I enter the Emergency Department and pull my blue surgical mask out of the crumpled paper bag as I cross through the entrance. I lock eyes with the triage nurse, my usual smile absent beneath the mask as I approach my shift. I quickly walk to the resident lounge, where I change into clean scrubs and proceed to don the rest of my outfit, including a pair of thick plastic goggles and a surgical cap to cover my hair.
I feel as though I am preparing for battle, and in a way, I am.
As an emergency medicine resident training at a busy, urban emergency department in Rhode Island, I am no stranger to stressful situations. On a typical day, our ED is overflowing with patients seeking care for a mix of medical and social concerns. As I progress through training, I am becoming well versed in the management of critically ill patients.
But this is different. We are currently in a pandemic and are lacking the basic necessities to keep our health care workers safe and test patients for this contagious virus.
As a country, we watched from afar as the coronavirus (COVID-19), swept through China and infiltrated Italy, knowing that it would inevitably affect the United States. Mentally, health care workers prepared to care for surges of patients, hospitals created testing algorithms, and the general public was forced to socially distance in order to “flatten the curve.” Yet some of the most crucial aspects of preparation were lacking, leaving us playing catch-up in a race that it feels we are already losing in our attempt to care for those afflicted with COVID-19.
Many of you have heard the cry for personal protective equipment, or PPE, the essential attire needed to safely care for patients with a suspected COVID-19 infection. After working five consecutive overnight shifts, mostly seeing patients with fever, cough, and shortness of breath -- hallmark symptoms of this infection -- I am extremely concerned regarding our nation’s ability to ensure safe protection for our health care workers.
Each patient encounter requires a full gown, gloves, face shield, goggles, and a mask to keep viral particles from entering the lungs or skin. We have been promised huge deliveries of supplies by our federal government that are not showing up in our emergency departments. Instead, our supplies are dwindling, and we are being urged to re-use masks on the order of weeks if possible, which constitutes “crisis capacity” strategies per the CDC. The use of bandanas as a “homemade mask” alternative has even been proposed, which in no way provides safe protection from this illness. This is not the time to lower our standards and accept substandard protection advised by our government. Without adequate protection, health care workers will fall ill, which has already happened to colleagues across the country.
Equally frustrating, of the countless patients I saw on my recent shifts, I was able to order only a handful of tests due to severe restrictions put on testing. I spent infinitely more time explaining why no testing could be done, apologizing and shouldering the blame for what feels like a federal failure.
To the young woman who had not slept in 24 hours out of fear that she would die due to her fever and cough if she were to fall asleep: I am sorry I could not provide you with the one answer you needed for comfort.
And to the young man living at home with his grandmother, I hope my directions to quarantine as much as possible in your small apartment will be enough to keep you and her safe from this disease.
Some still feel reassured by the low numbers of positive cases in some states, not acknowledging that we can test only the smallest percentage of patients.
As we remain socially distanced at home, it is essential that we continue to remain engaged and active citizens. This infection overwhelmed Italy and is creating a similar path of destruction in the US. Call your senators and members of Congress. I have, and I can attest that your voice will be heard. Advocate for more PPE. Advocate for testing.
We can continue this fight only so long as we are protected and armed with the tools for success.
Dr. Christina Matulis is a second-year resident in emergency medicine at a hospital in Rhode Island.