While the rest of us sheltered at home to buy them time, pitching in where we could, and maybe taking part in salutes to them every evening at 7, frontline medical workers have been putting their health on the line to fight a highly communicable disease. BOSS spoke with three of them who have different specialties and from different parts of the US to get a sense of what life has been like inside hospitals. Dr. Christopher Barrios is a pulmonary disease and critical care specialist at Saint Louis University Hospital. Dr. Naveen Kukreja is an anesthesiologist and ICU doctor at the University of Colorado Anschutz Medical Campus in Denver. “Claudia” is an emergency room nurse in the Boston area, one of the hardest-hit metropolitan areas. BOSS granted her anonymity for fear of retribution for speaking out.
One of the trickiest things about COVID-19 has been recognizing the symptoms. In some people, it presents as a classic respiratory illness called Acute Respiratory Distress Syndrome (ARDS), Barrios said.
“But we have had people test positive that did not have any respiratory symptoms. I’ve had people come in with abdominal complaints, get a CT scan of their belly—which usually catches the lower lung fields—and have the lower lungs be abnormal, and they test positive for COVID-19,” he said.
In other cases, patients have presented to the hospital with diabetic ketoacidosis (DKA) without respiratory symptoms and tested positive for COVID-19. Typically, people with diabetes presenting in DKA have a pre-disposing factor such as infection or medication non-compliance that causes their blood sugar to become elevated.
“If you can’t really find a reason for DKA, you start to wonder, ‘Is there something else?’” he said. “What we are seeing is that the diagnosis of COVID-19 is sometimes difficult to make because its presentation can be variable.”
If you’re one of those who thought—or still thinks—COVID-19 is just the flu, you’re not alone. Claudia even thought so initially.
“When it first started, I was on that bandwagon of, ‘It’s probably going to be just like the flu. It isn’t going to be that big of a deal,’” she said. “But then when we actually saw these patients come in, it’s like nothing I’ve ever seen.”
Usually if someone is not getting enough oxygen, you can tell right away. The person is panicked, sweating, can’t speak in full sentences, has a high heart rate. When COVID-19 patients began coming into the hospital, Claudia said, a woman in her late 30s came in.
“I’m just thinking someone who is short of breath obviously looks short of breath. I’m thinking, ‘She looks fine.’”
The woman got off the stretcher, walked into a room in the ER, and set herself on the bed.
“I put her on the monitor and her oxygen is at 70%. A normal oxygen saturation is 95-100. You want it above 90 ideally. She didn’t look like she was struggling to breathe, but when you stop and you look at her, you realize she’s breathing at 45 breaths a minute,” Claudia said, noting that 1218 breaths per minute is a normal range. “We’ve had to learn a different way. They just don’t look like someone that is very sick off the bat, and they’re the sickest patients we have.”
The woman died in the ICU.
Treatment & Recovery
To make sure their patients are getting enough oxygen to their organs, hospital professionals often intubate them to support their breathing. They’ve found that in certain cases of COVID-19, early intubation may not be necessary.
Instead, Claudia said, they’ve been giving them as much supplemental oxygen as possible. They’ll give patients who can breathe on their own a nasal cannula—a breathing tube with extensions that go in the nostrils—and a non-rebreather facemask and flip them on their stomachs.
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