I'm an infectious disease doctor. Please practice social distancing before it's too late.
- Dr. David Hirschwerk is an infectious disease specialist and vice chair of medicine at Northwell Health's North Shore University Hospital; he is also an assistant professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.
- He says that the healthcare system is navigating unprecedented times, and that we need more sustained urgency immediately.
- It's our responsibility to respond together and practice social distancing, especially young people.
- "We need each other now more than ever," Hirschwerk says.
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In a short period, the nation's healthcare system finds itself navigating unprecedented times - in a fierce battle with a pathogen that we've never encountered, for which we have no treatment, no vaccination, and inadequate testing. The number of ill patients requiring hospital care with confirmed or suspected COVID-19 has steadily climbed. Beyond that, there are numerous mildly ill patients who have a confirmed or presumptive diagnosis and are recovering at home on self-quarantine.
An aggressive situation calls for an aggressive response. There is no more time. We need to act and act as one. The only antidote to the novel coronavirus outbreak has been quarantine and social distancing. That's it. We desperately need our communities to adhere to these principles. The unnerving scenes of packed restaurants, bars, and public spaces are still so prevalent despite ongoing calls to adhere.
We need more urgency and it needs to be sustained. It is not easy, especially for young people who don't understand the gravity of the situation or feel invincible. We were all young once. But we are in a crisis and it is our responsibility to respond, together.
Lack of reliable testing and rapid results has far been the biggest challenge, which has strained our hospitals. When a patient is admitted, they need to be placed in isolation - in a single room - so others are not at risk. And they remain in isolation until COVID-19 is ruled out, which has taken up to 24 hours to diagnose, forcing hospitals to use double rooms for a single patient. Bed supply has been greatly diminished when we fear more and more people will need our services.
COVID-19 testing has been marred by woefully slow development, delayed approval, and poor dissemination. Despite herculean efforts of laboratory professionals, we can still only perform more than 100 tests daily. Making matters worse, inadequate supply chain leaves a bleak outlook.
In the interim, we've done our best to develop clinical algorithms to guide decision-making with isolation precautions. Essentially, those with moderate to high suspicion of infection are isolated. Those with a relatively low suspicion, but who we feel require testing, are directed to non-isolation beds - usually beds that are shared with others.
While this process has worked relatively well, it is far from ideal. But it essential to preserve bed capacity until testing availability and speed increases.
So, what can be done in the hospital to mitigate the novel coronavirus surge until then? To start, non-urgent procedures and surgeries are being postponed. This will allow for greater bed capacity, though in 2020 it is not very common for elective procedures to be performed in the hospital. We are also cohorting COVID-19 patients in specific units, with specific clinical teams. We are greatly curtailing visitation and are having all visitors and hospital staff wear masks. This will reduce spread of the virus within the hospital, from staff and visitors who may have only just started to have symptoms, perhaps even mild, or even not yet symptomatic and at a stage where they may infect others.
We also want our communities to recognize the current testing challenges. It will eventually improve, becoming more available and efficient. In a perfect world, which political leaders promised weeks ago, everyone who is suspected of having COVID-19 would be tested. This is not reality, though. The vast majority of infected individuals have mild illness and do not require medical care. They should separate themselves and recover at home. Those with mild symptoms need to realize they should not enter our hospitals. Only those with severe symptoms should seek critical care.
All outbreaks eventually end. We will survive this, but there surely will be heartache, pain, and loss. The final chapter of COVID-19 will be guided by obtaining the necessary tools to adequately care for patients, individuals recognizing their power, and understanding what must be sacrificed to get us there as safely and quickly as possible.
We need each other now more than ever.