Physicians are not “giving up”

We are scared.

This virus threatens our lives.  It threatens our families.  It threatens our friends.  We have physician friends crying between patients in fear that their partners who work in the emergency department (ED) may contract this virus, known to affect health care workers with greater severity than the average person.  We see reports of hospitals and health care offices running out of personal protective equipment (PPE).  What follows are “updated recommendations” from the CDC, decreasing the necessary amount of PPE required to treat patients with SARS-CoV-2.  We are begging friends and family and anyone we know with access to facemasks to send them to us or donate them to their local hospital as we are being told that bandanas and scarves may eventually substitute for specifically designed barriers.  We see death rates doubling every other day.  We see the logarithmic scale becoming exponential.

We are tired.

Every report on the news centers around this virus.  Our social media feed is filled with our next friend quarantined with the disease – another colleague taken off the front lines in this fight – and another loved one who may succumb to this illness.  The Dutch Medical Care Minister collapsed on the floor of parliament and has subsequently left his post. Our texts are filled with concerns from parents, friends, and coworkers, asking what they should be doing, asking how serious this actually is; concerned for us and for their own families.  And we go home, fall asleep in physical, mental, and emotional collapse before waking up and going back to the hospital, knowing today may be the day we notice the first of the symptoms.

We are annoyed.

We walk into the hospital, knowing we will get this virus.  Ask anyone who works in health care, and they are resigned to the inevitable truth that they will one day test positive for SARS-CoV-2.  And yet we see the governor of Oklahoma exclaiming proudly how he and his family and so many more people are out at a packed restaurant.  Meanwhile, the President of the United States has invoked the Defense Production Act.  He has proclaimed that we are at war.  But this is not a war that will be won with bombs and guns and rolling up our sleeves to get to work.  Rallies for morale will not energize Americans and get them past this.  This is a war that must be fought quietly in our homes, surrounded by our families, leaving only for the greatest necessities.  We must do what we can to help those in the vanguard.  The nurses who walk into every room in the ED not knowing what sits on the other side of that curtain.  The front desk attendants who must talk with patients fearful for their lives.  The cleaning crews who must sterilize and disinfect every surface to further prevent the spread of the virus.  These are our soldiers, the ones for whom we should be brandishing yellow ribbons.

And then we see a headline in the LA Times which states that LA County has given up on containing the virus and that doctors are told to skip testing some patients, as if this is somehow different from the standard of care.  Surely a nice piece of clickbait, one that will undoubtedly drive more traffic to the website and allow for increased revenue from ad sales, but not one that portrays the facts or the general recommendations of the leaders in the field dedicated to containing this virus.

The article reads, “Doctors should test symptomatic patients only when ‘a diagnostic result will change clinical management or inform public health response.”  This is standard practice across all of medicine.  One should never perform a test unless it leads to a change in treatment plan.  That’s the basis of good medical stewardship, both financial, medical resource and otherwise.

If a patient with minimal symptoms comes in coughing and febrile but in no distress that would warrant admission to the hospital, that patient should be sent home with instructions to take care of one’s self and to avoid contact with other people.  If that same patient comes in and suddenly has SARS-CoV-2, the instructions should be exactly the same.  Testing the patient does not containment make; appropriate self-quarantine does.  Unfortunately, SARS-CoV-2 has spread more rapidly than the adoption of self-quarantine; thus, all we are able to do at this point is slow disease transmission: hence the LA County Department of Public Health Advisory. The difference becomes when that patient must be admitted due to more severe symptoms, and the patient then will need to be properly quarantined within the hospital, which is a much more complicated endeavor.  Health care workers must know if this patient is contagious with SARS-CoV-2 or if they instead have the flu or bacterial pneumonia or any other number of diseases that may manifest with such generic symptoms.

Perhaps the title should have read: “LA County implores patients with minimal symptoms to stay home, thus becoming the real heroes as health care workers struggle to take care of the imminently dying.”  Perhaps the article should have spoken to the importance of self-quarantine for purposes of not further spreading a virus with an unpredictable course in the older and the infirm?  Perhaps the LA Times should have discussed LAC+USC emergency department residents, walking headfirst into the fires armed with nothing more than a thin sheet of cloth and the hope that their youth and vitality will keep their symptoms minimal so that they can then go back into the fire 2-3 weeks later, watching all the while as their colleagues fall one by one.

But that wouldn’t grab as many clicks, would it?  That wouldn’t sell as many advertisements.

We need your help.  We are scared.  We are tired.  We can’t fight this alone.

Please help us.

Grant Meeker is a resident physician.

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