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Will Covid-19 Keep Me From Patients I’ve Seen for Years? Routine Medical Care May Break Down, and Covid-19 Is Behind It
(about 4 hours later)
Over 12 days ago, when I walked into my otolaryngology office in Westchester County, N.Y., my office manager gave me one high-grade N-95 mask. These masks are not supposed to be reusable, but somehow I had to make it last: We didn’t have any more. I later learned that we only had 25 protective gowns — likewise designed to be single-use items — for an office of nine medical specialists. When I saw a delivery of protective medical equipment in our building the next day, I assumed it was for my office. Instead it was going to the lawyers’ office down the hall. We are finally getting 20 more masks, but our shortage remains acute.Over 12 days ago, when I walked into my otolaryngology office in Westchester County, N.Y., my office manager gave me one high-grade N-95 mask. These masks are not supposed to be reusable, but somehow I had to make it last: We didn’t have any more. I later learned that we only had 25 protective gowns — likewise designed to be single-use items — for an office of nine medical specialists. When I saw a delivery of protective medical equipment in our building the next day, I assumed it was for my office. Instead it was going to the lawyers’ office down the hall. We are finally getting 20 more masks, but our shortage remains acute.
We are not emergency room doctors, swamped by coronavirus-related cases while dangerously short on protective gear. But my colleagues and I, like doctors in thousands of other medical offices, provide vital care that patients need regardless of the pandemic. We may be exposing ourselves every day to Covid-19.We are not emergency room doctors, swamped by coronavirus-related cases while dangerously short on protective gear. But my colleagues and I, like doctors in thousands of other medical offices, provide vital care that patients need regardless of the pandemic. We may be exposing ourselves every day to Covid-19.
While the need to help hospitals and emergency rooms takes priority, practices that provide care and advice to patients, and act to triage those who might otherwise head to emergency rooms, cannot be ignored. How will the system treat asthma, chest pain, chemotherapy needs, orthopedic injuries or even a severe bloody nose if the emergency rooms are overburdened? Routine care could start to break down.While the need to help hospitals and emergency rooms takes priority, practices that provide care and advice to patients, and act to triage those who might otherwise head to emergency rooms, cannot be ignored. How will the system treat asthma, chest pain, chemotherapy needs, orthopedic injuries or even a severe bloody nose if the emergency rooms are overburdened? Routine care could start to break down.
I have been in contact with a member of a hospital medical board, the president of a New York state medical association and medical providers across the country for over four weeks. We all feel that from the beginning of this crisis, the authorities’ inability to provide adequate information about dealing with the virus, or adequate protection to confront it, has left us adrift — threatening our health and our patients’ care.I have been in contact with a member of a hospital medical board, the president of a New York state medical association and medical providers across the country for over four weeks. We all feel that from the beginning of this crisis, the authorities’ inability to provide adequate information about dealing with the virus, or adequate protection to confront it, has left us adrift — threatening our health and our patients’ care.
From the beginning, we have faced many unanswered questions and paradoxes.From the beginning, we have faced many unanswered questions and paradoxes.
When we heard federal officials say that test kits would be forthcoming, we asked, How can we test if there is no protective gear available? If testing is problematic and needs to be rationed, what are the priority cases? Those questions have still not been clearly answered.When we heard federal officials say that test kits would be forthcoming, we asked, How can we test if there is no protective gear available? If testing is problematic and needs to be rationed, what are the priority cases? Those questions have still not been clearly answered.
In a public health alert sent Saturday morning, the Westchester County health department said the federal Centers for Disease Control and Prevention determined that N-95 masks “are no longer required” to perform Covid-19 diagnostic tests. That memo, though, provides a link to a C.D.C. page that says N-95 masks should be worn during testing. Masks matter because, at the moment, only people with symptoms of Covid-19 are being tested at all — so the chances are that anyone performing the test could get infected, since the process involves a swab deep into the nasal passage and can send the virus into the air.In a public health alert sent Saturday morning, the Westchester County health department said the federal Centers for Disease Control and Prevention determined that N-95 masks “are no longer required” to perform Covid-19 diagnostic tests. That memo, though, provides a link to a C.D.C. page that says N-95 masks should be worn during testing. Masks matter because, at the moment, only people with symptoms of Covid-19 are being tested at all — so the chances are that anyone performing the test could get infected, since the process involves a swab deep into the nasal passage and can send the virus into the air.
Recently, the New York City health department told medical providers that even if they had a high-risk exposure to a patient later found to have the coronavirus they should continue to work as long as they are symptom free, and not quarantine themselves as previous guidance had recommended. These recommendations are the opposite of the sort of social distancing that state officials are recommending for everyone else. (I just found out that on March 11 I saw a patient who has been hospitalized with Covid-19, so I am staying home.)Recently, the New York City health department told medical providers that even if they had a high-risk exposure to a patient later found to have the coronavirus they should continue to work as long as they are symptom free, and not quarantine themselves as previous guidance had recommended. These recommendations are the opposite of the sort of social distancing that state officials are recommending for everyone else. (I just found out that on March 11 I saw a patient who has been hospitalized with Covid-19, so I am staying home.)
The state has also asked retired physicians to volunteer to help patients. Given how vulnerable to Covid-19 people age 70 and over seem to be, how sensible is that? Especially if returning physicians work without adequate protection?The state has also asked retired physicians to volunteer to help patients. Given how vulnerable to Covid-19 people age 70 and over seem to be, how sensible is that? Especially if returning physicians work without adequate protection?
The questions are endless, the answers not very satisfying and there is a growing fear among the soldiers in this battle.The questions are endless, the answers not very satisfying and there is a growing fear among the soldiers in this battle.
This week, of 534 doctors in family, pediatric and internal medicine responding to a survey, almost half said their offices had little or no protective equipment, a fifth faced staff shortages because of illness and half said Covid-19 had a severe or close to severe impact on their practices.This week, of 534 doctors in family, pediatric and internal medicine responding to a survey, almost half said their offices had little or no protective equipment, a fifth faced staff shortages because of illness and half said Covid-19 had a severe or close to severe impact on their practices.
Some of our needs are being addressed. Regulations in telemedicine are being streamlined so we can adopt it more quickly and widely.Some of our needs are being addressed. Regulations in telemedicine are being streamlined so we can adopt it more quickly and widely.
Still, one large local medical practice has closed down eight of their 11 offices in New York State because they don’t have enough protective equipment to cover them all.Still, one large local medical practice has closed down eight of their 11 offices in New York State because they don’t have enough protective equipment to cover them all.
Short and long term, the prospects for providers — and their patients — are daunting. Individual health care workers and their employees have been thrust into leadership positions and made to navigate an ever-changing situation.Short and long term, the prospects for providers — and their patients — are daunting. Individual health care workers and their employees have been thrust into leadership positions and made to navigate an ever-changing situation.
Health care providers are charging into a combat zone without support. We need dependable sources of information that can quickly answer our questions about testing, treatment, equipment and patient care. We need the government to ensure that we are provided adequate protection now. We need partners in leadership to do our jobs in this crisis.Health care providers are charging into a combat zone without support. We need dependable sources of information that can quickly answer our questions about testing, treatment, equipment and patient care. We need the government to ensure that we are provided adequate protection now. We need partners in leadership to do our jobs in this crisis.
Frank Shechtman is an otolaryngologist and emeritus section chief in the division of otolaryngology at White Plains Hospital Medical Center, in White Plains, N.Y.Frank Shechtman is an otolaryngologist and emeritus section chief in the division of otolaryngology at White Plains Hospital Medical Center, in White Plains, N.Y.
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