Faced with reporting to potentially dangerous workplaces last week, Georgia’s frontline healthcare workers started thinking not just about saving patients’ lives. They had to think about their own lives and their family members’ lives, too.
Over and over again, they made tough choices.
At a Wellstar hospital in LaGrange, one doctor volunteered last week to cover all the rooms of possible coronavirus patients to keep other physicians on staff out of harm’s way. An ER doctor treating infected patients in Atlanta started sleeping in the family’s garage apartment, so he didn’t risk exposing his wife and young children. Nurses in Augusta scrambled to get care for their children as schools closed, and they watched colleagues like hawks to make sure they were safely covered as they donned protective gloves, masks and gowns. Doctors and nurses across the state worked to stretch supplies that are quickly running out, amid worries about the realities of the weeks to come.
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“We’re all guarding each other,” said Irma Westmoreland, a nurse at the Charlie Norwood VA Medical Center in Augusta, where her daughter is a nurse, too.
While most of Georgia barricaded at home, attempting to stay safely hidden from the coronavirus, frontline healthcare workers got behind the wheels of their ambulances or began long shifts in emergency rooms and intensive care units where they come into direct contact with the disease.
As the numbers of confirmed cases started to grow exponentially and supply shortages simmer to a crisis, reports grew of healthcare workers being exposed or testing positive, and healthcare leaders acknowledged they were facing unprecedented challenges.
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Any frontline worker who tests positive and has to leave the ER or ICU to get better and avoid infecting others leaves a giant gap when all hands are desperately needed.
"Everybody has fear," said Dr. Enrique Lopez, who treats intensive care patients at Phoebe Putney Medical Center, which is swamped with COVID-19 patients. Workers have tested positive after just feeling a muscle ache or fever.
“They know without a doubt you’re putting yourself in harm’s way,” Lopez said. “But you know what? Everyone shows up. Every. Single. Day.”
Flattening the curve
Dr. Mitchell Blass, an infectious disease physician in Atlanta, had been monitoring the coronavirus carefully as it started to march across the globe. He said last Saturday, just a week ago, was “the day I felt like the canary in the coal mine died.”
As the first cases were reported in the United States, he thought of what already had rolled out in China, then Italy and France. He knows it’s difficult for the public to understand the issues of exponential growth and flattening the curve. Here’s how he explained the reality: If a city has 1,000 people who become critically ill and require a ventilator and that city has only 150 intensive care beds, it can handle the crunch if those patients get sick over 10 weeks. But not if they get sick over 10 days.
“It makes all the difference between life and death,” he said.
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As Blass finds himself in the midst of the biggest challenge he has seen during his 26 years in medicine, he’s focused on how quickly the illness could spread and how stable the healthcare workforce will remain.
“The matter at hand is that there are only so many of us trained in infectious disease and critical care medicine and pulmonary disease and respiratory disease, so we have to be very, very careful amongst ourselves so we don’t accidentally find ourselves ill, let alone our nursing staff and our associated paraprofessionals and ancillary staff at the hospitals,” he said.
“If we begin to lose those important components of our health care system, we will be in big trouble.”
Staff quarantined
With every healthcare system in the country struggling to get the supplies they need to keep workers safe, keeping everyone on the frontlines healthy isn’t a given.
Throughout the state, hospitals have already had to drop doctors and nurses from staffing, as a result of COVID-19 diagnoses or precautionary quarantines after they were exposed to patients with the disease. Floyd Medical Center, which had the first confirmed case in Georgia outside of metro Atlanta, had to sideline 20 employees into self-quarantine after test results came back.
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“That was critical for us because a lot of those were ER nurses,” said Sheila Bennett, executive vice president at Floyd Medical. “We’ve been able to make it through with people stepping up and covering shifts.”
None of those workers contracted the disease and they’re now back at work.
Most hospitals now aren’t sidelining exposed workers unless they show symptoms.
Dr. John Sy, president of the Georgia College of Emergency Physicians, on Tuesday sent a letter to Gov. Brian Kemp and state leaders asking for clarification on quarantines, so hospitals can retrieve some workers from home.
"We're already – everyone pretty much feels that we don't have enough resources as it is," Sy said. "And if we're taking out a chunk of our health care workers, that's going to be huge."
Some first responders, such as paramedics, also have been forced into quarantine, straining the EMS workforce, too.
It does not appear that anyone is tracking the number of Georgia health care workers diagnosed with COVID-19, or the number quarantined.
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Dr. Carlos Del Rio, who oversees the Emory University physicians at Grady Memorial Hospital, made a dramatic appearance on CNN last week as an anchor said nine health care workers were infected, and others were awaiting test results. They were not all at Grady.
“I will tell you, we will have more,” Del Rio told the AJC afterwards. “Transmission in healthcare settings is well known with his virus.”
Already, talks are underway about how to re-fill the ranks of healthcare workers who become ill or exhausted.
