My Perspective on the Unfolding of COVID-19

by
  • Dinges, Emily, MD
| Mar 24, 2020

Emily Dinges, MDOn Friday, February 28, the first case of community-acquired COVID-19 was reported in the Seattle area. Here is how it has unfolded from my personal perspective as an obstetric anesthesiologist at the University of Washington.


March 1
 

PAPR training tonight! There’s pretty much a sick person at every hospital in Seattle. It’s just a matter of time before this bomb goes off!

March 2 

Update from the frontlines: 

Ahhhhhh! COVID-19! Must buy fresh bread! Bread Shelf

Seattleites buy different things in snowstorms and virus pandemics. Produce and eggs vs pantry goods and bread. Also, I’ve heard there is no toilet paper anywhere in the region for sale. None for miles.

March 3

Update from the front lines of COVID-19 (Tuesday):

Healthcare workers and first responders [from Evergreen hospital and Kirkland Fire Department] are testing positive or are in quarantine. And my child and her 3rd grade classmates made up a tag-like game called "virus" where the number of people who are it, aka the virus, spreads exponentially.

March 6 

Friday COVID updates: 

-Next week we are training residents in PPE including PAPR. They want attendings to do the actual intubation, but residents can help us. 

-Covid is now a verb! As in something getting "covided" as in cancelled because of COVID-19.

-My hospital has pulled all the hand sanitizer from the wall outside of pt rooms and is encouraging everyone to wash their hands instead to save hand sanitizer for when you really need it (like inside the OR and such).

-Seattle is running low on blood and all PPE equipment.

-University of Washington has moved all classes online through the end of the quarter (so with Spring Break no classes the rest of the month).

-UW L&D now allowing only partner and certified doula with laboring patients and they have to stay with the patient. They aren't allowed in if sick.

March 9

Monday COVID-19 Updates:

-Update: UW Virology has a cool twitter page to follow! They can run tests from anywhere in the nation! Anyone (with a license) can order tests! 

-UW anesthesiology has cancelled grand rounds and resident education for the rest of the month.

-UW has forbidden medical staff from going to conferences for the rest of the month.

March 10 

Tuesday updates the COVID-19 front lines:

-Food delivery people won't be allowed to enter the hospital as of tomorrow.

-UW is making big changes to their visitor policy tomorrow.

March 11, Bonus 

I feel like I’m pregnant. I’ve been waiting and waiting. I know something big is about to happen, but I don’t know when. And I don’t know how. I don’t know how big this is going to be. And I know I could die, but that’s unlikely. But still. Some anxiety there. I know this is getting closer and closer. I want it to hurry up and get over with, but I know that the longer it holds off, the better. It’s just like pregnancy. Stay safe everyone. At least we don’t get newborns when this pandemic is over!

March 11 

COVID-19 Wednesday:

-SEATTLE PUBLIC SCHOOLS JUST CLOSED STARTING 3/12 FOR TWO WEEKS (at least).

-We’re all going to run out of PAPRs so consider if you’re going to bleach and reuse them

-Case numbers are increasing in Seattle from single digits in hospitals last week and double digits today.

-We have modified the code team and OR teams to only essential people for caring for positive cases.

-10 nursing homes are affected in the Seattle area. These patients are at high risk of death. 

-WA state has banned gatherings of >250 people in the Seattle area

-My leadership is “discussing” cancelling cases and “pruning” lists. Some surgeons are doing this on their own. One problem is that my hospital is like 2/3rds cancer cases which are elective, but you can’t push back a couple of months and have the same outcome.

March 12 

Thursday in Seattle:

-Finally! UW “rescheduling” elective cases starting Monday. FINALLY!

-WA's governor closed schools in 3 WA counties for 6 weeks!

-Turns out most infections come from people who have yet to develop infections.

-Schools are closed and I'm home on an academic day. One kid says she's bored after just an hour at home. Other kid plays "Eye of the Tiger" for three hours straight on the piano. This is going to be rough. 

-Other parents just don't understand social distancing and have been sending out emails about standing playdates and park meetups and such. We won't be going to any of it. FaceTime dates is it.

-The zoo and aquarium have closed for the rest of the month. All arts organizations have cancelled all performances for the rest of the month. City libraries closing too.

March 13

Friday in Seattle:

-All WA schools now closed for 6 weeks, not just the 3 most affected counties. OR Emily Dinges 2schools too. 

-The nurses are holding a retirement potluck for someone right now! Thankfully other hospitals in Seattle have banned such silliness. 

