Thursday, April 2, 2020

Preparing for the COVID-19 surge: a resident's perspective

- Enkhee Tuvshintogs, MD

The last two weeks of January, I was working nights in the ICU. We had just started to hear about COVID-19 and its quick spread in Wuhan, China. It was unclear at that time if the virus could be contained within China, or if it had already made its way to outside countries.

A low-lying sense of unease about patients who came in for respiratory symptoms existed in the Emergency Department (ED) and the ICU. Comments about when or if we should assess for COVID-19 came and went based on possible risk factors.

Just before the end of my night float rotation, I was called to the ED to admit a patient to the ICU for respiratory distress. There was some question if the patient had recently been to China. Our hospital had received guidance to follow guidelines similar to tuberculosis rule-out in these cases. The emergency medicine physician and I donned PPE hoods, N95 masks, and gowns. Given the acute nature of the symptoms, we entered the room, intubated the patient, and placed a central line in preparation for the move to the ICU.

By the time the patient was stabilized and admitted, it was time for morning sign-out to the day team. I wasn’t sure if the patient had COVID-19, but we were all concerned. We needed to notify the public health department and get testing done.

Driving home, I thought about what had just transpired. Had I been exposed to a patient with COVID-19? There were no cases reported in America yet. I tried to put it out of my mind, reasoning that the patient's history didn’t fully support the diagnosis. Still, until the test came back negative, I continued to check in daily.

By late February, the first case of COVID-19 in California had appeared and community spread was suspected. There was a lot to learn about this new strain of coronavirus.

As March began, more news came out about possible community spread. All of the reported cases in Sacramento were sporadic cases in the suburbs. There were no large outbreaks like those in Seattle just yet. Discussions among our faculty and administrative staff began about changes that our residency needed to make to tackle this emerging problem together. Swiftly, they jumped to the task.

Our program director and faculty decided to forgo time with their families to be part of the hospital's response. They placed themselves in the Emergency Department and on inpatient teams. Within one week, resident schedules changed to reflect the needs of the hospital. With the breadth of our family medicine training, we were well-equipped to work in the ICU, the ED, Labor and Delivery, and on inpatient teams. In the same week, faculty and residents on the outpatient side transitioned for the first time to telemedicine visits, while continuing some in-person visits in clinic.

We have not hit the surge yet, but we know we will. Our training has prepared us well to care for patients in all parts of the hospital. We have never encountered anything like COVID-19 before, but we are ready and willing to rise to the occasion.


Dr. Tuvshintogs is Chief Resident of the Methodist Family Medicine Residency Program in Sacramento, CA. and AFP's 2019-20 Resident Representative.