ER Doctor Explains How They're Handling Covid-19

[sirens blaring]

[Seema] The U.S now has the most

reported COVID-19 cases of any country in the world.

This is like having a hurricane hit

every single city across the United States

all at the exact same time.

To find out what it's like for healthcare workers

on the ground, and to learn more

about the hospitalization timeline of a patient

with COVID-19, I called up Dr. Cedric Dark.

He's an ER physician in Houston, Texas.

So say you have a waiting room full of people in the ER

who are coughing, who have fever,

how does triage work in the ER?

From the beginning of this,

we have literally separated anybody with cough and fever

from everybody else in the hospital.

Other hospitals have tents set up outside to screen people.

Initially it was, we're gonna ask,

Have you been to any of the countries

where it's present?

Have you been around somebody that's known

to be diagnosed, and are you having a fever?

If you screened in for any of those,

you're definitely thrown into this separate area.

Then symptoms.

Are you feeling short of breath?

Are you having a cough?

If you have any of those issues going on,

you're put in this special area where we can screen you,

where we can keep that part of the ER,

and the providers there, give them the maximum amount

of personal protective equipment.

Keep them safe, and then also keep everybody else

in the ER safe.

Because still, we're gonna get heart attacks,

we're gonna get strokes,

we're gonna get people that have been in car wrecks,

and we need to keep those folks safe

from catching a communicable disease as well.

If I see somebody that does have a fever

or that does have some abnormal sounds

when I listen to their lungs,

that person, I think, warrants getting a chest x-ray.

As the disease progresses,

there are these things called infiltrates

or little white spots that form in the lungs.

When you look microscopically inside the lungs,

think of it as like little bits of fluid

or puss or something that sits inside the lungs

which normally are like a nice little sponge.

And that makes the exchange of oxygen

with the air harder to happen.

And so, therefore, that's why people

start feeling short of breath.

[Seema] So talk us through a bit

about what the chest x-ray's look like

as somebody maybe first has COVID-19

and then as they get sicker and sicker.

That one that you're looking at right there,

that x-ray looks fairly decent.

I don't see a ton of haziness or white spots.

[Seema] What about this x-ray?

Yeah, that one's bad.

Not only can I see on the x-ray

that the person is ventilated, they have a breathing tube

in their trachea or their windpipe.

You see a lot of these little patchy spots

like little white spots all over the lungs,

and it's on both sides of the lungs.

So that, you know, tells you

that all that nice air-filled sponginess

of the lung has been filled in with fluid and gunk.

In this particular person, it's probably so bad

that they couldn't be maintained

just with like, oxygen through the nose that they had

to put in a breathing tube to give them additional oxygen.

[Seema] How would you treat this patient?

Let's say a patient comes in,

they're short of breath they get this x-ray.

At this point in time, I know I am going

to be admitting them to the hospital

and that person essentially is what the CDC would call

a person under investigation.

And so, that's the patient that would get tested

once that decision is made to hospitalize them.

And so, we would do the tests.

Right now the tests are taking a long time to come back.

The testing at this point is not for therapeutic purposes,

it's more for epidemiological purposes.

What help and support can you give a COVID-19 patient?

This is where it gets a little tricky

because there's no defined treatment specific for COVID-19.

What we need to do is what we call symptomatic treatment.

What that means is if someone needs oxygen,

we give them oxygen.

If they have a fever, we might give them medicines

to reduce their fever.

But other than that, we kind of

have to wait for the virus to take its course.

If someone goes into what we call respiratory failure,

where their lungs can't pull in enough oxygen,

that's when we have to put them on a ventilator machine.

And so, we do that for procedure

where we put the tube through the windpipe.

So, all of those patients have to be put

into a medically-induced coma.

They stay on the ventilator machine

for the duration until they improve

and get better and come off.

As the disease progresses, if it gets worse,

those little white spots you saw on the lungs

could consolidate even more and more

into a condition called ARDS.

What that means is the lungs become completely useless

and it's almost impossible to deliver enough oxygen

to keep them alive.

At which point, someone could eventually succumb

from the disease.

When would you take someone off a ventilator?

If someone gets really sick and they've been

on that ventilator maybe for a few days,

hopefully, the inflammatory response

or the virus affecting the lungs starts to resolve,

and their lungs clear up,

they can be taken off the ventilator

and go back to living a normal life.

At what point are you thinking

about rationing ventilators, and who would get one

and who wouldn't?

[Cedric] Those decisions are happening right now

and doctors are thinking about that.

And I'm fortunate to not have to think

about that at the moment.

But, it may become a real thing

if people don't take this seriously enough.

What are hospitals in the Houston area doing

to get ready for a potential surge of patients?

So, one of the things that they've been doing

is they've been canceling elective surgeries

so that we have fewer people in the hospital

in the first place.

The other thing that we have been doing

in hospitals, not only in Houston,

but across the country has been trying

to figure out ways that we can use one ventilator machine

for more than one patient.

Not only are we dealing with a deadly disease,

but we're also dealing with the inadequate resources

to protect ourselves from that disease.

We have supply chains that potentially could be disrupted.

We've seen people kind of hoarding things,

ranging from toilet paper to N-95 masks.

Even when they don't necessarily need it.

We've had to conserve resources

by reusing stuff that should only be used once

and instead using it all day as long as it isn't soiled.

The PPE that we need for every confirmed patient

to be absolutely safe would be a gown, gloves, face masks,

either surgical mask or N-95, and eye protection.

With like a face shield or goggles.

In terms of what most hospitals are experience shortages of,

it's the masks, sometimes the face shields,

that's what we're typically having to reuse on shift.

[Seema] Is this a situation you ever anticipated

being a doctor in America?

[Cedric] Never.

I mean, we think of the U.S.

as one of the most well resourced places in the world,

when it comes to healthcare.

But it just goes to show that when there's

sort of widespread panic, normal supplies

can be depleted fairly quickly.

And how do you mentally prepare

for what might happen and what's happening right now?

Not much is different from what we're used

to doing everyday in an emergency department.

We're used to taking care of sick people.

We are notoriously the people

that think about the worst case scenario.

Of the medicine world,

we are probably the dooms day preppers.

But, the thing where we're not prepared for

is making the ethical decision

of once we reach our saturation point,

who do I decide lives and who do I decide dies?

That, we're not ready for.

We don't know how big the surge is going to be

when it hits, right?

If it's small and we can weather that storm, great.

But, if it is long and sustained,

then it might completely flood and overwhelm the system

and with it, it will impact the health

of the people on the front lines.

And you have a kid at home.

So how are you managing that?

Coming home from the ER and being at home?

It's pretty difficult.

I think that the one thing

that seems a little bit reassuring is that

at least children seem to fair better

at this than adults, or especially older adults.

My message for the public, three things.

Number one, stay home and save lives.

We need to flatten the curve on this.

Number two, please do not come

to the Emergency Room expecting to get a COVID test.

If you're well enough to stay home, stay home

because we're not gonna be testing you anyway.

And number three, if you happen to have

any of that personal protective equipment

that we could use in the hospital,

consider donating it to your local facility,

or to the doctor that might live down the street from you.

Really grateful for your time,

and thank you so much for explaining this situation to us.

No problem, thanks.