Covid Journal 2: Lack of PPE Is Slowing Down Coronavirus Testing.

Cone Hospital COVID testing
Drive Up COVID-19 Testing in North Carolina.

It’s amazing how quickly how things have been developing and changing with this pandemic. To adapt something that @laxswamy posted on twitter;  so many of the things that we thought were unthinkable a month ago and a bit extreme a week ago now seem so urgent that we’re wondering why they weren’t done a month ago. 

In this past week most routine businesses closed their doors, restaurants became take-out only. Hospitals and health officials have been encouraging this in the communities that they serve, urging people to stay home, to practice social distancing, to avoid leaving home unless necessary. Yet inexplicably many health care facilities have kept their outpatient offices open, my own is among them.  I have been trying to call people to tell them to stay home, but many can’t be reached. Yesterday for example I saw an 80 year old man for a routine COPD follow up appointment, he had been keeping all of his appointments and even continued to go to pulmonary rehab! I urged him to cancel all of his upcoming routine appointments and call his physicians if he should have questions. I hope he listens, his age puts him at the highest risk profile of COVID-19, the very group that all these measures we’ve instituted are trying to protect. Yet there he was, moseying his way into the clinic and seating himself in a waiting room of sick people.  The eye of the storm. 

The supply front remains grim. Our hospital is down to a week supply of N95 respirators, despite the fact that we have not yet had a single COVID patient and only a few suspected patients that required isolation. Our shortage does not stem from us using the masks, it’s just that there are no masks to be had, and yet we’re still in better shape than many hospitals out there. To that end we recently received guidelines from the CDC, also adopted by our health system, describing how to re-use N95 masks. Subsequently our nurses received an email updating them on the leave and disability policy. It reminded them that if they are not able to work for 2 weeks because of a workplace COVID-19 exposure that they would not be paid. Yes folks PPE is in short supply in this pandemic, but irony, it appears, is in abundance. 

The testing situation remains woeful. In my last update I wrote about a hopeful development;  we were setting up drive through testing stations that could quickly screen patients. 

It lasted for a total of 4 days. 

It’s not that it wasn’t successful, in fact quite the opposite. The screening nurses were able to conduct numerous tests, but in doing so they also burned through quite a bit of protective gear. In light of the shortage of PPE, the hospital decided it would be more wise to save that gear for when people come in to the hospital. Think about that for a moment. We’re avoiding testing people in order to prevent spreading the virus so that we can take care of them when they get sick. That’s a terrible choice to have to make, and one that I would have never dreamed possible in this country. 

Deep Ramachandran, M.D. is a Pulmonary, Critical Care, Sleep Medicine physician, founding CHEST Journal Social Media Editor, and co-Chair of ACCP Social Media Work Group. He blogs at Caduceusblog. He is on twitter @Caduceusblogger.

Covid Diary 1: Plagued by Lack of Supplies and Misinformation, Coronavirus Testing Remains Elusive for Most Physicians.