Students: as you train to be future doctors and healthcare workers, we thought you might like to know what it’s like working as a doctor on the front lines of Covid-19. Much of the news is covering the biggest cities in America but in smaller cities like Portland, Maine, health care officials are working around the clock as well as they prepare for the coming weeks. Join Marlee, RN as she interviews Doctor Nathan (from her apartment in Israel). Their discussion touches on understanding transmission, viral load and mental health of healthcare workers in our hospitals around the country.
Note this interview was recorded March 27, 2020 and will give you a glimpse of what it was like on the front lines in the early weeks of the pandemic. For the latest news from Maine and other areas hard hit across the country, please check your local news sources.
What’s in this interview:
2:00 Waiting in limbo, preparing for what you can’t see
4:05 Understanding differences in viral load
4:38 Transmission explained
8:08 The effect on social interaction
10:23 Social distancing in different areas
12:03 The effect of isolation on mental health
14:15 Hygiene and the changes going forward
15:40 Where to look for trusted information
Doctor:
I’m a vascular surgeon at Maine Medical Center. It’s the largest hospital in the Northeast outside of Boston. Almost two weeks ago, we stopped doing purely elective operations across the board for multiple reasons, but mostly just to preserve and ration some of the supplies that we have anticipated that we were going to need moving forward. A lot of the kind of protective gear and equipment that a lot of the other hospitals in some of these hot zones have noted that they’ve been rationing or without. For me in my specialty, about 40% of what I do on a day-to-day basis is urgent or emergent, so I’m still operating a fair bit and still seeing patients in the clinic, but really only if people have acute limb or life-threatening problems.
Doctor:
It’s really been scaled back a lot here. There’s a lot of questions and confusion about things that are appropriate like job security and pay and salary and livelihood. Not just among the doctors, but also among many of the support staff and other medical professionals. It’s a weird time. We have not yet been hit with – kind of – that upswing. We haven’t seen the exponential growth curve here like they’ve seen in New Orleans or New York City or even Detroit, but we’re still on that flat portion of the curve where we do see an increase in numbers of those both testing positive as well as those who are sick with the virus.
Doctor:
But we are in this weird state where we’re kind of waiting for the storm to hit, but we don’t know: A. when it will hit, and we don’t know; B. how bad it will be. It’s kind of, are we preparing for something that we can’t even prepare for, or are we preparing for something that will never materialize here?
Marlee:
Are you preparing as if it’s going to be as bad as other places?
Doctor:
I guess it’s both good and bad. It’s good in that we can speak with some of our colleagues who are in the hot zones both nationally and internationally and see where they’ve succeeded and where they’ve felt fallen short and kind of prepare for the challenges that some other facilities have had. The downside is that it’s like you hear the… If you’re at war and you hear the screams and (see) the gunshot wounds and you don’t know how far away it is in the distance and you don’t know who’s actually being wounded or injured. You get reports that there are medical staff and medical professionals who have been stricken ill quite severely, some of them from occupational exposure from a patient to physician or patient to nurse, for example, transmission.
Doctor:
We’re trying to prepare for all sorts of different outcomes and variables in this situation.
Marlee:
Is that something that worries you?
Doctor:
It worries me. It is something that worries me. I’m 40 years old and I’m healthy, so my overall mortality or the risk that I die if I contract this virus is, well, under 1%. What worries me more are the stories that I’ve heard coming out of people who have been taking care of people who are quite ill and then have contracted the virus and have actually got a more severe form of the illness. They think that these folks who are quite ill have a higher viral load. When they cough or in their septum, they’re shedding more virus. If so, when we come into contact with a higher load of the virus, theoretically I guess you can get more sick. It’s kind of like if you look at radioactivity and you’re responding to Chernobyl. If you’re closer to the nuclear reactor, then you’d get quite ill.
Doctor:
That’s the way it’s kind of coming out anecdotally, although I haven’t seen a scientific publication that that’s true.
Marlee:
Okay. Can you explain a little bit about the transmission for people, just the general public, not even doctors because I think people are kind of confused. It is droplet and what does droplet even mean, or is it you’re touching a surface? What exactly can you explain about how people need to be safe? Do masks actually work? Because we’re hearing mixed things about that. Do people need to be gloving up as they’re leaving the house? What actually makes sense?
