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The view from a R.I. emergency room: ‘Frantically doing the best we can, but we can barely keep up’

Rhode Island Hospital in Providence.
Rhode Island Hospital in Providence.Lane Turner/Globe Staff

PROVIDENCE, R.I. -- The emergency room physician for Lifespan sounded anxious as she described what she and her colleagues are facing.

There aren’t enough surgical face masks, so doctors, nurses, and aides are reusing what they have, until the masks are soiled -- not a recommended practice. They fear there won’t be enough beds for the inevitable onslaught of the sick, so they’re quickly retrofitting regular rooms into isolation units.

They’re ready to test people for the coronavirus, but they don’t have enough swabs. They worry about the “routine” emergencies -- victims of car wrecks, people with heart attacks -- who come in for treatment and, only later, are discovered to also test positive for COVID-19, the respiratory illness caused by the virus. This puts the healthcare workers, and other patients, at risk.

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"We are frantically doing the best we can to prepare, but the situation is changing so quickly, we can barely keep up,” Dr. Megan Ranney said over the phone late Wednesday morning. “Day by day, the patients with respiratory complaints are increasing dramatically. We still can’t test most patients. We’re worried about what’s going to happen, in three days, in a week, without access to protective equipment.”

When Lifespan, which owns five hospitals in Rhode Island, asked its employees if they needed help with childcare, more than 500 people responded affirmatively within 18 hours. But what happens when the healthcare workers go home after work? Do they have to quarantine themselves from their families? What happens if they get sick -- who will replace them?

19rierdoctor - Megan L. Ranney, MD, emergency physician at Rhode Island Hospital. (Handout)
19rierdoctor - Megan L. Ranney, MD, emergency physician at Rhode Island Hospital. (Handout)Handout/Lifespan

Ranney, an emergency physician at Rhode Island Hospital and The Miriam Hospital, said strategies are changing each day as doctors and others learn more about how the virus spreads. But learning how contagious this virus is can be stressful.

“The mood in the E.R. is nervous," she said. "There is camaraderie among staff -- we’re all in this together and all for patients -- but it’s more nerve-wracking than anything I’ve been through, and we’ve been through a lot. It’s partly because we don’t know where this ends, and we don’t have direction from the federal government.”

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Ranney and Lifespan spokeswoman Christina O’Reilly declined to say how many people with respiratory illnesses the hospitals have treated. However, during a news conference Wednesday afternoon, state health director Dr. Nicole Alexander-Scott announced that 10 more Rhode Islanders were diagnosed with COVID-19 overnight, including four who needed to be hospitalized. That brings Rhode Island’s total to 33 residents who have tested positive.

And Alexander-Scott warned that number will grow as testing increases. She confirmed earlier this week that Rhode Island is seeing community spread.

The lack of resources is a national issue that state officials across the country say has hamstrung their efforts. Frustrated, Ranney and other experts in public health drafted policy recommendations for the White House and Congress to combat COVID-19. The document, published Thursday in Health Affairs, proposes ways to protect healthcare workers, ensure equity in patient care, bolster the healthcare delivery system, preserve economic stability for people affected by coronavirus, and promote research.

Ranney said she hopes the federal government will listen to people like her who are on the front lines.

“The lack of preparation on national level is hurting hospitals that are well prepared,” Ranney said. “My hospital has been thinking about this since the first report in Wuhan in December, but the national response has been so inefficient, we can’t prepare better -- because we can’t get the supplies we need.”

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As of Wednesday, 122 of the 188 beds in intensive care units in Rhode Island hospitals were occupied, said Health Department spokesman Joseph Wendelken.

That leaves hospitals looking for other ways to convert beds and create isolation rooms, Ranney said.

The state Health Department has so few swabs for tests that it had to establish criteria for who should get tested first.

So the hospitals have come up with ways to triage -- decide who meets the criteria as well as where and how the patients are questioned. Right now, Ranney said, those who are critically ill or hospitalized or with known contact with someone who is positive are the first priorities. They also prioritize testing healthcare workers to make sure they are healthy and not spreading the virus.

Everyone who works with patients is told to wear regular masks at all times, Ranney said, under the assumption that some patients may be contagious and not know it.

However, there aren’t enough masks to do this for long, Ranney said. So, she said, “we’re being told to reuse the masks until they are soiled, use them for days on end, otherwise we will run out.”

The Health Department says that there are a few hundred ventilators in stock to be used to help patients with severe symptoms of COVID-19.

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However, Ranney said, they are finding that other equipment that helps patients breathe can’t be used because it could spread the virus.

For example, even though nebulizers work well for people with severe asthma or chronic obstructive pulmonary disease, they can spread the virus if used on someone with COVID-19, she said.

Since not everyone is tested for COVID-19, the hospital can’t use the nebulizers and take the risk of spreading the virus, she said. So instead, they are using spacers -- holders for inhalers -- for all patients with respiratory illnesses. But there aren’t enough.

Ranney praised the response from Governor Gina M. Raimondo and how she is pressuring the federal government and congressional delegation for resources.

But those working in hospitals can see what’s coming. Ranney hears it from her peers who are exhausted working at hospitals across the country. The number of cases in Rhode Island may be low now, but that’s sure to increase.

“This disease doesn’t respect borders,” Ranney said. “This disease doesn’t stay in a state or a city.”

Clarification: An earlier version of this story made it seem as though Rhode Island Hospital currently does not have enough beds for patients with the coronavirus. A hospital spokeswoman said there are enough beds.


Amanda Milkovits can be reached at amanda.milkovits@globe.com