Wolfe predicted.