Wednesday, April 8, 2020

Start Button

I guess 3:30 is my new start button so at the risk of talking too much I suppose I'll continue.

We all got less than 24 hours notice about three weeks ago when they converted the doctor's parking lot into an outdoor COVID-19 testing site. But first, they painted sequential numbers in each spot. As I pulled into work some were still dripping and smudged with white paint. I walked into Bell's office. "What the holy hell?" 

"I guess they are giving us assigned spots."

I suppose the reasoning is that if enough people present to the ED with symptoms they can give them an assigned number to wait for the lonely (tech? nurse?) they have assigned to the lot to walk over and test them in the safety of their car. Whoever that is sits at a large table in full PPE. There's a port a potty by the stairwell. I've never seen more than three cars in the testing site. One of my employee/friends said she instinctively holds her breath every time she passes the lot on the way into work, but I reason, since I now park right above the doctor's lot and pass it on the way into work, that I am far enough away that social distance rules allow me to keep breathing. That may or may not change in the next couple of weeks.

I researched online and the outdoor testing site is a thing, so it makes sense - keep the symptomatic patients out of the hospital, send them home if you can, make them wait for test results. My best friend from med school's husband, who is an ICU nurse in Jonesboro, is currently grounded at home for 48 hours awaiting test results. It's funny - he's got cough and sinus and GI symptoms, so he got tested. She had to pass along her ED call for ophthalmology to another partner and ground herself until he is cleared. Yet our cytology supervisor, who has been grounded for a week with sinus symptoms, could not get a test in Little Rock because she didn't have a fever. She ended up going to some third party lab in NLR to alleviate her anxiety. And as far as I know, outpatient and ED testing is still with Quest, so there is a 5-7 day turnaround here in LR. The 24 hour Viracor is only if you are inpatient.

I follow a pathologist online who's medical husband tested positive a couple of weeks ago. He's nearing the end of his quarantine. It was scary for a while - he has some medical issues and they freaked around day 10-11 when the cytokine storm can happen, but he made it through at home and is now working in the yard with a cough. But the thing is he was not notified by the HD that he had the bug until a week after he tested. And she wasn't notified by the HD to stay home until he was almost over his quarantine. So without medical knowledge she might have been out and about as an asymptomatic carrier.

We've got our clinicians pushing hard for the serologic test - the one for the antibodies - but there isn't a good one out there yet. I was stressed about it when I checked on the status of the Cepheid PCR test with the micro supervisor yesterday. "Is it coming?" She rolled her eyes. "They are saying maybe by the end of the week. We've heard that a lot in the past few weeks, haven't we?" I asked her, "What are we going to do about the serologic test? I'm worried. The danger is, if we release the results of a bed test, and there is a false negative, that person can go walking around with a false sense of security and infect a bunch of other people. Then we are just creating a more dangerous situation during this thing." She replied, "If we get a serologic test, we are looking into it to make them happy, I agree there's nothing out there CAP recommends, we will only do it alongside the PCR test and release the results together. They have to submit the NP swabs alongside the blood sample. That way they can use the information together, instead of using the bad test as a solo piece of information." That makes sense, and gave me a lot of relief.

Surgical cancer cases are still running at a steady pace, but apparently a reporter called our hospital out on Sunday to our governor during a press conference for starting the OR back up so there was an emergency meeting and they were going to allow the cases this week to go through but next week is going to be dead again. This is just a public shaming technique. We are running very few OR's, and they are all cancer cases. Cancer should not have to wait a month for COVID to go through. I was talking about it with my partner Melody - if I was a patient with cancer during this pandemic I'd be freaking out. There is a point, there must be, when the invasive cells cross a lymphatic space and hit the bloodstream, rendering the tumor metastatic and high stage. It's gotta happen in an instant, overnight, what have you. It's a ticking time bomb, and it's not fair to put those patients on hold.

But decisions seem haphazard during a pandemic. Rules are not applied, at least in our country. This thing is rolling out so fast and our response is all over the map. So my thinking is that decisions made based on yesterday's information could change based on tomorrows. And all we can do is put one foot in front of the other and take it as it comes.


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