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Friday, March 13, 2020

AHEAD OF PRINT: WHAT TO D.O.: 'I'm Scared of the Coronavirus Too/

'I'm Scared of the Coronavirus Too'

BY RICHARD PESCATORE, DO

I have hesitated to write anything about the global viral pandemic of COVID-19 because the dynamic nature of the spreading disease has meant that nearly anything penned today is likely to be outdated well before publication.

And the predictions or prognoses we might make now (it's mid-March as I put thought to paper) are just as likely to be wildly (if not embarrassingly) inaccurate as they are to be prescient for what the weeks to come will bring. Nonetheless, pandemic coronavirus has gripped the world, and it is difficult to focus on anything aside from the perpetually worsening predictions of what will happen as COVID-19 spreads through our communities, homes, and hospitals.

CORONAVIRUS-CDC.JPG
CDC/Alissa Eckert, MS; Dan Higgins, MAMS

As I write this, travel restrictions are growing while public places are closing. Testing has been slow to mobilize, and in the past few days we've seen first diagnoses in most states. New Jersey, where I live, announced its first patient death March 11. Social and lay media abound with discussion and information of questionable quality, and while we know little at this time about the virus's spread, we do know that fear and preoccupation have infiltrated every corner of the map and continue to incubate in a world of confusion and concern.

There are many more questions than answers, with armchair epidemiologists who just last week learned about R0 and case fatality rates making confident declarations devoid of everything except hubris. Physicians have taken to networks to share clinical experiences and advice for patient evaluation and management, but most conversations have been dominated by questions and difficulties surrounding triage and testing, stealing valuable time and attention from surge planning that would benefit emergency departments and hospital systems most.

Not Alone
The fact is I'm scared of the coronavirus too, and I think many of my fellow emergency physicians share my perspective on what is to come. Even the most conservative estimates from researchers and public health agencies expect staggering increases in hospitalizations and devastatingly high rates of respiratory failure requiring intubation and ICU admission.

As the front line and safety net of the health care system, emergency physicians face every threat with open eyes and a dedication toward the job to be done. There's never a doubt that the ED will adapt and overcome when needed, and every day we bear the strain of a health care system already bursting at the seams. For many of us, though, hallway medicine and overflowing waiting rooms are already the norm, and we know that even the most muted pandemic is all but guaranteed to break the final straw on the camel's back. For many years, emergency physicians have pleaded with administrators and regulators to reexamine and repair the litany of factors that contribute to ED crowding and misutilization, but been ignored at each turn, continuing to accommodate increasing needs with diminishing resources. I am afraid that the proverbial chickens have come home to roost, and that they mean to stay for far too long.

It is likely that I will become infected in the next few days, if I haven't already. I'm young and healthy, so I should be fine. My wife, also a physician, and I want to do all we can to contribute, but don't know what we'll do if (when) schools close and our small children are sent home. We hesitate to ask our own parents for help, terrified that we might be responsible for transmitting the virus. If one of us is quarantined or isolated, I don't know what the far-reaching effects will be. If our families become ill as resources become scarce, I don't know at which point my need to be at their bedside will outweigh the call for me to staff my normal post. All I have, it seems, are endless questions and concerns.

I am buoyed, however, by the few answers I have.

I know that my children are likely to be safe (nearly all data show COVID-19 has muted effects in children). I know that I'll have a chance to help others in a time of international need. Most importantly, I know that emergency physicians and our colleagues have risen to meet every threat we've ever faced, and COVID-19 will be no exception. While the weeks to come may bring unprecedented health care strain and potentially unimaginable experiences, I know that emergency physicians will answer the call and serve as the critical responders for this worldwide emergency.

Good luck out there.

Dr. Pescatore is an emergency physician in New Jersey and the host with Ali Raja, MD, of the podcast EMN Live, which focuses on hot topics in emergency medicine: http://bit.ly/EMNLive. Follow him on Twitter @Rick_Pescatore, and read his past columns at http://bit.ly/EMN-Pescatore.