Perspectives of a medical resident during the COVID crisis

This article was first written in May 2020 at the very beginning of the COVID pandemic.

We are facing a once in a century global health crisis. SARS-COV-2, the virus causing COVID, is highly transmissible and unfortunately can cause rapid respiratory decompensation in susceptible individuals. As we all know, the elderly and those with underlying health conditions are particularly at risk. This virus is more infectious than SARS and MERS (other virus in the coronavirus family), and more deadly than influenza. Even some seemingly healthy, young people without any past medical history are dying of this disease. Intensive care units are overwhelmed with patients succumbing to respiratory failure and needing ventilator support. Outpatient clinics have had to change their business models completely by shifting to telemedicine, where clinic visits are being completed over video. As any physician or medical student knows, it’s hard to manage patients when we can no longer examine them in person. Rather, we’ve had to adapt and practice medicine from a distance. Even in the ICUs, critical care physicians are limiting the number of physical exams they perform to avoid exposure to these very, very sick patients. I, personally, am very frightened of this virus. I know that I am not alone in this sentiment. The New England Journal of Medicine recently published a series of cases where patients testing positive for COVID developed strokes. This is quite remarkable. A respiratory virus that is not only sending patients to the ICU with respiratory failure, but can also potentially lead to strokes in some patients. Thankfully, strokes have not been commonly reported in COVID patients, and it is still unclear whether SARS-COV-2 itself is to blame.

As a medical resident, my exposure to COVID has been very limited. We are not currently working in the COVID ICUs as a means to reduce exposure to these critically ill patients. The reality of being a resident is that we are always going to require attending oversight. So, at this point, why throw teams of residents who are not fully trained in critical care to manage these patients when a single attending physician is capable of managing on their own? Instead, for the time being, we are being funneled into the non-COVID units of the hospital. However, if the time comes where the intensivists need backup, we will be there to help. During this time, I have gained so much respect for all of the intensive care physicians (and emergency room doctors) that are putting their lives on the line each day. Commonly performed procedures in the ICU such as intubations, where a tube is placed down a patient’s airway, aerosolize the virus from the patient’s respiratory tract and put the procedure operator at significant risk of being infected. Some of the earliest reports of physician deaths, particularly coming out of Italy, were from doctors performing intubations without the necessary personal protective equipment. My fears about COVID lie in the fact that seemingly asymptomatic individuals can infect others. Additionally, the current COVID test is only about 70% sensitive. Essentially, this means that only 70% of the people with COVID will have a positive test. So, even though I am working in units with patients who are COVID negative on testing, some of these people almost certainly have COVID. This is perfectly fine with me, because as a physician it is my job to help during this crisis. But, I go to work each day knowing that I have a reasonable chance of being exposed to the virus, even when I’m not working in the dedicated COVID units. Several weeks ago, I did chest compressions on a patient with respiratory symptoms concerning for SARS-COV-2 infection. While his first COVID test was negative, many of his symptoms were consistent with COVID and he had recently been re-tested. The patient unfortunately did not make it, and for several days after this exposure I was scared that I had been exposed. Just this week, I intubated a patient in the non-COVID ICU. Again, intubations are very high risk procedures for the spread of COVID. Who’s to say that this patient does not have COVID? Even though he had a negative test on arrival to the hospital, we all know that patients can become infected with viruses and bacterial infections after being admitted to the hospital. What I mean to say is that we cannot be 100% effective in delegating patients with and without COVID to the proper units of the hospital. We cannot catch every singe case. Again, as a physician, I am excited to help and if I’m ever called upon to staff the COVID units I would be there without hesitation. This does not mean, though, that it is not scary. I worry for my family and friends. What if I become infected and bring the virus home?

Despite the fear and devastation that has come about from SARS-COV-2, I remain hopeful and have a newfound sense of faith in people. The entire world has rallied around the healthcare community. Patients who have recovered from COVID are donating their plasma to give to others in dire need. Scientists around the world are working day and night to develop a vaccine. Some of the world’s most talented and gifted minds are bing put to the test each day. Companies large and small have shifted their business models to help fight this disease. Ferrari is working on manufacturing ventilators. New Balance and numerous other companies are making masks to address the much needed demand. I, for one, am confident that we will beat this. To you, the reader, thank you for what you have done to help. It is not going unnoticed. In this dark, seemingly never ending crisis, I’m reminded of the many wonders of being human. I’ve witnessed us all come together and fight. People are persevering day in and day out in the most extreme of conditions. As humans, I’m seeing what can be accomplished when we all work together as one.