Doctor:
Right. I think that there is a lot of misinformation and some of it is quite scary that’s out there. The biggest worry is that this is transmitted in an airborne fashion, and airborne basically means that the particles can travel in the air for an unknown distance. Just by breathing in air where the particles are in the vicinity, you can get sick. For diseases that are airborne, then the recommendation is that people use these N95 relatively impermeable filtered masks or respirators, so that when you breathe, you’re breathing entirely filtered air. I know that a lot of people in the community and people who are concerned are snatching these up online and buying them for ridiculous prices just so that they can protect themselves.
Doctor:
I do understand that because there’s enough information that’s come out that suggests that there may be an airborne component of this. But from what I know and have read, that’s not true. I think that a less, kind of a one step down from airborne is droplet precautions. Droplet precautions – basically a mucus fluid from one person gets released into the air and really can only travel, we’ll say two meters or six feet. That’s why we talk about a six-foot away distance. If someone coughs in your vicinity and you’re a foot away and you breathe in then that air, that can transmit the virus through droplet precautions.
Doctor:
Obviously sharing any sort of saliva or body fluids, etc., that can also share that, but droplet precautions I think is how most people think it is transmitted. Routine – kind of – keeping your distance two meters or six feet away, people who wear even just a cloth mask that can protect from some of these droplets is also wise, and obviously avoiding the contact with some of your exposed mucus surfaces: either eyes, nose, mouth, that does tend to help. Then the third way is contact, so contact precautions. People talk about, “Oh, how long does this live on any given surface?”
Doctor:
I think it was in The New England Journal of Medicine that looked at the viral load on a surface and they looked at surfaces like copper or cardboard, etc., to determine how long some of these viruses can live on the surface. I think that what people are recommending is not necessarily, do you need to wear gloves all the time? You probably don’t, but if you’re worried, sure, go ahead, but gloves do nothing if you still wear gloves and then touch your gloves to your face, your eyes. I think that good hand hygiene and avoidance of face touching, cleaning surfaces that you come into contact with, I think those are all very, very useful things to do.
Marlee:
We were talking about how it’s creating almost a phobia of even other people just on like a societal level. You walk down the street, depending where you are, and even just coming within 10 feet of someone, you just kind of freeze a little bit. Do you feel like something like this, especially when it’s all over in the… I mean, who knows when it’s going to be over, but do you think it’s going to impact the way we interact as people?
Doctor:
I think it certainly can. The longer that this goes on, I think the more that it will impact people. When I get into an elevator, for example, people give me this look if I’m standing too close, which never would have happened. I was in a grocery store line and the normal thing is you just stand there behind someone else. The woman turned around and she said, “Can you back up six feet?” Part of me was offended because I look clean and I don’t have the virus, but at the same point, she’s right during this time. We need to really focus on this. It’s true that it could really affect people’s ability to kind of get out and about and get close with other members of society.
Marlee:
Where you are right now, what are the restrictions? Because we’re in full lockdown and I know every state is very different. What are you guys at this point?
Doctor:
Maine is geographically a fairly large state, as you know. It’s about the size of New York State, but our population is much less. We have about 1.2 million people. I’m in Portland, which is the largest city. It’s really only 70,000 people with about a quarter million in the surrounding area total. It’s still not very densely populated. But within Portland, all of the non-essential businesses have been shut down. But otherwise, it’s not as – kind of – draconian as we’ve seen in some other countries. But at the same time, I think that it’s a very different feeling right now when you drive down the street and there are really not many or any cars and no businesses are open.
Marlee:
Do you feel like it needs to be even more restricted than what it’s at now? Are people abusing that like there have been in other places?
Doctor:
For the most part, the Portland and the Maine population as a whole has been really good at social distancing. I think by the nature of many people who live here in the state, a lot of people live here either because they like that quiet pace of life or they don’t really want to be close to their neighbors or other people. I think who’s going to be hardest hit by this are a lot of the restaurants, some of the small businesses. I really feel for them or people living paycheck to paycheck because this is really going to be a hard financial hit for many, many, many Americans.
Marlee:
Does it change anything you do when you go home? Are you seeing family? Are you staying away from people?
Doctor:
My parents live about a 10 minute drive from where I am right now, and they’re both in their late sixties, early seventies. I’ve seen them once since this all began. When I went to see them, I didn’t go in the house. We went for a walk in their neighborhood and kept distance, but I would not at this point. Number one, I’ve got occupational exposure presumed, and so I wouldn’t want to transmit to them and get them sick. I’m just keeping my distance, which is quite frustrating because normally we’re a very close family and I would go over there for dinners. I (would normally) go for Shabbat dinner and everything else, and you can’t do that because I don’t want to get them sick. I’ve got a brother in Boston who’s got young kids and I FaceTime with them, but otherwise can’t go see them.
