In our ongoing coverage of the Coronavirus crisis, we like to hear from doctors working in the front line in various parts of the country and what they are observing and experiencing. While most of the attention is currently riveted on the intense conditions prevailing in New York City, other major coastal cities and their metropolitan areas, we should keep in mind that while these are the existing focal points, the contagion will be making its way across America, starting from the major hubs and reaching across the less densely populated centers.
What are these hospitals and care centers away from the glare of the spotlights doing to prepare for what they are sure to experience in the coming weeks? This account comes from Doctor Richard Fremont, a pulmonary critical care physician at Nashville General Hospital in Tennessee. Dr. Fremont is also an Associate Professor and the Chair of Internal Medicine at Meharry Medical College. Nashville General Hospital is considered the “city safety net hospital” and mostly serves a minority indigent patient population.
Dr. Fremont, can you describe the current conditions that you are seeing at your hospital?
“As a critical care physician, I run a 15-20 bed Intensive Care Unit where we are preparing to manage the sickest of the Covid-19 patients in our hospital. Currently, we have had only 1 patient requiring intubation and mechanical ventilation, but by most predictions that we are following closely, here, we are in the beginnings of this crisis and bracing for what is to come. Starting this past week, I have also been part of the Medical School’s and the city’s screening program, where we are screening residents for free if they have symptoms of the coronavirus. We have created a drive-thru set up where we screen individuals, get demographics, and then swab them to help determine prevalence of the disease in the larger community. This is an effort sponsored by the city of Nashville and we are one of 3 testing sites.”
How equipped are you to manage the crisis through an intense stage?
“Right now, Nashville has not been hit as hard as some of the larger cities in the United States. But even so, with all the patients we have to rule out for the disease, we are going through the personal protective gear very quickly. Once we start seeing the influx of patients that we all expect, it won’t be long before we run short on masks, gowns, gloves and ventilators. Even now, in our early stages, we are having to ration masks and gowns which are being depleted at an alarming rate. Even though we are getting ready, most of us realize that the volume of patients could overwhelm even the best preparation and send us into crisis mode.”
What preparations are you making as you wait for the surge in the Nashville area?
“From what we know now, it appears that April should be worse than May, and that this situation may persist for a few more months, so while some in the medical community are already seeing the worst of this crisis, the rest of us are preparing and hoping we can get ahead of it. That’s the goal, to get ahead of it so that we don’t get overwhelmed. Most hospitals and critical care teams who are in the waiting mode, as we are here at Nashville General Hospital, are currently tightening up our protocols, stockpiling as many supplies as we can, and making sure we are ready for the expected surge of cases. We are all reading up on other hospitals’ experiences and seeing what we can learn from them. Just as importantly, we’re hoping that some of the experimental medications now in use start having some real robust data to support their usage and give us hope.”
Have you learned anything particularly useful about the course of the disease as it unfolded in places like Italy and New York City?
“The most important thing we learned is that the ‘stay at home’ directive that is meant to flatten the curve is vitally important because it will hopefully help us to avoid a scenario where the majority of those infected would be sick at the same time; that could overrun the medical system. This is exactly what happened in Italy and looks like what is happening in places like NYC and New Orleans. Tennessee finally issued a ‘shelter at home’ order from the Governor, yesterday April 2nd. Most of us in the medical community have been asking for this for over two weeks and hope that it has not come too late. Other things that we are seeing and learning from out of Italy and NY is that we need to prepare for rationing of medical interventions and that very difficult decisions may have to be made in the future. In other words, we need to be prepared for a situation where we only have one ventilator but two patients. Medicine in the United States has not faced a time where we might have to pick and choose which patients we can or cannot treat, based on resources. This is something that none of us are truly prepared for and seeing what happened in Italy is forcing us to face this as a potential reality.”
What is the best advice that you can give our readers?
“The best advice that those of us who are on the front line treating COVID-19 patients can give the population is to stay at home and keep appropriate social distancing. Really!”