Inside Medicine. What Are You Seeing?

Reports from what is going on inside hospitals are very limited. The big hospitals in New York are shown on the news but I wonder what we all are seeing out there in other places. Those of you with health care workers in the family or with first hand knowledge otherwise, care to comment?

My relative who is a gastroenterologist is working only telemedicine. They have had to lay off much of their staff since routine colonoscopies and endoscopies are not being done.

In a large university hospital for which I have first hand knowledge, pregnant doctors in some specialties which don’t have to do with COVID-19 treatment are being told to do telemedicine and not have in person patient contact.

Another relative who is a nurse says that the hydrochloroquine treatment is going well in her hospital in a large metro area that is slammed with cases.

I have no insight into our local hospitals because almost nothing is being reported on the news and I don’t know any health care workers here personally.

Are hospitals being slammed? Are things quiet for now?

Neighbor is a hospitalist, her specialty is internal medicine. She’s now being trained for ER and ICU. Her hospital is fairly quiet, only a few CV-19 cases, but they’re bracing for patients to start arriving in large numbers - perhaps in a week or two.

A good friend is a doctor at a Children’s hospital here. Because large numbers of children with CV-19 aren’t expected, all other hospitals will divert their juvenile patients needing care/surgery here, to make room for CV-patients in their facilities.

In both hospitals, all non-emergency surgeries/procedures have been rescheduled. Everyone is focused on CV-19 preparation. The virus has not peaked here nor are hospitals swamped with patients, yet.

Some hospitals in my state are getting slammed. Others not so much so. But that could change.

All elective procedures have been ordered cancelled until further notice. This includes screening mammograms, colonoscopies (screening), and all elective surgeries.

Dental offices are closed except for emergencies.

Physical therapy offices are closed for in person therapy. Patients can have telepractice if that will work them.

Doctors offices have at least reduced hours. Many places are seeing only acute issues. All that I know of are separating appointments so folks aren’t in the waiting room at the same time.

I had a specialty appointment on March 20. The waiting room can seat about 50. I was the only one there. They quickly moved me to an examining room to wait. No one was waiting in the waiting room. Even then, all elective surgeries were not being scheduled until the beginning of June.

Colorado - just heard from a neighbor that his large hospital in Boulder county has seen very few coronavirus patients, and they have lower than usual ER traffic (as are other hospitals across the country, https://www.insidesources.com/unexpected-consequence-of-covid-19-crisis-empty-emergency-rooms/). They are experiencing PPE shortage. He thinks our governor is doing a great job.

Both my D and SIL are in Residency at a big city hospital. D is on 2 years of research so has been able to strictly work from home. SIL is in Internal Medicine so is at the hospital 5 days a week, but luckily he is not interacting with any Covid patients, in a completely separate ward.

D just called and told me she has picked up a 12 hour shift tonight in the ED. Say what??? She said it has actually been slow there. She is going in early to get fitted for her N95 mask. Apparently the brand that she has already been fitted for is no longer available at this time, so she has to get fitted again for the 2 brands they now have. She told me other female docs have said these new ones don’t fit as well. Just great. The good news for her is that if there is a procedure that requires a N95, attendings are doing it themselves, no resident in the room.

I’m sure she told me more, but everything she said after telling me she picked up a shift in the ED tonight was pretty much a blur.

Local hospitals are still keeping up. Several are continuing to do elective surgeries. Dental offices are closed as well as physical therapy. Doctors have switched to doing all appointments via telemed.

I have worked in the ED/Level 1 trauma center for over 20 years. We typically were seeing 200 plus patients each day. Overall numbers are down but acuity is high. Meaning, while some of the frivolous cases are being smart and staying away, the patient who are coming in are very sick.

PPE is an issue. The ED is now out of N95 masks and although supposedly treating them with “ultraviolet light”, it doesn’t help those who didn’t already have one saved in their little paper bag. Many healthcare employees are testing positive here.

Med school lad got an update that his hospital will be building a giant tent hospital and are looking for ways med school students can be used as volunteers if they want to be involved. Expectations are for using it in 2-4 weeks. He’ll be volunteering if it’s an option.

