Inside the ER: Local Hospital Waits for COVID-19

Dr. John Campbell has been practicing medicine for 25 years, 20 of those in the Gig Harbor area. He’s currently an emergency room physician at St. Anthony Hospital.  Campbell said he and his colleagues became aware of the novel coronavirus and the disease it causes, COVID-19, in early January the same way most people did. By watching the news. “As ER docs, we’ve got to keep our eyes on infectious diseases,” Campbell said. “We’ve got to be alert so we know when travelers are going to be in our area with symptoms.”  For the past 18 months, he has also been the Medical Director for the Key Peninsula Fire Department and was recently hired as the department physician. The department formed an incident management team at the onset of the coronavirus and asked Campbell to liaison with the medical community to inform their response.  “When everything was first starting and we knew nothing about the disease, it was really scary for myself, for my family and for my coworkers,” Campbell said. “We just didn’t know what to expect.”  Even daily activities he didn’t generally think about had to be adjusted. Before coming home, Campbell began disinfecting his hospital locker, as well as the counters in the locker room, before taking a shower and changing into fresh scrubs. “I go through this whole decontamination process before ever coming home.”  The focus of St. Anthony Hospital’s response was to keep staff safe while observing and treating patients and limit the spread of the disease within the hospital, Campbell said.  Staff trained how to safely don personal protective equipment, and more importantly, how to take it off without contaminating themselves. Cleaning procedures became more robust and frequent. Plans were put into place on how to isolate potentially infected patients.  “We had rows of tents outside to triage and test patients,” he said. “We were prepared for this huge surge in cases. But it never came.”  Although preparations for coronavirus patients ramped up quickly, it began to feel like a waiting game just as fast. But it’s not just a surge in coronavirus patients that’s missing here, Campbell said — overall patient volume has decreased significantly.  For a relatively small, community hospital, St. Anthony has a busy emergency room, Campbell said. Before the outbreak, he would see anywhere from 12 to 20 patients every night. Now that number is down to about three. “People are afraid to come to the emergency department,” he said. “Either because they’re afraid they’ll get the coronavirus, or because they think it’s their civic duty to not overburden the hospitals.” As a result many people are forgoing treatments or examinations. The issue is that people are waiting until their health concerns become urgent, Campbell said, and what was once an easily treatable condition becomes a dire medical emergency.  “Since the start of all this I’ve probably seen more ruptured appendixes than in my previous 20 years as an ER physician,” Campbell said. And while appendicitis surgeries might be up, heart surgeries are down, he said. According to the U.S. Centers for Disease Control and Prevention, heart disease is the leading cause of death in the U.S. and about 18.2 million Americans suffer from coronary artery disease. Those patients didn’t just vanish, Campbell said, and if they don’t seek treatment it could be fatal.  “I get people coming into the ER saying ‘Oh, we’re sorry, we know you’re overrun.’ And that’s just not the case,” he said. “If you’re sick, if you have a medical condition, come to the ER. I really have to stress that.” However, there are other issues facing the coronavirus response that are harder to see and harder still to treat.  “We’ve been doing social distancing for a while now and it’s important to understand that there’s a cost for that as well,” Campbell said. “Mental illness is up, substance abuse is up, unemployment is up. These have to be weighed against the benefits of the effort we’re taking to slow this disease.”  The Substance Abuse and Mental Health Services Administration (SAMHSA) reported its helpline saw an 891 percent increase in March 2020 compared to March 2019. The federal Coronavirus Aid, Relief, and Economic Security (CARES) Act sets aside $425 million for SAMHSA “to address mental health and substance use disorders as a result of the coronavirus pandemic.” Another $100 million is marked to supplement the agency’s federal grant programs, according to the U.S. Department of Health and Human Services. “With these response measures, we set out to flatten the curve, so hospitals wouldn’t be overwhelmed. We’re well beyond that now,” Campbell said.  Another facet to the emergency response issues is hospital staffing. Many hospital staff are being furloughed or having hours cut due to a shortage in patients. Campbell said traveling nurses are nervous about where their next job will be because no one is hiring right now. This is the case for most hospitals outside of urban centers, he said.  “My fear is that if we go along reducing staff and cutting hours, we’ll be short-staffed by the time we open the state back up and see a wave of new cases,” he said.  Communicable disease experts say more test availability is needed to safely open states. The Trump Administration said testing capacity will soon be doubled, allowing for an estimated 500,000 tests a day. One prominent research group, the Harvard Global Health Institute, suggested the U.S. should have the capacity to conduct 900,000 tests per day before it is feasible to safely open states.  The U.S. had tested approximately 818,000 people in total by May 15, according to the CDC. Washington state was administering 5,277 tests per day by then, slightly fewer than the 6,656 minimum needed, according to the Harvard study. Campbell said it’s important for people to remember for the duration of the “Stay Home, Stay Healthy” order not to neglect their needs. Social distancing, washing hands, disinfecting surfaces and eating healthy are all important, but social interaction is important too. Campbell said we have to practice “physical distancing,” not social isolation, to stay healthy.