-Last day of elective surgery at my hospital and volume is noticeably lower than normal.

-A couple CRNAs have fevers and a couple more have spouses with fevers. I’m anticipating many of them will be sick soon.

March 14 

Saturday in Seattle:

-Multiple members of my department are awaiting testing or testing results. 

-10 first grader Zoom meetings are hilarious.

March 15 

Sunday:

-Restaurants are limited to delivery and take-out only by order of the governor.

-REI is closing retail stores for two weeks (if you understand Seattleites, you understand why this is a big deal).

-Went to the park to run the kids in the field. Noticeably fewer people out. 

-Monday OR list [first day of no elective surgery] is obviously much smaller than normal and is all cancer or CT.

March 16 

Monday in Seattle:

-My county (King) is the 12th largest in the country by population and has 420 cases as of this morning. 

-Nitrous oxide for labor analgesia should be avoided for everyone + or PUI.

-I have heard that hospitals are running low on PPE.

-Every hospital in town has people in the ICU.

-Bars, clubs, restaurants, etc are all closed. Take-out/delivery only for the restaurants right now.

March 17 

Monday: 

-More and more patients in the hospitals here but I suspect that this really is the beginning.

-Have you figured out a back-up plan for your OB floor when someone is stuck in a COVID CS? We did one on a pending pt and it took 3.5 hours given all the PPE and transport to/from our main OR. You must have another attending on backup to come in and watch the floor when you're tied up doing that. You can't just park your resident there while you run in and out dealing with other stuff. 

-I don't know if people are desperate and bought all the chewable acetaminophen (because all the Tylenol is gone) but I could only find liquid when I tried to buy some today.

March 18 

Tuesday:

-Updated stats from WA: 65 total deaths with 35 associated with the one nursing home in Kirkland, Life Care.

-My children asked that their bedtime story “not be about the corona and social distancing!”

-My children have already started to whine about getting another vaccination, even though the vaccine is at least 18 months away. Trial started yesterday in Seattle!

-Bunch of stuff published online in Anesthesiology today re COVID.

-SOAP is officially cancelled in May. I was really looking forward to visiting Maritimes and of course SOAP. But it's the right decision. 

-Don't touch the ibuprofen! (WHO says so)

-My hospital is finally cutting down on clinic visits turning as many as possible into virtual visits or simply postponing. The hospital was eerily quiet when I left this morning. 

-Your first COVID CS will be a bit of a cluster. You can make it better by sitting down beforehand and walking through every step and making a plan for who will do what. Make sure you have a knowledgeable runner outside the room to grab you more stuff as you need it. 

-I just started virtual school with my kids and boy is it hard!

March 19 

Thursday in Seattle:

-The Department sent an email reminding us that we are not required to provide care we believe is futile and that two attendings can make a pt DNR. They said nearly all elderly patients with comorbidities who are intubated do not survive. Pt or family consent not required, but assent is good if you can get it. Sad but true. 

-My University says very few staff in any of our hospitals have tested positive and the majority of those had known community exposure. So that’s good. For today at least. 

-I found out a classmate of my kid was very mildly ill and now his mother has COVID. It’s been 8 days since the kids were at school. 

-Finally broke down and set the thermostat to stay on all day so we can stop wondering why it’s cold at 8:30 every morning. Heating bills will be high. 

-Going to start signing a logbook at work affirming we’re not sick.

March 20 

Friday in Seattle:

-Remember that deaths by suicide spike in the Spring and that social isolation is a big risk factor. Please take care of your mental health. And don't forget to look out for your teenagers, elderly relatives, friends, and neighbors. (No, I haven't lost anyone I know, just a general PSA.)

-Departmental grand rounds have become all-Zoom all-COVID for the foreseeable future and there is record attendance. What do you know, none of us give a shit about pain in rats.

-My institution is modeling that we're about three weeks away from the peak, though this depends on how well people do flattening the curve. If you can guess how far your area is behind Seattle, you can get a very, very rough guess when your peak will be. 

-My institution sent out a survey asking all of us how we feel about taking care of ICU COVID patients--asking for volunteers and asking if we'd be comfortable managing patients with protocols to follow.

-My children finally remembered that they like playing outside! They are so much happier and less stressed out now! I will hold off on school today so long as they are outside. 

-I'm on call tonight but have my nanny all day since she's on spring break. I'm going to spend the day hiding in the basement because this book chapter isn't going to write itself!  

Leave a comment