I find myself hoping the social distancing and some of these new meds work so they don’t end up needing the tent.

Around here I haven’t heard recently. We have an ED nurse who lives next door, but we haven’t talked in person lately due to social distancing. I know they were creating their own place to live in the garage. I know the hospital they work at had the county’s first death.

What state are they still doing elective surgeries in? I thought all of those were cancelled due to needing the PPE for emergencies elsewhere?

My allergist said she will do our visit via telemedicine or we can come in, our choice. I think we will try telemedicine. Told S to see if his insurer will pay for telemedicine but not sure he’s checked. Mine WILL pay.

My niece is podiatrist. She can only get paid for telemedicine visits if she goes to the clinic, not when she works at home. Her H is pathologist, with same rules. My lung md has offered to have phone visit with me—he’s in SF and I’m unlikely to travel anywhere in near future.

Our cases keep climbing about 30 or so every day. We are now over 300 cases in our small state and 3 deaths. The ICUs are getting very crowded. One of the patients is a 90 year old and has been kept alive.

My relative is very busy and stressed at Kaiser Honolulu. Many of the cases are Kaiser patients and very ill.

Our local hospital has asked sewers to make 500 masks for their wound care unit—for patients and providers. My relative who is a urologist has had to continue seeing urgent cases and procedures, making his family stressed. My relative who is a dermatologist does telemedicine from home exclusively. Our med school cancelled it’s rotations and my relative is studying at home—hopes to graduate from med school on schedule this year.

The ICU nurse my relative knows says the ICU at her hospital is full of COVID-19 patients and we are so far lucky that most HI patients have not needed hospitalization.

D1 is a Emergency Medicine attending physician at major academic hospital in New England. (Not the same one as @CottonTales daughter and SIL, though ;)) I talked to her yesterday at some length.

She is seeing a steady run of Covid-19 patients in the ED. She’s says typically she’s admitting 5-8 patients a day to the ICU or step down ward for Covid-19. She says that that infants under 3 months are especially susceptible and there are 10 infants with Covid-19 at her hospital.

The good thing is people are not clogging the ER with trivial complaints. Her PA actually yelled at a young woman Thursday who came in just wanting a pregnancy test and sent her home. The people coming in are for the most part really sick. Not just Covid, but all the usual things you see in the ER–strokes, heart attacks, MVAs, sickle cell episodes, accidental injuries.

The scary thing that’s happening is the hospital (one of largest hospital systems in New England) is running out of critical medications. She had a patient come in earlier in the week with very serious asthma attack and there simply were no drugs available to give the patient. D1 thinks that very shortly a lack of medications is going be the much bigger problem than PPE scarcity. PPE supplies are slowly starting to trickle but many medications sold in the US are manufactured in India or if they are manufactured in the US use basic chemicals made in China. The supply chain is unreliable right now.

My other D is a R2 at western academic program. She’s in a surgical field. She says she hasn’t been all that busy because all elective surgeries have been canceled and the only cases she has been handling are emergencies and cancer surgeries. She also reports the ER is slow with few non-emergency patients coming in. Whenever possible she is doing telemedicine visits with her high risk patients.

Her state is seeing a recent sharp uptick in the number of Covid cases and Covid deaths (and a governor who refuses to issue a state-wide state at home order—don’t get me started…) so all residents at her program are now required to take sim labs in patient intubation and extra classes is how to manage vented patients. She says it’s a very scary situation and she feels anxious and unprepared to handle seriously ill Covid patients.

@WayOutWestMom – sending my best to your amazing daughters.

Things I learned from my week in L&D this week (all pertain to UMich hospital):

-They’re taking beds from places like L&D to add capacity to the ICU unit.
-They’re also taking volunteers to move from their current department to ICU & ER.
-The sports fields are being turned into field hospitals.
-Most COVID patients are still in Detroit hospitals, not around the state.

Hospital in Cap District of NY are taking COVID19 patients from NYC. I’m under a flight path and can hear the helicopters if I’m outside.

