39. COVID-19: A Physician’s Journey Through the Pandemic!

It's been 5 years since COVID-19 hit us. My take on the events during and after the Pandemic 5 years ago. A lot has changed since the start of the pandemic.

It was spring 2020, and the patient came to the ER(Emergency Room) with severe breathing issues. The ER was already packed. A sea of people was already gathering in the ER. It's only 7 am. Typically, the ER is slightly less busy, but it was crazily busy that day, and top it off, it was a sign-off time when the new team arrived to take over the overnight team. ER doctor called me to see if a patient was to be admitted to the step-down unit. This patient was in his mid-50s, morbidly obese, with a history of hypertension and diabetes. He started coughing for a few days and has difficulty breathing and high fevers; he was exposed to someone sick at the office. In the ER, he was noted to have rapid breathing more than 30 times per minute Average is 12-18). As in any systemic illness, the first thing the body shows signs of sickness is the subtle increase in rapid breathing. It's how the body responds to illness, especially the severity of systemic infections like sepsis, etc. This patient's working diagnosis was suspected pneumonia. The ER doctor said there was something strange about the patient. Can you admit this patient?

In the ER, for patients who tend to be sick, the ER wants to get them settled into the appropriate hospital beds, either ICU/ IMC or hospital floor beds. This patient was noted to have severe breathing problems, and as per the ER doctor, they stabilized the patient. Now, it's our turn to assess the patient and lay eyes on them to be stable for intermediate care. As I looked at the patient chart, I noticed a few things. This patient was severely hypoxemic; his oxygen level was low, his white count was elevated, and his heart was beating fast, indicating severity; he appeared critically ill. When we looked at the XR, it showed bilateral congestion in the lungs. ER doctor noted patient XR showed what appeared to be whiteout of both lungs, indicating possible severe pneumonia. As the patient was low on oxygen, he was placed on high flow with possible pressure support. Even with the pressure support, his oxygenation was borderline and continues to be tachypneic(breathing more than usual), better than when he came but still breathing rapidly.

Due to the critical nature of the patient, I agreed to admit the patient to the step-down unit. The patient needed a higher oxygen concentration due to the nature of the illness. The patient was started on a cocktail of medications, including antibiotics, steroids, and high-flow oxygen with pressure support. The patient continues to breathe hard; when somebody breathes so hard, they can tire out the lungs and heart and cause decompensation, severe injury, and even death. Hence, we recognize that as the breathing worsens or oxygen, we intubate(artificial breathing tube down the throat) the patient to give rest to the lungs. Overnight, he decompensated, unable to hold his blood oxygen levels; he was intubated and transferred to the Medical ICU, where he was treated for ARDS (acute respiratory distress syndrome), requiring significant monitoring, and stayed for more than a week. Even after a week, he continued to show sickness and was relentless. He was transferred back and forth to the intermediate care unit. After a few weeks, his body finally showed signs of improvement. Patient had COVID 19. Many of us actively taken care of the patients during the initial phases, typically managed with multiple antibiotics, steroids, Antivirals, Monoclonal antibodies, etc. These were all happening while protocols were changing in the individual hospitals.

Obesity significantly increases the risk of severe COVID-19 complications due to its impact on immune function, lung capacity, and overall metabolic health. Individuals with a BMI(Body Mass Index) ≥ 30 are more likely to experience hospitalization, ICU admission, and mortality. This patient had BMI>30 and diabetes making him vulnerable for the contagion. Obesity also impairs lung function, making breathing more difficult and increasing the risk of acute respiratory distress syndrome (ARDS). Additionally, it raises the likelihood of blood clots, which, combined with COVID-19’s hypercoagulability effects, can lead to life-threatening complications. After around 4 weeks on full oxygen support, he finally was out to the hospital floor. The patient was later discharged to acute rehab as this caused extreme weakness, and continued to use oxygen for support.

Shout out to all the medical professionals including Physicians, Nurse practitioners, Physician Assistants, Paramedics, Respiratory techs, Medical assistants, and the all the family of the medical professionals to deal with the COVID- 19 Pandemic. 

This patient's story had a positive outcome; however, many others did not survive. It was a devastating time, with numerous patients being placed on and off ventilators, and some ultimately passed away. This experience has left a lasting impact on me and all the physicians who provided direct care during this period. The nurses, physicians, technicians, nurse assistants, and ER staff who worked during this time were true warriors, fighting tirelessly for their patients. The sacrifices made by these dedicated medical professionals saved many lives.

It's been 5 years since COVID-19 hit us. My take on the events during and after the Pandemic 5 years ago. A lot has changed since the start of the pandemic.

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COVID 19, Courtesy CDC

2020 started with a bang. I spent the last weekend of 2019 in California with friends and family. It was a memorable time(it feels like ages). As an avid travel enthusiast, one of my pastimes is to look for unique destinations with culinary tastes all over the World. After the vacation in January, things have been returning to normal, returning to the huddle as a physician and running a small practice. To put it simply, I have come back to the grind. I started seeing patients in and out of the hospital. I was covering other physicians during the weekends. I was working 24/7. Also, rounding in rehabilitation centers and nursing homes as time permitted. This was when I was practicing inpatient and outpatient medicine, and critical care fully involved in patient care. I have just been on my own for more than a year.

By mid-January, it was noted that some strange cases were going on in China. The information was half-baked news. Obviously, China was not letting the news out. Later, we found that some patients sacrificed themselves to inform the world, especially the ophthalmologist from China, Dr. Li Wenliang, who warned the rest of the world on social media about suspicion of the contagion and later passed away with the same infection. They have been reporting that it started in the wet markets of Wuhan; a virus was mutated out of dead bats and dead Pangolins(stories of manmade viruses also got a lot of press). I am busy with my usual stuff, bills, EHR, and patients; since my practice is only over one year old, I am trying to build a patient base. I was doing reasonably well and was staying busy.

