Rapidly mounting COVID-19 coronavirus case numbers, stripped grocery shelves, and increasingly strict social distancing policies across the country can feel like towering thunderheads about to unleash their worst. In the hospital, however, among the staff and specialists, from environmental services to critical care, a silver lining has shone.
"It's an uncertain time. We're all highly anxious, but everyone is really galvanized by the need to help one another and excited about having the opportunity to work together as a team with one common goal," said Jason Katz, MD, director of cardiovascular critical care at Duke University Health System in Durham, North Carolina.
"We spent all these years training. We know why we do what we do and why we practice medicine. The opportunity to tackle one of the biggest crises to our society ... I feel honored to have an opportunity to do this."
Across the U.S., cross-discipline planning to ramp up the COVID-19 response as local needs dictate have been in the works.
To help, the University of Washington in hard-hit Seattle released a comprehensive resource site with its . "Since the outbreak began, our colleagues, locally and nationally, have been reaching out to us for assistance as they start to see cases," it said. "We hope that by sharing our work, we can assist your teams and facilities to move more quickly and to spend more time responding and less time typing."
One tool has been , a move taken by the University of Washington, University of Pennsylvania, Brigham and Women's Hospital, NewYork-Presbyterian, the University of California San Francisco, , and others.
Even the cath lab has a role, noted Ajay Kirtane, MD, SM, director of the cardiac catheterization laboratories at Columbia University Irving Medical Center/NewYork-Presbyterian Hospital in New York City.
Number one is to not take up beds needed for a potential surge of acutely ill COVID-19 patients, but cutting noncritical percutaneous procedures also keeps vulnerable heart disease patients away from hospital-acquired infection and preserves hospital resources, he told 鶹ý.
"Every time we do a cath, there's typically at least two or three people who are wearing a hat, mask, and gown," he said. Also, "even other aspects of the infrastructure: Every time we do a cath procedure, the room gets cleaned. That requires environmental service," which could be "over-committed on the COVID side."
The decisions aren't always intuitive, Kirtane noted, giving an example of the woman he saw with accelerating chest pain who likely would have needed to return to the hospital within the peak COVID-19 case load for the area. "We expedited her cath procedure for today."
Italy's experience has been telling in how physicians across specialties have joined in to help.
"Having basic medical and cardiovascular knowledge can be useful as a team member in the management of critically ill patients," Katz noted. "If these patients are going to require mechanical circulatory support like ECMO [extracorporeal membrane oxygenation], then we're going to have to utilize our interventional and cardiac surgical colleagues to help us institute those therapies."
"Everyone has to sort of pull together with a limited resource pool, and a resource pool that's at high risk of developing infection themselves," he said.
Some of the mitigation efforts that are undertaken are going to have psychological tolls, too, Kirtane said. Even staying home and curtailing social activity is not that easy. "Those are a lot of ways humans can relieve their stress. So just make sure you try to do some exercise at home, meditate, speak to people on the phone ... We're all in it together."