The Georgia Composite Medical Board announced that it could issue “emergency practice permits” to physicians, physician assistants, advanced practice nurses and respiratory care professionals to work in Georgia even if they aren’t currently licensed here.
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Advanced practices nurses say now is the time for Georgia to lift restrictions on their practice so they can fill the gaps. Georgia could also consider trying to bring back retired doctors or even let trainees handle more.
How far Georgia will have to go to care for its residents, and what the risks would be, is one of many unknowns with the pandemic.
Getting to work
Just reporting to work and going home can be tricky these days for those on the front lines. Schools have closed. Daycares have shut down for both babies and the elderly.
Hospitals, nursing homes and ambulance companies all know their workers are facing unique challenges, and all sorts of solutions are popping up to try to support the frontline.
A group of nurses at Wellstar Kennestone Hospital created a Facebook childcare group to connect with one another and help care for everyone’s kids. Donations from churches and community members have been rolling in to try to help them. Some hospitals are trying to come up with childcare options for their workers.
Westmoreland, the Augusta VA nurse, said because both she and her daughter had to report to work, they had to figure something out for her daughter’s young children. “We’re lucky, we have two teachers in our family,” she said. So they set up a system for the kids to rotate. “The two teachers are going to home school,” she said.
But having childcare covered doesn’t stop all the worries. “You also have to worry about kids being afraid,” she said. “We want to make sure our family is protected.”
An Emory University epidemiologist who is on maternity leave touched a nerve when she tweeted last week about measures to protect her family. She and her husband, an ER doctor treating coronavirus patients in Atlanta, decided he would move into their garage apartment for the time being. They have a newborn and two young children. The risk seemed too great.
So can the sacrifice.
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“It pains me to wonder how many weeks will go by that he won’t get to hold our new baby or see our older kids,,” tweeted Rachel Patzer, an associate professor at Emory University School of Medicine and director of the Emory Health Services Research Center. Patzer admonished people to follow the social distancing advice of public health experts so that healthcare workers could manage the crisis.
“As I attempt to home school my kids (alone) with a new baby who screams if she isn’t held, I am worried about the health of my spouse and my family,” she tweeted. “This was not how I envisioned my maternity leave, but I know things could be worse.”
Her tweet attracted thousands of comments, many sharing their own stories of working the frontline. Former President Barack Obama even retweeted her message as a way to acknowledge the sacrifices by health care workers.
Health care workers also are seeing other consequences of being on the front line.
Earlier this month, when cases still seemed rare in Georgia, a group of Floyd Medical Center employees who were going out to lunch were confronted by a customer who told them they weren’t welcome in the restaurant.
“It is a scary time for everybody,” said Bennett, the hospital executive. But the way the hospital employees were treated in their community, she said, didn’t make their tough job any easier.
Leading the fight
Despite the risks and uncertainties, front line workers have focused on helping others.
In a few days at Stockbridge-based AmeriPro Emergency Medical Service, medics have transported three patients with coronavirus-related symptoms, said senior paramedic Paul Beamon. While medics are carefully abiding by infection-control policies and taking care of each other to make sure all their personal protective gear equipment is on properly, they know risks of their jobs can never be eliminated.
“It’s the unknown, and everybody has to take this extra seriously. They don’t know if their neighbor has it. They don’t know if the patient they pick up on the street has it.”
Still, he said, they stay on the job.
“They want to help others, and so they risk their own lives to do that. It is just a part of them and who they are,” said Beamon, who is also vice president of AmeriPro EMS, overseeing a staff of more than 200 medics.
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It is in the DNA of many doctors and nurses, too.
At Wellstar West Georgia Medical Center in LaGrange, to reduce the risk of exposure for other doctors, Dr. Melhim Bou Alwan, the medical director of the hospitalist program, volunteered to be the only physician to consult with admitted patients diagnosed with COVID-19 or being evaluated for the virus. Several experienced ICU nurses at the hospital also volunteered for care for the patients, to keep other nurses safe, Wellstar said.
Dr. Enrique Lopez and his fellow doctors in Phoebe Putney’s intensive care units have been treating the deluge of patients in southwest Georgia. When at home Lopez is sleeping on a foam mattress in the living room and changing in the garage, eating separate meals at a separate time from his family. He talks to his three small children by FaceTime while his wife tends to them herself. They tell the children he’s sick.
Wednesday night he heard his 4-year old daughter crying — it turned out a toy wasn’t working — and ran upstairs as he usually would. “It was just natural. But when she ran outside — I’d forgotten. And I yelled at her, ‘Stop!’
“She was like, ‘Daddy, you’re here! I love you! I love you!’ …. I said, ‘Momma’s going to come. Daddy’s sick, please stop.’ She started coming to me again. She said, ‘Daddy I’ll take care of you.’ I said, ‘Baby, please don’t come any closer.’”
“And that’s going to go on for some time.”
