One mask per shift, the mental health impact of COVID-19: Q&A with a New York City primary care physician
We spoke with an attending physician about current hospital working conditions, PPE availability, and medical didactics during the rise of the COVID-19 outbreak in New York City. They kindly answered our most pressing questions; in turn, we honored their request to remain anonymous.
Full interview below.
Tell us a little about yourself. Where do you work? What is your role there?
I am a primary care and general medicine doctor in the South Bronx. My primary role is as an outpatient, primary care doctor, although I also attend in our main hospital and teach medicine residents.
Is the case load of COVID-19 patients straining your hospital’s capacity for ICU beds, ventilators, PPE equipment, etc.?
I haven’t been in the ICU or worked on the general wards yet, so I cannot speak to those areas directly—I’ve been called in to work in the ER. I can say that PPE is carefully provided and we are extremely mindful to maintain the PPE that we are provided for in a shift. What does this mean? Often using the same disposable mask the whole day. I have not been without gear, however, and all of the nurses, techs, and other support staff (environmental control, etc.) I’ve seen have had PPE as well. Some people are bringing higher quality n95s from home, but at this point, that’s not necessary.
Does your hospital have enough ventilators for patients?
Thus far, we have been able to keep up with the ventilator and other respiratory support needs of the patients who have come in, however with the continued exponential rise of patients, I don’t know how long that will last. Keep in mind that we still have patients coming in with non-COVID respiratory needs (IE, COPD exacerbations), and those patients may also require respiratory support.
How has your hospital responded to the growing need for PPE? Do you have access to N95s?
N95s are essentially restricted to people doing procedures that might be aerosolizing, such as intubation or swabbing patients for the virus. Our hospital is trying to dedicate people to do those tasks for an entire shift so that they reuse or don’t take off their mask the entire day.
Are you re-using PPE equipment? If so, how long are you using the same PPE equipment before disposal?
As above, at least in the ER, we are generally using one mask per shift. If you need another (yours got soiled or wet), additional masks are available. We do have sufficient gloves and paper gowns, so those can be discarded after each patient contact.
For eye protection, people performing high risk procedures have face shields (like a sheet of plastic that extends over your face and mask – picture a welders mask). Those of us not performing this task have reusable eye protection (similar to goggles from chem lab).
You interact with medical residents—can you explain how you think COVID-19 has affected medical training across hospitals in New York?
We are all being called in to take care of the overflow of COVID patients. For trainees this means that most non-essential rotations are cancelled, as well as most didactics.
How is your hospital—or you yourself—balancing minimized exposure (i.e. number of contacts) against the medical training system? Teams classically consist of 1 attending, 1 resident, 2 interns; is that structure intact, or have they slimmed teams down?
Our teams—at this point—consist of one attending, one resident, and one intern. This may change as we have more patients. We have had to create new medicine teams almost daily (at least three new teams on top of an already busy medicine teaching service). I can’t speak to how they have had to adjust the hospitalist medicine services but I am sure they have also had to adjust their team structure to increase capacity.
Is any kind of mental health support—formal or informal—being provided to residents and attendings?
There are some informal things happening across the country – Headspace is free for physicians, for example – but I think our residency program leadership is still trying to figure out what they will be able to provide our residents. The ramp up to staff the hospital has happened so quickly that I think the scramble now is: how do we help our residents and attending get through this incredibly difficult time?
Is your hospital recruiting non-hospitalist and non-intensivists to take care of hospitalized patients? If not, do you believe this could soon become necessary?
At this point, they have called in volunteers from medicine subspecialty services to work, mostly in the ER and in the testing tents that are part of the ER. We have also shut down all in person visits in the outpatient practices and made general medicine physicians available for work in the hospital. We have not—to my knowledge—asked for non-intensivists to work in the ICU.
I worry about what will happen when we start to see doctors and nurses get sick.
Are there exceptions to the no visitor policy? What about end of life? Labor and delivery?
I can’t speak to this exactly, sorry. My understanding is that the answer is “No” for both of those circumstances, but I’m not sure of the official policy off the top of my head.
What is the state COVID-19 testing? Any idea of current turnaround times?
Until my institution had their own testing capability, the test was sent to an outside lab that could take 3-4 days. Now, it can take 12-24h, or even quicker (3 hours), depending on the time of day the test is sent. All of the tests are done in batches to minimize waste.
What insights would you offer to those health care workers who could soon be responsible for caring for a similarly large number of COVID-19 patients?
The psychological burden of this pandemic for medical providers is impossible to overstate. These patients get sick quickly and there are so many- the challenge seems insurmountable. Try to find ways to rest and recharge if possible. Take care of yourself—we will be in this fight for the foreseeable future.