What your doctor is reading on Medscape.com:
MARCH 28, 2020 -- Fear. Helplessness. Rage. I felt many emotions as I watched the threat of the novel coronavirus spread across the world.
At first, the promise that otherwise healthy young people were having good outcomes was reassuring, but more recent outcomes in the United States have removed that comfort, with many young people in critical condition. I've been worried for my patients and what this will mean for them, especially those with diabetes. Compared with those in other nations, American children are not "healthy"; a third of them are overweight or obese and have corresponding complications known to portend poor outcomes with COVID-19.
I have been in close contact with physician friends around the country. We updated our wills, talked to our parents about advance directives, and set up our homes to quarantine ourselves from those we love most, all while watching the rest of the country go on as usual, indifferent to what is to come.
I took time to brush up on hospital medicine and intensive care skills, but in reality, by the time pediatric endocrinologists are asked to manage ventilators, there won't be enough ventilators left to manage.
Everyone Can Do Something
As a pediatrician, advocacy is in my bones. Prevention is my middle name. After a couple weeks of fretful worrying, I shifted from a state of disempowerment to one of resolve. If I can protect my patients and community from COVID-19, then I may save more lives this month alone than I will for the rest of my career.
What makes COVID-19 especially frightening is its ability to spread through presymptomatic carriers. Published clusters of cases demonstrate that around half were spread through asymptomatic contacts. Worse, nosocomial spread is proving to be a problem around the world.
It's time to batten down the hatches. Everyone can do something. Here are the steps that I, a pediatric endocrinologist in rural Mississippi, am taking to fight COVID-19.
1. I have moved almost completely to telemedicine.
What endocrinologists do is essential to the lives and health of our patients, but most of it can be done on a telehealth platform. We are delaying labs and imaging as much as possible and remotely downloading pump and continuous glucose monitor data. These actions will keep my vulnerable patients and their caregivers at home.
Even if we sanitize our offices meticulously, our patients drive long distances and use public restrooms and restaurants while in transit. Most concerning is that children are thought to be asymptomatic vectors of disease that would put others at risk. By practicing what we preach about staying home, we will influence far more patients to heed this warning.
2. I am keeping my patients out of the emergency department.
Resources may quickly be overwhelmed, and the last thing my hospitalist and intensivist colleagues need is another patient with diabetic ketoacidosis in the intensive care unit. We are calling patients with a history of frequent admissions and making insulin adjustments. We are sharing the specific threat of COVID-19 exposures in an inpatient or emergency department setting and are imploring patients to call us first before going in. I can supervise sick-day rules, call in antiemetics, and even give intravenous fluids in my office to prevent the need for emergency or inpatient care.
3. I am using my voice.
I have been actively sharing accurate information and debunking myths when I see them on Facebook, Instagram, and Twitter. I have been amplifying the voices of physicians on the front lines by sharing their words. I have mobilized others in our community to urge everyone in their circles to use the most powerful tool currently in our kit: social distancing. Everyone around me knows to #FlattentheCurve.
This has been extremely effective; many people told me that they didn't know what to believe but that they trusted my take. As healthcare professionals, our voices carry tremendous influence and credibility. People are listening.
4. I am leveraging any power I have to close nonessential services in my community.
My husband is a pastor, so our church and many others in our denomination closed before state mandates were issued to limit gatherings. I called my optometrist, dentist, salon, and daughters' ballet studio to urge closures, and they all responded positively. One of our school board members thanked me for my advocacy and support in their difficult decision to close schools before the first documented case of COVID-19 in our state. That action appeared very wise indeed once testing started in earnest.
5. I am supporting my friends on the front lines.
My entire family has written to our local representatives for funding for more personal protective equipment. I have rallied local construction companies to donate N95 masks to other clinics and local hospitals in short supply. My porch is filling up with supplies to deploy where needed. Veterinarians in our city have closed their own waiting rooms and are sharing masks, gloves, and sanitizers. A local factory has donated protective gear.
The creativity and generosity in our community astounds me. We can send out calls to action and use any downtime to help support our exhausted inpatient colleagues. Local doctors are offering to scribe for inpatient physicians. Medical students across the country have arranged babysitting services for hospital employees, as many are no longer on the wards for safety reasons. I am in contact with other physicians in town, and we are grocery shopping for one another to prevent additional trips into the marketplace.
This is a scary time for many people. We can have our children send art to local nursing homes, check on people living alone with phone calls, buy gift cards to local businesses, and pay every outstanding balance we may personally have. These seemingly small actions will help keep others afloat through the storm.
We will speak of these times to our grandchildren. Rather than be overwhelmed by what is to come, I am choosing action over passivity, fortitude over fear. By changing the behavior of even one person, I can prevent a multitude of infections and deaths. Join me as we protect those in emergency departments, intensive care units, and nursing homes across the world. The more we do now, the better our outcome will be.