In hospitals across Greater Boston, efforts have intensified to confront the building wave of COVID-19 cases that are upon us: Respiratory illness clinics have sprouted up; staffing pools are beginning to struggle to keep pace with new COVID-19 inpatient units; physicians are combing the literature in search of new COVID-19 treatment data; and intensive care units that once had few COVID-19 patients are now filling with them. As the numbers rise, we are in a sprint to deal with the challenges facing us:
▪ We remain urgently low on personal protective equipment, most critically, N95 respirators. Hospitals in this country are invoking extended and reuse PPE policies, a standard never before witnessed by any of us. We are deep into community spread, finding COVID-19 disease among patients hospitalized for other reasons. Other industries that use PPE — factories, dentists’ offices, nail salons – should consider donating their boxed and unopened supplies to health care workers on the front lines.
▪ A cohesive coordinated statewide effort is desperately needed. We urge state and local governments to collaborate with hospitals and other health care facilities to ensure appropriate distribution of patients with COVID-19, ensuring the best possible access to beds, ventilators, supplies, and specially trained health care personnel.
▪ Testing for COVID-19 remains a scarce resource. The scientific community has mobilized in spectacular fashion to develop testing capabilities, yet testing is limited by other resource constraints. Swabs, many of which are made in Italy, are a new unanticipated scarcity. There is also a shortage of health care workers who obtain the samples and convey results.
▪ Hydroxychloroquine is not a proven treatment or prevention for COVID-19. Hydroxychloroquine, a drug used to treat malaria and rheumatologic disease, might be helpful, but the data are limited to laboratory studies, anecdotes, and two small studies of fewer than 50 patients each. Despite extensive media attention, which in some cases hyped the drug’s promise, there is no guidance on its proper use or dosing, and it carries potentially serious cardiac side effects. Moreover, the supply is limited and should be reserved for those who require it and for certain patients hospitalized with COVID-19.
As those of us on the front lines keep up this sprint, we — and all of you — are also running a marathon. We are all attempting to become accustomed to this disconcerting new normal. The coronavirus has altered every aspect of life, from our ability to gather with friends for dinner, to difficulty finding toilet paper in stores, to the need to take crash courses in Zoom and Skype so we can connect to work, school, and religious and social activities. We are all part of this extraordinary collective feat of endurance.
Yet we must endure. It’s crucial we all do our part, however challenging.
Staying home is not easy, but it’s vital. We applaud Governor Charlie Baker’s stay-at-home advisory that reinforces the gravity of the situation. The advisory asks people to limit interactions as much as possible; it allows access to only the most essential items (e.g., prescriptions, groceries) and permits outdoor activities that allow 6-feet of distance between people (e.g., walking, running, biking). Data from China suggest that social distancing alone slowed the outbreak’s curve, but it took draconian measures like separating families and geographically isolating the ill to produce a downturn.
We are in this for the foreseeable future, so please be patient. The first COVID-19 case was reported in China last December and it took until mid-March — even with drastic steps, ample testing, and redeployment of health care workers — to reduce new cases there to fewer than 20 a day. We are just starting to appreciate the steep upswing in cases and the shortages that are ahead for Massachusetts. Collaborating with colleagues in New York and Seattle has helped us to better understand the challenges we’ll face in the coming days. Mathematical models suggest Boston is likely to have peak activity in mid- to late-April, but life as we knew it may not return until late May.
Never has the medical and scientific community been so unified toward a common foe. We know we will confront challenges and sadness in the weeks ahead. We reaffirm our commitment to work hard on your behalf — and we count on your help.
Dr. Tamar Foster Barlam is chief of the Section of Infectious Diseases at Boston Medical Center. Dr. Helen W. Boucher is chief of the Division of Geographic Medicine and Infectious Diseases at Tufts Medical Center. Dr. Daniel Kuritzkes is chief of the Division of Infectious Diseases at Brigham and Women’s Hospital. Dr. Mary LaSalvia is interim chief of the Division of Infectious Diseases at Beth Israel Deaconess Medical Center. Dr. Matthew R. Leibowitz is chief of Infectious Diseases at Newton-Wellesley Hospital. Dr. Rochelle P. Walensky is chief of the Division of Infectious Diseases at Massachusetts General Hospital. Dr. Kenneth M. Wener is chair of the Division of Infectious Diseases at Lahey Hospital and Medical Center.
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