US.

now has the most reported COVID-19 cases of any country in the world.

This is like having a hurricane hit every single city across the United States all at the exact same time.

To find out what it's like the health care workers on the ground and to learn more about the hospitalization timeline of a patient with Covid 19.

I called up Dr cedric dark.

He's an er physician in Houston texas.

So you have a waiting room full of people in the er who coughing who have fever.

How does triage work in the er from the beginning of this we have literally separated anybody with cough and fever from everybody else in the hospital.

Other hospitals have tent set up outside to screen people.

Initially it was we're going to ask have you been to any of the countries where it's present?

Have you been around somebody that's known to be diagnosed?

And are you having a fever?

If you screened in for any of those, you're definitely thrown into this separate area then symptoms?

Are you feeling short of breath?

Are you having cough?

If you have any of those issues going on, you're put in this special area where we can screen you where we can keep that part of the er and the providers there give them the maximum amount of personal protective equipment, keep them safe and then also keep everybody else in the er safe.

Because still we're going to get heart attacks, we're gonna get strokes.

We're going to get people that have been in car wrecks and we need to keep those folks safe from catching communicable disease as well.

If I see somebody that does have a fever or that does have some abnormal sounds when I listen to their lungs, that person I think warrants getting a chest X.

Right as the disease progresses there are these things called infiltrates or little white spots that form in the lungs.

When you look microscopically inside the lungs.

Think of it as like little bits of fluid or plus or something that sits inside the lungs which normally are like a nice little sponge and that makes the exchange of oxygen with the air harder to happen.

And so therefore that's why people start feeling short of breath to talk us through a bit about what the chest X rays er look like as somebody maybe first has covid 19 and then as they get sicker and sicker that one that you're looking at right there um That X ray looks fairly decent.

I don't see a ton of haziness or white spots.

What about this X ray?

Yeah that was bad.

Not only can I see on the X ray that the person is ventilated, they have a breathing tube in their in their trachea or their windpipe.

Um You see a lot of these little patchy spots, like the little white spots all over the lungs and it's on both sides of the lungs so that you know tells you that all that nice airfield sponge, spongy nous of the lung has been filled in with fluid and gunk in this particular person.

It's probably so bad that they couldn't be maintained just with like oxygen through the nose that they had to put in a breathing tube to give them additional oxygen.

How would you treat this patient?

Let's say a patient comes in the short of breath.

They get this X ray at this point in time I know I'm going to be admitting them to the hospital and that person essentially is what the CDC would call a person under investigation.

Um And so that's the patient that would get tested.

Once that decision is made to hospitalize them.

And so we would do the test right now.

The tests are taking a long time to come back.

The testing at this point is not for therapeutic purposes, it's more for epidemiological purposes.

What help and support can you give Covid 19 patients is where it gets a little tricky because there's no defined treatment specific for covid 19.

What we need to do is what we call symptomatic treatment.

What that means is if someone needs oxygen, we give them oxygen, They have fever.

We might give them medicines to reduce their fever.

But other than that, we kind of have to wait for the virus to take its course.

If someone goes into what we call respiratory failure, where their lungs can't pull in enough oxygen, that's when we have to put them on a ventilator machine and so we do that procedure where we put the tube through the windpipe.

So all of those patients have to be put into a medically induced coma.

They stay on the ventilator machine for the duration until they improve and get better and can come off as the disease progresses.

If it gets worse, those little white spots you saw in the lungs could consolidate even more and more um into a condition called a R.

D.

S.

What that means is the lungs become completely useless and it's almost impossible to deliver enough oxygen to keep them alive.

At which point, you know, someone could eventually succumb from the disease.

When would you take someone off a ventilator if someone gets really sick and they've been on that ventilator maybe for a few days.

Hopefully the inflammatory response or the virus affecting the lungs starts to resolve and their lungs clear up and they can be taken off the ventilator and go back to living a normal life.

What point are you thinking about rationing ventilators?

And who would get one?

And who wouldn't those decisions are happening right now?

Um, and doctors are thinking about that and I'm fortunate to not have to think about that at the moment, but it may become a real thing if people don't take this seriously enough, what our hospitals in the Houston area doing to get ready for a potential surge of patients.

So one of the things that they've been doing is we've been canceling elective surgeries so that we have fewer people in the hospital in the first place.

Um The other thing that we've been doing in hospitals, not only in Houston, but across the country has been trying to figure out ways that we can use one ventilator machine for more than one patient.

Not only are we dealing with a deadly disease, but we're also dealing with the inadequate resources to protect ourselves from that disease.

We have supply chains that potentially could be disrupted.

We've seen people kind of hoarding things ranging from toilet paper to N- 95 masks, even when they don't necessarily need it.

We've had to conserve resources by reusing stuff that should only be used once and instead using it all day.

Um as long as it isn't soiled the PPE that we need for every confirmed patient, Um to be absolutely safe would be a gown gloves, face masks, either surgical mask or in 95 and eye protection with like a face shield or goggles.

In terms of what most hospitals are experiencing shortages of.

It's the masks, sometimes the face shields, that's what we're typically having to reuse on shift.

Is this a situation you ever anticipated being a doctor in America?

Never.

I mean, we think of the US as one of the most well resourced places in the world when it comes to health care, but it just goes to show that when there's sort of widespread panic, normal supplies can be depleted fairly quickly.

And how do you mentally prepare for what might happen and what's happening right now?

Not much is different from what we're used to doing every day in an emergency department.

We're used to taking care of sick people.

We are notoriously the people that think about the worst case scenario of the medicine world.

We are probably the doomsday preppers.

But the thing where we're not prepared for is making the ethical decision of once we reach our saturation point, who do I decide lives and who do I decided guys that were not ready for?

We don't know how big this surge is going to be when it hits, right?

If it's small and we can whether that storm great, but if it is long and sustained then it might completely flooded overwhelm the system and with it it will impact the health of the people on the front lines and you have a kid at home.

So how are you managing that?

Coming home from the er and being at home, it's pretty difficult.

I think the one thing that seems a little bit reassuring is that at least Children seem to fare better at this than adults are, especially older adults.

My message for the public three Things # one, Stay Home Save Lives.

We need to flatten the curve on this.

Number two, please do not come to the emergency room expecting it at a covid test.

If you're well enough to stay home, stay home because we're not going to be testing you anyway.

Um, and number three, if you happen to have any of that personal protective equipment that we could use in the hospital, consider donating it to your local facility or to the doctor that might live down the street from you really grateful for your time and thank you so much for explaining the situation to us.

No problem.

Thanks.