This Is Life For Emergency Professionals On The Frontline Of The Coronavirus Outbreak

Heather, an emergency nurse of seven years, described her medical department in Southern California as a war zone.

She works in one of the busiest emergency departments in Los Angeles County, but this week things were more intense for patients than usual.

It starts even before anyone even enters the hospital, Heather said. (She asked to be identified by her first name to avoid repercussions from her employer, which has a policy against speaking to the press.)

There are stations set up outside to separate visitors from patients and to funnel patients with COVID-19 symptoms into a separate triage tent. Security guards are on standby to tell visitors they cant visit loved ones; police have to be called if those visitors push back against the new policy.

And thats just the outside of the building.

Inside, Heather and her colleagues have been asked by hospital administration to bring in bandannas and scarves in case they run out of protective masks the same advice offered by the federal government this week to hospitals with dwindling supplies.

The ER is considered a war zone right now, and this is the last place people should be, Heather told HuffPost over the phone.

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In The Ladies Room with Dr. Donnica Podcast (@AskDrDonnica) March 20, 2020

As city and state officials urge residents across the country to self-isolate and shelter in place to stop the spread of COVID-19, health care workers are on the frontline juggling their commitment to their patients, the panic from their patients and their own anxiety.

HuffPost talked to doctors, nurses and emergency medical technicians in California (which has at least 982 reported COVID-19 cases), New Jersey (at least 742 cases), Hawaii (at least 26 cases ) and Rhode Island (at least 44 cases) about what its like fighting against the pandemic. Many health care workers requested anonymity due to hospital policies on speaking to the press.

This week, Heathers hospital in Los Angeles County announced that visitors were no longer allowed inside, which has led to confrontational and upset would-be visitors. Administrators also set up a tent to keep patients with mild COVID-19 symptoms separated.

Inside the emergency department, Heather and her colleagues are briefed daily on new developments on coronavirus and COVID-19 research released by the Centers for Disease Control and Prevention (CDC). This information changes all the time, which then affects their day-to-day procedures.

Its anxiety-provoking for sure, she told HuffPost. Were barely able to grasp these new developments that come day to day and change our method of practice, let alone have to combat paranoid and panicked patients.

Heather said that it can be difficult to comfort patients who are exhibiting severe symptoms of COVID-19. Some patients have asked her if their condition would get worse; others have asked her if they were going to die.

Sometimes we just dont know what to say, Heather said. Even the CDC doesnt know.

Sometimes we just don't know what to say. Even the CDC doesnt know.
- Heather, an emergency room nurse in Los Angeles County

Infectious disease researchers say that it is still unclear how severe the disease actually is. According to the University of Chicago Medical Center, the numbers of people diagnosed and dying around the world are changing daily, and the numbers that we are seeing now mostly are just estimates.

The CDC has a banner prominently displayed up high on its website noting that it is still trying to figure out how the virus spreads. The agency also notes numerous times that there is still a lot they dont know about the virus, including how it is transferred.

Every day, doctors and nurses are briefed on the latest information on COVID-19, then they go off to tend to their patients the best they can.

Every hospital has its own procedures on how to handle a person who is exhibiting symptoms. Heathers hospital in California, which is one of the four states with the highest reported cases, begins the evaluation and testing process at the stations outside.

At a hospital in Honolulu, nurses perform these tests while wearing a full PPE (personal protective equipment) suit, including a gown, mask, gloves and head cap.

The test involves long Q-tip-like cotton swabs that nurses swab deep inside both of the patients nostrils, often triggering the patient to sneeze near them.

Most emergency professionals are treating every patient as if they might be carrying it to avoid spreading and catching the virus. That has led to a dangerous shortage of PPEs for medical workers.

From a FB contact: Used a CO2 sampling NC. Bag on over head w/seal. O2 10 L. He sampled his CO2 to monitor. He did this for 10 min (long enough to intubate a patient). THIS is what we have to do b/c we have no PPE. Pls demand appropriate PPE! Pls RETWEET. Ask community 4 masks. pic.twitter.com/fayg7gc1NH

Rekha Kuttikat, MD (@rekhakuttikat) March 19, 2020","type":"rich","meta":{"author":"Rekha Kuttikat, MD","author_url":"https://twitter.com/rekhakuttikat","cache_age":86400,"description":"From a FB contact: Used a CO2 sampling NC. Bag on over head w/seal. O2 10 L. He sampled his CO2 to monitor. He did this for 10 min (long enough to intubate a patient). THIS is what we have to do b/c we have no PPE. Pls demand appropriate PPE! Pls RETWEET. Ask community 4 masks. pic.twitter.com/fayg7gc1NH Rekha Kuttikat, MD (@rekhakuttikat) March 19, 2020\n\n","options":{"_hide_media":{"label":"Hide photos, videos, and cards","value":false}},"provider_name":"Twitter","thumbnail_height":783,"thumbnail_url":"https://pbs.twimg.com/media/ETgYdWFUwAAnjrW.jpg:large","thumbnail_width":666,"title":"Rekha Kuttikat, MD on 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From a FB contact: Used a CO2 sampling NC. Bag on over head w/seal. O2 10 L. He sampled his CO2 to monitor. He did this for 10 min (long enough to intubate a patient). THIS is what we have to do b/c we have no PPE. Pls demand appropriate PPE! Pls RETWEET. Ask community 4 masks. pic.twitter.com/fayg7gc1NH
Rekha Kuttikat, MD (@rekhakuttikat) March 19, 2020

Dr. Megan Ranney, an emergency physician in Rhode Island and professor at Brown University, says it is highly likely that health care facilities will soon run out of protective gear as the outbreak continues.

Ranney has been trying to get the federal governments attention to address the shortage of equipment and COVID-19 tests by tweeting at celebrities and encouraging others to use the hashtag #GetMePPE.

This week, she and several other medical doctors launched a petition asking President Donald Trump to increase the supply of protective equipment and ventilators and to develop federal guidelines to protect health care workers from infection.

Similar petitions have been launched across the country, from the East Coast to Hawaii. In San Francisco, members of the California Nurses Association protested against Kaiser Permanente Medical Center for restricting the use of N95 masks and not doing enough to protect them from coronavirus.

Nurses at Kaiser in SF protesting what they say are dangerously relaxed standards. Nurses asked to reuse one-time use equipment like masks and goggles, risking cross-contamination. pic.twitter.com/zTMRP4jPBK

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Nurses at Kaiser in SF protesting what they say are dangerously relaxed standards. Nurses asked to reuse one-time use equipment like masks and goggles, risking cross-contamination. pic.twitter.com/zTMRP4jPBK
Megan Cassidy (@meganrcassidy) March 19, 2020

Ranney said shes concerned after hearing that other hospital administrations, in an effort to preserve PPE stock, directed doctors and nurses to wear masks only if they expected to test the patient for COVID-19.

Which is totally creepy and goes against all of the medical evidence that we have, Ranney told HuffPost.

Patients dont always know what they have before theyre diagnosed. Thats why they come in to see us, she said, such as patients who come in for things like car crash injuries or stomach pain.

If patients dont report that theyve had a cough or a low-grade fever for a few days, and Im not masked before I find out that information, and they happen to breathe down or cough on me, then Im at risk of catching the infection and then I cant take care of other patients, Ranney said.

Health care workers also run the risk of passing on the virus to other patients if they are not properly protected.