Leading Through a Pandemic by Michael J. Dowling

Author:Michael J. Dowling
Language: eng
Format: epub
ISBN: 9781510763852
Publisher: Skyhorse
Published: 2020-08-14T00:00:00+00:00

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We established a standard process for evaluating patients presenting in our emergency departments, starting with an assessment: What suggested that this patient might be COVID positive? Initially, patients who had recently traveled to China, Italy, or Iran were likely candidates. Patients with fever, cough, and difficulty breathing were also candidates. For most patients, especially young healthy people, the best course of action was to ride out the disease at home. Tens of thousands came to our urgent care centers, and most of these patients were also able to recover at home. Several thousand that we examined in our EDs were sick but nonetheless able to manage at home, although a small percentage of these patients returned much sicker and were admitted.

At a higher acuity level were patients presenting in our EDs with respiratory distress. Any patient not oxygenating well and with labored breathing was admitted. We learned over time that symptoms varied. Some patients experienced generalized body pain, fatigue, persistent cough, stomach pain, diarrhea, or headache. But the key factors in identifying a COVID patient centered on oxygen levels and difficulty breathing. These people were admitted to our hospitals through the ED and moved to the units as quickly as possible so that our EDs would not become overwhelmed.

One of the many problems throughout the pandemic was the question of how exactly to treat patients once they were up on the unit. The unknown nature of the virus made creating treatment protocols challenging. “There’s a lot of stuff out in the press where people say, ‘oh this is great’ and some of it may be, but we really don’t know,” said Jarrett. “And you can’t give all the medicines because some conflict with others. So we have to figure out based on the studies we’re doing what are the best therapies.”

Every patient that showed up in our ED who required admission was tested for the virus, given a chest X-ray, and, in most cases, put on oxygen. The progression of the disease was different for different patients. Some were stable for a couple of days, then crashed. Others collapsed in the ED having gone from a normal blood oxygen saturation in the 95 to 100 percent range down to 75 or 80 percent within hours. There were some patients who, while awaiting test results, would experience extreme pulmonary problems. In general, we followed the Acute Respiratory Distress Syndrome Net protocol (ARDSnet), a NIH agreed-upon protocol for acute lung injury.

The differences in symptoms and the rate and manner of disease progression made it hard to know exactly how to treat COVID patients. The lack of clarity was evident in a late March memorandum from physician leaders to doctors throughout our system:

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