When the Chinese New Year hit January 22, 2020, either the NY Times or the Washington Post alarm bells were ringing about the nature of COVID-19 disease. As this was a holiday month for the Chinese, people from the Republic of China had already started traveling out of Wuhan, China. More than 5 million people might be traveling out of Wuhan province, China, as part of their month-long holiday worldwide. And where do they end up? They ended up in the most traveled holiday destinations: Italy, New York, Paris, Madrid, San Francisco, etc.

In February, it was noted that contagion was happening fast, and Chinese people were dying in scores. The whole region was under lockdown. Actually, they have shut down the country. WHO declared an emergency during this time. The ban on Chinese passengers entering the country went into effect. In Italy, the first few cases were noted, and wildfire spread in and around Venice, which soon engulfed the whole of northern Italy, especially Lombardy County. Back in America, President Trump was unprepared and never thought something like this would hit the shores of America. After denials for a few weeks, we lost the prime time combatting coronavirus. We started looking more seriously at the end of February. Finally, the WHO returned and said it was a pandemic (I believe it was too late).

My work in February was ongoing. I was seeing patients, and I wanted to wear masks, but unfortunately, hospital systems were not prepared and advised staff not to wear masks. In the beginning, there was chaos in the medical world. Nobody knew the correct policies to combat the virus during the pandemic. We didn't know where the enemy was coming from. Everyone was in the dark, waiting for some light, but the light never came….

By March, things took a turn; we started to see death rates climbing exponentially in Italy; it was the time that the US began with few cases in the second week, the finally executive office started noticing the impact in Italy and most of Europe, found Corona Virus Taskforce to combat the pandemic in America lead by Vice President pence. It was declared a National Emergency to free up resources to fight the deadly pandemic. I still remember that it was March 2nd week, per CDC, with a social distance of at least 6 feet, washing hands, etc., when a campaign started. Also, as the testing for the coronavirus failed miserably, especially our shores in Washington state and New York began to hit badly initially. CDC was unprepared for the onslaught, and testing was a big failure; as most of you remember, the testing took 7-10 days to report as the samples flew back to CDC Atlanta.

This time, things were changing on the medical side and giving care to the patients. Now, changes were happening by the minute. I had to shut down my office and start arranging Telehealth services. CMS just approved TeleHealth services as part of the Emergency. It was the new normal for patients and doctors alike. The shortage of PPE(personal protective equipment) in the hospital was palpable. It was not until mid-March that wearing hospital masks was mandatory. We started seeing COVID-19 patients trickling in by the end of March. Being a smaller community hospital, things were in full gear. Multiple meetings among the hospital staff on how best to tackle and what treatments are best were discussed weekly and sometimes daily.

In March 2020, everything we take for granted changed; things were not the same. Meeting friends and family became distant. Going out to get groceries was like warfare; schools were closed, and at home with kids, trying to stop them from playing either Roblox or Minecraft. Life as we know it came to a complete halt. Never Imagined we would relive the 1918 Spanish flu again. It was only read in the books. At least this time, we have much-advanced health care to tackle the complications, either putting them on ventilators or giving antibiotics for bacterial infections. At the end of March, the government took drastic steps to help practices and Doctors through various programs, including much-needed loan guarantees to stay afloat. Thanks to the US government, many smaller practices and hospitals benefitted from the program. Unfortunately, millions of people lost their jobs.

In April, things started to peak; New York was the worst hit of all places. Exponential deaths have been reported in New York and surrounding New Jersey. One of my previous work Hospitals in New Jersey was severely hit with some staff being sick and ending up on the ventilators, battling for their life. The whole hospital was turned into a COVID hospital. In Virginia, things started worsening. It was said that as NY starts to plateau, VA/MD/ DC will begin to peak, so we were ready to take care of the patients. I have signed up for the Surge physician if needed.

“The world came together while staying apart.” -Anonymous

While in the hospital, the COVID unit where the patients were kept was like a war footing; first, one must appreciate the fight against the unknown enemy; we have become warriors(you can call COVID warriors). Everyday, I go to the intermediate care unit and notice all the staff in scrubs and at various levels of donning and doffing (wearing and removing personal protective equipment). This is no less than a war. The doctors, nurses, and techs are fighting in the frontlines, taking the whole thing off and on for every patient, placing it back on every time, and knowing the unknown enemy lurking just next to you. The impact on healthcare workers is immense, both physically and emotionally. It is commendable to see how people come together and work for the common good, caring for the patients, especially in dire situations like this.

The doctors, nurses, and techs are fighting in the frontlines, taking the whole thing off and on for every patient, placing it back on every time, and knowing the unknown enemy lurking just next to you.

Approximately 1.2 million people have lost their lives to the deadly contagion, causing numerous ailments for countless others. This pandemic has become one of the worst crises that America and the world have ever faced. It is a stark reminder of what is truly important in our lives: cherishing our families and maintaining strong bonds. Please take care of yourself—exercise, eat well, and reflect on your experiences. The pandemic has changed many of us in various ways. Like many other medical professionals during the pandemic, I was glad to have the opportunity to serve the population in need as a physician on the frontline. Will I do it again? You betcha!

Suman Manchireddy MD FACP

Internal Medicine,

Leesburg, VA.

Email: Care@ReliantMD.com

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Disclaimer: This is for purely informational and educational purposes only. Seek medical advice before starting any testing or treatment regimen. The data presented here has been extensively researched and condensed for a broader audience, and it should be viewed for educational purposes only. The blogger or blog has no affiliation with any pharmaceutical company.