Front-Line Clinicians Share Lessons from Battling COVID-19 | Health News

Mayra Ramirez remembers listening to a news report in January about a novel coronavirus spreading across Wuhan, China. A world away in Chicago, Ramirez didn’t worry too much about it until nearly two months later, when Illinois Gov. J.B. Pritzker issued a stay-at-home order, Ramirez said during a webinar hosted by U.S. News & World Report as part of its ongoing Healthcare of Tomorrow series.

The 28-year-old paralegal transitioned to working from home and avoided close contact with others, knowing that her autoimmune condition put her at high risk. Despite her efforts, she contracted the virus in April, and she went on to spend more than six weeks in an intensive care unit struggling to breathe. She was intubated soon after being admitted with an oxygen saturation reading of just 54%, she said, instead of a more typical figure above 90%.

“She was one of sickest people in the hospital, at times probably the sickest,” during her lengthy stay in the ICU, said Dr. Elizabeth Malsin, a pulmonary and critical care specialist at Northwestern Memorial Hospital who treated Ramirez and also shared her perspective during the webinar.

Ramirez lingered on the edge of death for the next several weeks, and by mid-May it was clear her lungs were too damaged to heal. “The questions started to come up: Are there going to be people that would benefit from lung transplants?” Malsin said.

Though she said she’s still working through the lingering emotional impact of her brush with death, Ramirez is feeling physically stronger every day and said she felt emotional seeing the doctor who saved her life for the first time since she was in the ICU. She doesn’t remember initially meeting Malsin because she was so sedated. “But now seeing her brings back memories,” she said.

For her part, Malsin said seeing Ramirez and how healthy she looked was “surreal,” in part because she looked “like a completely different person.” Getting her back to her healthier self was a team effort, Malsin said, crediting her colleagues at Northwestern for Ramirez’s recovery, which she thinks offers a rare ray of hope as the pandemic enters a difficult new phase in America.

Battling Burnout and Embracing Teamwork

That all-hands-on-deck approach to coping with the COVID-19 crisis has been a defining feature of all phases of the pandemic, according to Malsin and three other clinicians from around the country who shared their insights during the second portion of the webinar.

New York City for months was the epicenter of the U.S. outbreak, and Jessica Montanaro, assistant nursing care coordinator for the medical-surgical trauma ICU at Mount Sinai Morningside, had a front-row perspective on what unfolded.

“One of the most devastating and heartbreaking things of COVID for nurses and clinicians was the isolation of families from their loved ones during the middle of a time when they really needed people to be there,” she explained. Reaching out to family members for context – such as nicknames, a current photo, and likes and dislikes – offered nurses and other caregivers a much-needed window into the human beings at the center of this crisis.

In Oregon, which was also an early hot-spot in the pandemic, Dr. Esther Choo, a physician and professor in the Center for Policy and Research in Emergency Medicine at Oregon Health & Science University, said that while her state responded robustly to the first wave of COVID-19, the next wave threatens to overwhelm emergency rooms and hospitals all over again.

One reason for that surge is that health care workers themselves are having to take time off either because they’re sick, they have a loved one who is ill or they are struggling with child care needs. “For docs and nurses and advanced practice providers and all kinds of workers, it’s been hard for them to come back full-time,” Choo said. “We have a big shortage – it’s not just the physical beds, but it’s the staffed beds.”

Though Choo’s ER and others around the country have gotten more adept at triaging and caring for the sickest patients who turn up, this new surge could still bring surprises. Access to adequate personal protective equipment and supplies is still an issue, and as ICU bed availability falls, concerns are rising, she said.

Being on this constant state of high alert has been draining for everyone on the front lines, said Dr. Vin Gupta, a pulmonary and critical care physician and affiliate assistant professor of health metrics sciences at the Institute for Health Metrics and Evaluation at the University of Washington.

The lack of federal response to the pandemic has resulted in a patchwork method of moving providers where they’re most needed, Gupta said. “You’re seeing now military assets getting utilized to some degree” for support, he said.

But this is all a “bandage approach,” he said. “We should federalize a response.” It seems that while this pandemic is exceedingly local in many ways, it’s truly a problem impacting all corners of the U.S., and a more unified strategy could help control the outbreak, Gupta noted.

As case counts increase heading into winter, the outlook is grim. “We’re still expecting 471,000 souls lost by February,” Gupta said, noting that that figure may actually be an underestimate depending on response measures. “Loss of life is inevitable. We’re probably past the point where we’re going to be able to mitigate that.”

The never-ending influx of patients has been dispiriting, the panelists noted. Choo described it as a “feeling of almost betrayal” of health care workers because “people will cheer for us, and then they’ll have big family gatherings where they’re not wearing masks. Those sentiments aren’t compatible.”

As Thanksgiving approaches and some 38% of Americans have said they plan to go ahead with plans to gather in large groups, the panel worried about what that means for the next several months in this pandemic – and the lasting impacts that such decisions may have on health care providers for years to come.

“I would fully agree that hearing that people are going out and having big Thanksgivings and are not masking, it feels disrespectful,” Malsin said. “It feels hurtful to people on the front lines.”