Reflecting back on my time during the initial COVID surge, I recall some difficulties but also some great successes at my hospital. As a member of the COVID strike team, I saw firsthand how we re-engineered our clinical operations at a department as well as at a hospital and even systemwide level. I was involved with the changing protocols, data collection for risk stratification, and subsequent inter departmental communication for COVID testing and PPE guidelines.
But in the midst of ongoing uncertainty and evolving knowledge of the disease, there was a concern that we were not wearing sufficient PPE in certain clinical encounters and that specific scenarios, such as intubation, were being selected to preserve PPE rather than necessarily being evidence-based. this fear was obviously exacerbated by discrepancies in the recommendations given by our national leadership with respect to clinical and public protection.
On a personal level, I always felt protected. Our attendings always made it clear that we were not obliged to put our safety at risk, whether that meant making sure that we had our appropriate PPE on before entering a room to run a code or minimizing our exposure to patients who likely had COVID. However, like many, we are also still putting our N-95 masks into extended use.
It was also incredible to see the rapid innovation that took place to facilitate care of a substantially increased number of critical care patients who were mechanically ventilated. I remember participating in a simulation exercise that reviewed worst case scenarios with a hypothetical clinical tool which would prioritize patients based on their comorbidities and chance of survival. We never got to that point of course where we had to decide who would need to be taken off the ventilator to preserve resources but it was a very real fear that hospitals across the country were preparing for. And a fear that I already was carrying as my family was already going through the surge in New York City.
It was a very difficult time for all of us with respect to dealing with clinical uncertainty, our safety, and of course taking care of critically ill patients who were often not allowed to have their family members at their bedside even during their last moments in our hospital. Despite it all, I am very grateful for the strong sense of camaraderie that emerged within our hospital. The feeling that we were all part of a family entrusted with each other’s well-being developed not only for those within the emergency department but all across the hospital. And I find it so remarkable now when I see patients who present to the ED not in critical condition but learn that they were actually just recently discharged from a prolonged hospitalization for COVID treatment, including being on ECMO, and have successfully recovered since then.
For me, moving forward as we prepare for the next surge, I anticipate it will be even more important that we start strategizing about how to address social needs in the ED. More and more people are becoming unemployed and subsequently are now uninsured with food and housing insecurity, for instance. Our patients’ mental health needs are also growing. Yet, at the same time, we will have to grapple with cuts in state and federal funding for safety net hospitals and public health departments and I think that is going to be the greater challenge for all of us. But it is a challenge that I’m confident we will be able to take on and I’m personally invested in tackling that head on in the coming months.
Tehreem Rehman, MD MPH 