Dr. Campen is an ER doctor at Providence Saint Joseph Emergency Department, a Clinical Instructor of Emergency Medicine at UCLA Medical Center, and the CMO and Founder of Vital Medical Services. Follow her down to earth evidence based information at @glamERdoc.
1. We are heading into the third month of the quarantine, and it appears Los Angeles has moved past its peak in terms of Covid19 cases. What do things look like in the ER and hospitals in general? I'm also hearing hospitals are opening up for more elective and non-emergency surgeries that weren't happening over the last several weeks.
We have become more accustomed to putting on and taking off PPE between every patient. We know more about how to treat patients and what does not work. We are so appreciative of the outpouring of support by the community (gifts, cards, meals etc.). Volumes are still very decreased from previous. Initially I thought it was because the non-emergency visits were staying away, but now I am concerned that some actual emergencies are staying away! It is safe to go to the ER. We are treating each patient as if they are infected (to protect everyone). Don’t delay with chest pain, focal weakness or numbness, shortness of breath, or any other emergency.
2. What have you learned about this virus over time and how it affects people? How has your treatment of it evolved over the last two months?
The main item I have learned is to not “jump on the bandwagon” and follow the latest trend. We must stick to evidence-based practices and evaluate potential treatments very carefully. There are maneuvers we are doing to improve oxygen delivery to the body, such as placing the patient face down or prone. Additionally, one of the important things I have learned is prevention is key. Avoiding the illness is more effective than trying to treat the disease. It has become clear that it is the body’s immune response that causes the most damage to health, not the actual virus. Overwhelming response and exhausting the immune system causes many of the problems. Doing our best to reduce that response while still supporting an immune system (our defense to infection) has been a delicate balance. This is why plasma infusions have been so hopeful for treatment.
3. The state, county and city are starting to slowly ease some of the restrictions. How do you think people have done so far during this pandemic, and what advice do you have for everyone going forward as restrictions ease - to enjoy the rediscovered freedoms we have but do so in a safe and responsible manner?
We must do our part to continue to protect ourselves. We are not out of the woods. Good hand hygiene (cleaning hands when touching ANY public surface), wearing masks to protect those around us, and avoiding those without masks for 6 feet are the key! Doing this will keep you safe. I have cared for 100s of positive patients and have done procedures (intubations) on more than 20 and have kept myself safe, protected, and negative. This shows the power of protective measures.
4. When the coronavirus first hit our shores, a big concern was lack of testing. Now, it seems testing is nearly everywhere. Who should get tested, and what's the difference between the nasal poke test vs the cheek swab. Also, is there value in people testing for the antibodies?
Because we are finding many people are testing positive and have no or minimal symptoms, it is recommended that everyone get tested and then continue to test every month (as long as you remain negative). The antigen test identifies actual virus in your secretions. The nasopharyngeal swab (deep into the nasal cavity) is more accurate, but not always the most efficient to perform in large groups (such as the drive through testing.) Additionally, we don’t know how long people remain positive (infectious, shedding the virus) and I have seen some stay positive for up to 6 weeks. Antibody tests (from the blood) can be used to see if you had an infection more than 2 weeks prior.
5. What do you anticipate will be the impact of coronavirus over the next couple of months as temperatures rise, and what sort of overlap is the medical industry expecting between coronavirus and the annual flu season?
With the relaxing of restrictions, we are prepared for a spike in infections. There is no way around this. Thus, vulnerable people (elderly, obese, smokers, vapers, and those with kidney disease, hypertension, and other chronic diseases) should continue to stay home. Because the stay-at-home order has prevented many children from their normal vaccines, there is concern that measles will make a resurgence this summer. Additionally, we in the emergency room are frightened about having a flu season with COVID-19. It is unknown if influenza can make COVID-19 infection worse. I urge all people to do their part in reducing the spread of influenza by getting your seasonal flu shot this September or October. YOU CANNOT CATCH THE FLU FROM THE FLU SHOT- it does not contain a live virus.
6. The government has focused on a "safer at home" mentality, necessarily, to slow the spread of the virus and flatten the curve. What concerns and/or advice do you have for people as it relates to mental health while staying at home. For many safer at home means being alone, isolated from friends and family. Where do you see the line drawn between being safe as it relates to coronavirus but not isolating oneself completely from friends, family and the outside world?
I think of my home as my “bubble.” At home I don’t distance, wear a mask, etc because everyone in my family has been practicing the same as me. It has been found that the virus definitely travels in households -- if one person has it, the whole house has it. I see a way of safely helping your mental health while still protecting your physical health is to “expand your bubble” to include other households with similar safe practices. It would include respecting each other’s safety and keeping physical contact only within the bubble.
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