My H is now working overseeing parts of the creation of two “hospitals” on SUNY campuses on Long Island. The DEC commissioner is in charge of it. He has a military background in logistics, from what I understand.

One of my neighbors husband works for an engineering firm whose biggest client is the VA. He’s been working 20 hour days on some aspects of getting VA hospitals ready to take COVID19 patients. I’m not exactly sure what type of engineering firm he works for so don’t know the specifics of exactly what he is doing.

@WayOutWestMom

Thank your daughters from me. I’ll keep them in my thoughts as the crisis continues.

@CottonTake wrote:

D1 said this her process also. Doing intubations are such high risk that she send everyone out of the room except for herself, one volunteer nurse who administers medications for the procedure and monitors the patient’s vitals (patients being intubated are given sedatives, paralytics and pain killers to prevent them from struggling during what is a very unpleasant and painful procedure), and one volunteer RT who sets up ventilator and operates it once the patient has been intubated.

She always asks for volunteers and never shames anyone who doesn’t want to participate in the procedure. Because of the high risk of infection, she believes it’s unethical to force anyone to participate.

Besides having extra bodies in the room just increases the odds of those people becoming infection vectors and wastes PPEs.

At my system (i’m in administration), all elective surgeries have been postponed until June. We just made our medical school building (across from our main campus) a Covid-19 Hospital and it will be a 1,000 bed Hospital when it’s ready in about two weeks.

Same here. Anyone in the room where intubation is happening must have very high level of protective gear.

We have a nurse stationed by the front entrance (all patients/family walking in must go through a metal detector) and are taking temps and asking exposure questions. Most visitors are turned away due to non necessity. We also have a nurse sitting by our ambulance bay again taking temps of every patient just outside of the ambulance bay doors before they enter the department. Pts oxygen levels are checked through a small opening in our otherwise bullet proof glass that triage staff sit behind.

We have converted what was an outpatient observation unit off our ED to a respiratory care unit. All lower acuity stable patients with any possible symptoms are sent there. We are trying to keep as many rule out COVID patients as possible out of our trauma/resuscitation bay as those are the only beds without glass sliding doors.

I worked as this was just starting and I did have PPE available. I get daily emails and updates and now they dont have N95’s and are working on how to keep their staff safe. I am scheduled to work coming up but I will be checking in first to ensure they have what I need or as sad as it is, I wont go into work.

I have a close friend who is a cardiac nurse in an outpatient clinic who is on standby for being called up for COVID shifts if their hospital system gets overwhelmed.

Same with an MD friend in another state. They had a lottery system and she was pulled for Phase I.

So far neither has been called as both states are not yet overrun with cases. We’ll see what happens.

All elective stuff cancelled here too. Emergencies only.

My S is a neurosurgery PA in NC. His practice is really slow. Most of his appointments are no-shows, so he started calling patients the day before to see if they were coming. He was recently fitted for an N95 mask, so I wonder if he will be moved to another area. His wife is a gastroenterology PA, and because she is pregnant, has been working from home. She couldn’t figure out how to set up videoconferencing, so is only doing phone visits with the few patients that agree.

I have no idea what is going on in my own city, but no news is good news…I think.

The thing about this kind of thread that scares me is that there are people out there (or here in CC land really) who are looking for any reason to think “it’s not so bad out there”. Hospital doesn’t appear to be too busy? Then “it must not be that bad in my area”. Please don’t operate that way.

I work for a medical school and health system. We get a daily updates on a variety of numbers - # of people tested, # positive, # hospitalized, # died, # of beds being used, # of bed available, #of ventilators… and on and on. Trust me, it continues to increase.

There is a lot of controversy now - over the ability of medical providers being able to bill/count telemed well care visits - at least for children (I work in Pediatrics). The trend is to only see in the office those well care visits that include an immunization - so that means largely the under 2 crowd. At some point this will be a problem in the fall as all the entering K kids need to have their complete immunizations for school entry (assuming schools are open) but there will be a deluge of people trying to catch up on well care once offices are open again. Summer is typically the highest season of well care visits as it is.