Key takeaways for doctors during COVID-19

Now that COVID-19 has reached all 50 states, with more than 14,250 cases and 205 deaths in the United States as of March 20, 2020, updates across all platforms in real time on the coronavirus, COVID-19, generate anxiety, uncertainty and fear. 

A genuine concern is that this epidemic may mimic the Spanish flu, which killed about 20 percent of the world population in 1918 — almost 50 million people. As of March 20, globally there are 250,856 cases of COVID-19 and 10,389 deaths. 

Some key, distinct challenges facing physicians and health care workers include protecting vulnerable populations, safety of health care workers and decreasing the number of infected patients by enforcing social distancing. 

As a cardiologist and medical director of the Rush Heart Center for Women, I see firsthand that Rush University Medical Center is one of 35 hospitals equipped to respond to bioterrorism and has been proactive to respond to the COVID-19 pandemic. 

To help prevent the spread of the infection, administrators enabled patients to do a virtual visit so doctors can give advice to those who are concerned that they may have the virus. Additionally, the emergency room has been outfitted with tents to take care of patients outside of the hospital, and scheduled outpatient visits have been switched to phone visits. 

Medicare and many insurance companies have approved coverage of these telehealth visits — once reserved for very few patients — switching in-person interactions with patients for routine visits to telehealth visits. 

Caring for those who are most vulnerable in the hospital, my job is to prevent heart attacks, strokes and deaths. Cardiac patients are some of the most vulnerable patients to the life-threatening effects of COVID-19. In general, the risk of dying from COVID-19 is about 1 percent, but for patients with cardiovascular disease, the risk can be as high as 10.5 percent.

A big concern for health care workers is that they get infected and become sick, as is the case with health care providers in California, Arkansas and Washington. 

This is a big concern since one health care worker will be quarantined and unable to help patients for at least 14 days. Another scenario would be the health care worker becoming fatally ill, which happened in China. Health care workers need guidance to protect themselves and medical centers need to make sure their employees are not overwhelmed. The lack of personal protective equipment (PPE) and its proper use, especially taking it off so as not to release the virus into the air, is so crucial. Healthcare workers have to endure being in these gowns and masks — for hours at times — and that can be very stressful. 

Projections of the number of cases will be exponential in the next few days as the United States ramps up testing for COVID-19. The numbers have been low only because many people have not been tested. Testing is crucial and cannot come soon enough; it is the only way to isolate those who are infected. 

Federal and state government can help by imposing and enforcing social distancing by continuing to close schools, bars and restaurants. Governors of states such as New York, Illinois and California have aggressively done this, but a national effort has to be implemented right away. 

Businesses and sports organizations are doing the right thing by having their employees work from home and suspending their seasons. Unfortunately, a national U.S. lockdown similar to what is in play in China, Italy and Spain may be inevitable to get the spread of the virus contained.

Cardiologists in the United States have been using live webinars to confer with Chinese cardiologists to learn from them what works and what does not. The Chinese cardiologists enlightened us about the cardiac consequences of COVID-19 and what we can do to save our patients. 

Social distancing is the best and only way to decrease the number of people infected. This is what flattening the curve means; buying time for doctors to treat patients without being overwhelmed and for the scientists to create vaccines and treatments to mitigate the potential fatal effects of this novel virus. Although clinical trials are now underway to see if a vaccine is effective against COVID-19, it will take several months to yield answers.

Social distancing will also help the health care system and providers take care of very sick patients, and not be overwhelmed with having to make choices on who should receive treatment on life-saving machines. 

I think of some of my patients, including a 70-year-old woman who developed a weak heart from the stress of caring for a family member who is dependent on her, or the 72-year-old blind and deaf father whose daughter translates for us by holding his hand so he can feel what her hands are signing. 

My heart aches for the difficult lives some of my patients endure. The least I can do is provide them the best care possible to protect them from a global virus. If I cannot interact personally with patients and must confer virtually with them, then I need to make sure the care is still optimal. 

It is necessary and urgent for all health care professionals and our local and national government leaders to be proactive in order to prevent COVID-19 from replicating the outcomes of the 1918 Spanish flu. History must not repeat itself. 

Annabelle Santos Volgman, MD, is the McMullan-Eybel Endowed Professor of Cardiology at Rush University and medical director of the Rush Heart Center for Women. She is the governor-elect of the Illinois American College of Cardiology, and a Public Voices Fellow with The OpEd Project.