A New Normal

I have been going to work now with a mask and a shield. No, I did not become Captain America, nor did I become an Avenger. What I meant is I’m going to work with a medical face mask and a face shield. This has become the new normal for me.

If I am going to do a procedure that is at risk of aerosolizing the virus, like putting an endotracheal tube or doing a bronchoscopy on a known or suspected COVID-19 patient, then I even use my “powered suit.” Not a powered suit like that of Iron Man, but it is a battery powered air-purifying respirator or also known as PAPR.

I rarely take my temperature before. Now, it is taken at least once a day and sometimes more. This daily temperature probe is not to determine if I’m ovulating or not, for the last time I checked I am a male. For your information, the “temperature method” is a family planning method that takes the woman’s daily basal temperature to determine if she is in her fertile or infertile periods of the menstrual cycle.

I am having my temperature taken whenever I enter the hospital, with additional screening questions of “Do you have fever, cough or shortness of breath?” If from the hospital I would go to the outpatient clinic building, I would get my temperature checked again and have the same screening questions, with an additional inquiry of “Were you exposed to a person with known COVID-19?” The last question is tricky to answer, for if I say yes, then they might not let me enter the building. But how else could I answer that question if I have just seen patients with confirmed corona virus in the hospital? Lie, if we must.

I don’t know if we have flattened the curve in our community. I am not talking about the bulge around the waist, for that has definitely ballooned more in many people with the stay-at-home order and the uncontrolled eating, plus with the gyms being closed. I guess a mask can help with this, as it is impossible to eat when you’re wearing a mask. But I digress.

We still have lots of COVID-19 patients in the hospital, though it maybe less compared to two weeks ago. Yet I still saw 15 COVID patients in the ICU this weekend, and many of them were on ventilators. I say it’s less, for at one point we had more than 20 COVID patients in the ICU and had a steady admission of 1 to 3 more a day. Good thing was many recovered fast, although some also died. There was also a time that we registered close to 50 admitted COVID patients in our hospital, both in the ICU and wards. So are we really flattening the curve?

Even though it is terrifying, we as physicians, have gained lots of knowledge and experience taking care of the critically ill COVID-19 patients. One thing we learned is that not all COVID patients with severe hypoxia needed to be on ventilators. Placing them on humidified high flow (pressurized) oxygen via nasal cannula can prevent intubation, and in fact they have faster recovery and less complications with this. Of course there are still patients that would require ventilator as a last resort, but we probably avoided more than half of our COVID patients from getting on a machine. Our experience in our hospital was extremely good that it was even featured in the local news. We might be publishing a paper on a medical journal about this experience in the near future.

Our hospital has also gained so much experience in placing patients on prone position if their oxygenation is failing. Never have I seen so many ICU patients on their belly. If the patient is awake and not on mechanical ventilator, we instruct them to lay not on their back if able. If they are sedated and on ventilator, we avail a team to flip them on their belly. And based on our experience, this really improves their respiratory status – belly down prevents them from going “belly-up.”

There are also interventions that have rapidly fallen out of favor, at least from our experience. Like giving hydroxychloroquine, the anti-malaria medicine, which we initially give to all our infected patients at the onset of the pandemic, but stop doing so. I don’t want to be political, but there is currently no robust data supporting it. We are also part of the on-going study of giving convalescent plasma to our patients, that is transfusing blood from a person that has recovered from COVID-19 and thus has presumed antibodies. We are also giving other drugs like Remdesivir and Tocilizumab, agents that are still under investigation. We are even conducting our own small trials using other novel drugs. At this time, no one really knows which medicine works. It might turn out that all of these medications are worthless.

As we open our communities more and more, I am anxious that we would see a second wave of infection. Yet I have to accept the fact that we cannot keep the world close indefinitely, for that is not considered living either. We just need to embrace the new reality.

For simple recommendations, first, we need to keep a distance from each other. At least 6 feet they said. But is that distance scientifically sound when we know that a sneeze or a cough particle can travel much farther than that? That is why wearing mask is helpful, for it protects us from each other if we cannot keep a safe distance.

So another new normal is that we need to wear a mask when going out. I know it is a barrier for communication as we cannot see the facial expressions when we talk to people. It is really bad for the deaf or for those who read lips. Probably good for people with bad breath, for they can be accepted back to the society. And perhaps sad for many, as we cannot see anymore each other’s beautiful smile.

Lastly, no more handshakes. This act of shaking hands evolved from an era when nobody was trusting anyone, that people have to approach each other with an open hand to show that they were not holding a dagger as they meet. This developed into the custom of a handshake. Maybe now we need to greet each other with a bow, like some Asian cultures do. Or maybe a curtsy. That would be cute. Or perhaps some kind of a salute. Just not the “Italian salute.”

Stay safe everyone.