In this extraordinary time in which we are living, no set of people has been more affected by changes than medical professionals. Doctors, nurses, psychiatrists and emergency response personnel are all undergoing immense differences in their practices. The COVID-19 virus has had an enormous impact on the health profession, and some of the changes may be permanent.
Three doctors from the Jewish community in Colorado Springs were asked for their input on the changes they have experienced lately.
Kate Raphael, MD, is a general practitioner at a psychiatric hospital in Colorado Springs. She performs checkups for resident patients with medical issues and admissions physicals for incoming patients. Raphael sees between 15 and 20 patients daily.
In the past three months, she has referred five people for COVID testing, four of whom tested negative. The fifth patient still awaits the test results. At the start of the pandemic, she referred patients for “on precaution” status if they presented with a cough or shortness of breath coupled with fever. The observable symptoms may differ: any flu-like symptom such as sore throat, fever, body aches or sinus problems, as well as the aforementioned complaints, with or without fever, are cause for referral.
Raphael reports that the majority of patients who do have the virus are asymptomatic, thus complicating the professional’s ability to pinpoint the source of the infection as well as the span of time the patient is contagious.
Raphael says that in March she and her colleagues were “freaked out” when seeing patients in person. They wore masks, gloves and goggles, and went through a rigid protocol before and after each visit. In June, the restrictions were somewhat relaxed, and the doctors feel better about doing their jobs.
Raphael now takes precautions when in the same room with her patients. She practices “telemedicine in person,” meaning that she does not have physical contact with the patient unless there is a specific complaint. She says that a comprehensive health history from the patient generally suffices to narrow down the problem.
When she returns home after a day seeing patients at the hospital, she throws her clothes into the washer in her garage before entering the house, showers and washes her hair.
Earlier in the year, when no one was sure how much medical equipment would be needed for the sick, Raphael reports that she experienced difficulty getting tests for patients she referred to the emergency room. The expected shortage of testing kits caused ER personnel to be selective in their use. She had placed one of her patients “on precaution” at the hospital who was not tested at all.
The situation has improved as of June, with the number of kits stable and a decrease in the number of patients to be tested. The use of ventilators has changed as well: the initial response was to call for its use for every patient. Raphael now only uses a ventilator as a last resort. An “alternate oxygen delivery system” such as a BiPAP machine, used for sleep apnea, has been found to be effective, as well as a high flow cannula to deliver oxygen.
Allan Davidson, MD, is a pulmonologist at Evans Army Community Hospital on the Fort Carson Base in Colorado Springs. He has seen between six and eight patients with the novel coronavirus since the beginning of April. Davidson lists several treatments he has recommended for COVID patients: oxygen, drugs such as hydroxychloroquine and remdesivir (which is experimental, used for “compassionate” treatment), plasma transfusions and a ventilator as a last resort. (On June 12, the FDA revoked its emergency use authorization for the drugs hydroxychloroquine and chloroquine for the treatment of COVID-19, although the drugs can still be prescribed legally off-label.)
Of his practice, Davidson says, “It’s a different world.” Usual activities have been cancelled. The huge surge of people needing ventilators didn’t happen. Personnel and patients wear masks and have their temperature taken before they enter the hospital. The pharmacy is drive-through only and doctors are relying more on telephone and computer appointments.
It is hard to make a firm schedule, Davidson reports, because it takes extra time to dress in the protective garments needed and to clean the examining rooms and equipment after use. Doctors and nurses wear gloves, masks and personal “blowers,” a tube connected to the mask that filters the air.
Davidson says that he limits his contact with patients as much as possible. He observes them from outside the room when he can. He reports that “sometimes I use binoculars to see the patient up close from the other side of the window.”
Lori Wertheimer, MD, is a pediatrician with the Mountain View Medical Group, now part of Optum. Her experience these past months has been very different. “We have seen a marked decrease in the number of children coming in,” she says. The reasons? The virus did not hit kids as strongly as adults; the closure of schools ensured that the students were not passing the disease around as they do the flu; respiratory ailments usually slow down as the weather warms in March anyway.
Her practice is using telemedicine as much as they can at this time. It has merged five offices into two for well-baby visits. One extra office sees children who have respiratory complaints.
Wertheimer is worried that pediatricians are not seeing the children they need to see at this time. Parents are afraid to bring their children into the office, and the result is that these kids are at risk for non-immunization.
Some differences in Wertheimer’s practice at this time include: scheduling appointments for 30 minutes instead of the 12-15 minutes pre-pandemic (the extra time is spent cleaning); no congregating in the waiting room; a nurse in the lobby takes temperatures and does a health screening before patients and parents are allowed inside. Wertheimer reports that social distancing for examinations is not possible for infants and toddlers, as they are usually examined while sitting in the mother’s lap.
Raphael, Davidson, and Wertheimer all agree that there will be an increase in mental health problems as a result of the pandemic. The following are all happening now and will continue to grow for the foreseeable future: people afraid to go to the doctor for unrelated medical issues because of the virus; depression; an increase in child abuse and domestic violence due to parents and children remaining in close quarters for so long; people afraid to come in to refill needed medications; an increase in suicide and attempted suicide; an increase in the number of children with mental health problems due to a non-ideal home environment and lack of contact with friends; children frightened by the news and masks; financial difficulties.
The doctors agree that the initial response by the US government was necessary and important to slow the spread of COVID-19. Social distancing, staying safe at home and closures all helped. However, now that the economy is beginning to open up, Wertheimer worries that people will not be as careful now as they were before. She hopes there will not be a second wave of COVID-19.
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