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Shuhan He, MD, is a physician in the Department of Emergency Medicine at Massachusetts General Hospital. He has been a frontline doctor treating coronavirus cases in the state since the eruption of what is known as the Biogen cluster, when more than 90 cases, including 77 in Massachusetts, were linked to a Boston meeting of the biotech company at the end of February.
We all knew about the Coronavirus early. Let’s be clear, I was worried about it. We had protocols early on dealing with Covid. At the time, it was still well controlled. We have protocols for SARS, MERS, Covid, and Ebola, so if people come from any countries where these are active, they get screened. If they have a fever and symptoms, they stay in the DECON [decontamination] room.
We had the protocol, and we were ruling cases out. If a patient came in off a plane from Wuhan with a cough, they went into the DECON room; it’d be an isolated incident. Covid was something we knew had a high CFR (case fatality rate). In time, we did have community spread. That’s an easy bifurcation point: When you start to have community spread, it no longer becomes a disease that is easily quarantined. I was part of treating the initial Biogen cluster in Boston and helped diagnose part of those early clusters.
So we knew about Covid early on, but last week is when the volume started to increase. I’m lucky to work in one of the largest hospitals in the world, Massachusetts General Hospital. We knew the volume was going to become quite concerning.
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The community spread is beyond significant. I had a patient yesterday who I didn’t think had Covid — two months of an allergy-like dry cough. My true pretest probability on this patient was low; then I found out this morning she’s going to be presumptively positive. I think she was having acute-on-chronic symptoms. It’s one of those differences between the triage note, the note that you initially see, and the time you finally see the patient.
We had a patient come in with abdominal pain and then ultimately get diagnosed with Covid. This happens all the time in emergency medicine, when a person’s chief complaint is not the same as the final diagnosis. But what we’re finding is there’s a pretty wide range of chief complaints that end up having a Covid diagnosis.
The reason that’s important for us as doctors is that it’s hard to triage who needs PPE [personal protective equipment], who’s high risk, and who’s low risk. We know from the data that there are five main symptoms: fever, cough, sore throat, chills, body aches, and even things like headaches or just not feeling well. So we know those five are the main categories that we’ll generally screen for most patients. That’s why most hospitals have gone toward a tent model, like a separate area just for these patients. At the same time, there are patients who have diarrhea. So it is quite challenging right now to figure out who has it, especially when the public also is aware of this and kind of hyperaware. They’re not always telling you what they actually feel, but what they feel like they should be telling you.
We’re getting daily briefings, and our recommendations for treatment are different every single day. To give you a sense of it, we wouldn’t change our management for a heart attack daily — it’s been the same for 15 years. So the pace that information is changing is also shocking to everyone in the system. We just have to learn to adapt.
It’s really picked up pace since last week. That was when I think people started to realize we’re now in the exponential curve. That’s when the NBA was canceled, on March 11. You could really feel the hospital on full alert. This is like a war basically.
Everything is Covid all the time right now. Everything is getting canceled, it’s all hands on deck. All research is canceled; I have active research sites that have nothing to do with Covid, obviously, and they’re on pause right now. When there was a community spread in Seattle and then Biogen started happening around Boston, we knew that was our early warning. But you didn’t really start to feel it and know it until late last week. That’s when we started really intubating the sick ones.
Over the weekend, what I have noticed is that patients have gotten sicker and sicker. No one from Biogen was really sick from what I saw, but over last weekend, we had some really sick people come in, and I’m presuming they’re all Covid. They’re relatively young, healthy people with pretty profound symptoms.
Maybe the ones who are a little younger, they survive, but they’re also in the ICU, and they’re intubated on a ventilator. I think a lot of the messaging around young people is that, yeah, 20-year-olds probably aren’t going to get intubated—a 50-year-old still has a whole life in front of them. That’s pretty young. So that to me is concerning. But we’re starting to see more of these.
I feel relatively protected. We don’t walk in and think to ourselves, “I have no equipment.” We don’t have the Wuhan bodysuits yet, but I don’t think we quite need to. If I had really, really sick patients all the time, intubating, I would probably feel like we probably need to head toward that direction.
Those suits also pose risks toward patients because you don’t change out of them. So you just move from patient to patient. We’re doing protective PPE right now, head to toe, which I feel pretty good about. The danger is that we know we’re going to run out, and at the pace we’re using, it is unprecedented. We’re changing for every single patient with a cough. We would never do that in a normal situation.
If you look at the pictures from what was happening in Wuhan, those people aren’t changing, but the patients are so sick it doesn’t matter. So you just intubate, intubate, intubate, and you protect the health care workers more because the patients all have it anyway. It becomes a shift, when there’s suddenly enough people who are sick that that calculus changes. But we haven’t gotten there yet.
My fear is that someone on staff is going to get really sick before that happens. There are ER doctors I know of already who are quite sick. They’re not intubated, but they are sick from presumed Covid. I fear that might change in the next few weeks.
I’m 32. We have a very senior leadership — I don’t want to put an age on them — but they definitely have white hair. They’re experienced and knowledgeable. We have a tight group among us, and we’re definitely keeping in mind that some people are higher risk than others. I try to volunteer for shifts because I know I will be fine. I have full confidence that I will not have any personal medical problems based on this. I’m young, healthy. I’m staying away from my parents. I’m staying away from my grandmother. I do get a sense that it is my responsibility to do more and see the sicker patients.
How doctors are keeping up right now because things are moving so fast — it’s purely medical Twitter. It’s amazing. I actually never used Twitter before this, but just being able to follow the people I follow—I read a paper that came out four hours ago in the New England Journal of Medicine that was terrifying. I would’ve never known about it otherwise. They’re publishing things so fast about Covid; it’s absolutely incredible.
I’m not going to the gym anymore. They shut down. I’m not going to take the T anymore; I’m just walking to work. I definitely can’t take public transit after work. I have much more caution about just who I’m hanging around. I’m trying to avoid anyone who may potentially be sick. If you want to get personal, I’m not going on dates because you just can’t. I know a lot of ER couples that are trying to separate their homes so that the ER doctor sleeps in another room. We’re a high-risk population, I understand that. We all have to make sacrifices.
Will this ever truly go away? I don’t know. The coronavirus is the same family as the common cold. We don’t have a vaccine for the common cold. And we have a flu vaccine, but it doesn’t go away every year. The truth is that every year people die from the flu. I suspect that in the coming years, this is our new reality: People will die from coronavirus or Covid and it will be just one of the other reasons people die, just like strokes, just like heart attacks, just like sepsis. Right now we’re in the phase where we have to avoid everyone getting sick at once because then if all the ICU beds are taken and someone’s in a car accident and needs an ICU bed, they’re not getting it. That’s terrible because that’s preventable. The world still goes on and still people have other diseases.
We’re doing this quarantine thing, but people still need to take care of themselves. People need to be kind to each other and check in on each other and have a social balance. I’ve been hanging out on G-Chat with my friend all day. I still need to spend time with friends.
I think people still need to take care of themselves. And people need to take it seriously. Understand social distancing. But go for a walk, get some fresh air. That’s still okay. I’m still going to plan to have a G-Chat with my friends, and we’re all going to drink wine together.
We’re still human beings; we’re social creatures—that never stops. Take care of yourself because this is going to be a while. If people burn out real fast, then we’re going to get crushed again. So people need to last for months.
This interview has been edited and condensed for clarity.