Marlee:
How do you feel it’s going to affect people’s mental health if this is something that’s longer than a couple of weeks?
Doctor:
I think that one of the reasons why the folks in China did the lockdown and shutdown so well is that it’s a communist nation. They’re used to being told what to do by the government. They’re used to being told what to eat, where to live, how to live by the government, and that’s just not the American way of life. It is very difficult, I think, to take that American mentality of, “Hey, we’re free and nobody will tell us what to do,” and then have the government step in and start saying, “You need to stay home. You need to not go out. You need to not go to the bars and the restaurants and the stores and not hang out with your friends.”
Doctor:
Many people have resorted to getting around this either reading books, watching Netflix and movies, doing online yoga classes or having Zoom meetings to try to stay socially connected. It’s a lonely time with a lot of isolation. Some people probably really love (the physical distancing) and others are really just tolerating this. I know that for myself, I’ve been going to work every day so I haven’t really had the same “lock in the house loneliness” as some of my friends who I’ve spoken to. But at the same time, some of my partners are now switching to a one week on, one week off schedule. These peers of mine who are home are not doing great because it’s a lot of (uncertainty), like “I don’t know what’s coming,” “I don’t know what next week is going to bring,” and so on.
Doctor:
I think there are a lot of concerns that people have and stressors that are unnatural that people are having to deal with on top of this feeling of isolation.
Marlee:
How different are things going to feel or be with hygienic practices on every level? Do you think it’s going to be completely different thing, like how 9/11 changed security like crazy? Do you think it’s going to kind of have the same effect with how we deal with hygiene?
Doctor:
I think, number one, depending on how long this goes on and how ingrained this becomes in our way of life will dictate how people respond to this. I think that people probably will become a bit more hygienic and that’s probably good. Every year when it’s influenza season, we push people to get the immunization. We also tell people, “Wash your hands. Don’t touch your face,” like all these same things. A lot of people say, “Oh well, it’s the common cold or it’s the flu or I get the cold every year,” and they kind of brush it off because, number one, I don’t think anyone whose young thinks, “Oh, I’m going to die from the flu,” and number two, they don’t see this as being really a pandemic.
Doctor:
But the possibility for this to change the way they have to live their life, I think is quite huge. I don’t think people will necessarily continue to bleach every article of mail or package that comes to their home, but I think this will raise awareness of the transmissibility of some viruses and illnesses.
Marlee:
Is there any message that you want to share with people who may either not really understand what’s going on or not taking it very seriously? Do you have anything that you want to spread the word on?
Doctor:
Yes, I would say trust science. Don’t trust – necessarily – politicians and government and economists and business people, but trust science. I mean, this is absolutely fascinating on an epidemiology study because epidemiologists create all these mathematical models to model how this disease will progress and how pandemic will occur. The models are matching up exactly with the growth curve and the spread of these viruses. If you look at the exponential growth in cities like New York and New Orleans and Detroit, it’s fascinating. It’s saddening. It’s incredibly sad, but it’s fascinating. Sometimes science just needs to be trusted. It frustrates me when I see people online, especially some of our big name politicians, who refute science and say, “Oh well, this’ll be fine and everybody will be fine.”
Doctor:
I understand not wanting to create a panic among the population, and there are probably things that the general population can’t understand and process and tolerate, but at the same time, I think that the realism of the science needs to be stressed. What we’re seeing right now is science in play. We’re seeing these hospitals being overrun by these patients and people dying. People maybe we don’t know dying, but now every day when you look at the news, you see someone who was famous for one thing or another who has died. It’s almost like that part of the Oscars every year where they show the role of who died last year, but now it’s like every day.
Doctor:
It’s really sad. But I think that the message I would say is trust science, trust the scientists, trust the information that we’re getting from the folks who really are on the front lines with respect to medicine and the study of viruses and epidemiology, and listen to them. The quicker we adhere to these guidelines, the faster this will either be over or the better we’ll be able to react to it.
Marlee:
Awesome. Thank you so much. We really appreciate it.
Doctor:
Yeah, it’s my pleasure. Absolutely.
Marlee Liberman, RN, Master Nursing Scholar
As a registered nurse, Marlee understands the struggles that nursing school throws at you – not to mention the overwhelming pressure preparing for the NCLEX®! Marlee brings a unique skill set and perspective to Picmonic with her previous degree in broadcast journalism, her creativity in video production, and her wandering nomad lifestyle. Her blend of talents provides her with the knack for simplifying complicated concepts and demystifying the world of nursing.
