Linden Hills doctor: ‘The lack of testing creates a big problem’

The Southwest Journal is documenting the coronavirus pandemic by recording the personal stories of Minneapolis residents and workers whose daily lives are in a state of flux. As the outbreak evolves, we will be checking in with the participants regularly. Read all of the stories here.

All interviews are edited for length and clarity.

Peter Kumasaka, Linden Hills, Regions Hospital ER doctor

It’s still relatively slow in the emergency department. There’s been good messaging from the media, government and health plans to stay away from hospitals and clinics. Most of what we’ve been doing is preparing for the expected surge. I’m being set up to work in the intensive care unit if they get overrun.

We’re trying to figure out how we can manage patients who may or may not have COVID. The screening criteria for COVID is growing. It used to be just fever, cough and shortness of breath, but now they’re starting to include GI and other symptoms. 

The lack of testing creates a big problem. Normally, if you came in with emphysema and had difficulty breathing, we’d handle it a certain way. Now we’re more likely to have to intubate you because we don’t know if you have COVID or not. Even if everything else may say you don’t have COVID — that you have an emphysema or COPD exacerbation — we can’t treat you that way because of the potential you do have COVID and we can’t find out. This means more ventilators are being used.

But everything is in flux and changing every day. In New York and Italy, there are schools of thought that intubating some of these COVID patients may be wrong and that we should be doing something else to buy them time and keep them off the ventilator as long as possible. 

We’ll find hitches in how we do things and make changes the next day. In the emergency department, if you had someone very ill who needed to be intubated, normally a whole team would come into the room and help check their blood pressure, resuscitate them, intubate them or whatever. Now we’re trying to minimize the number of people in the room to prevent potential exposure to COVID. This makes communication much more difficult. We now have pharmacists and techs outside the room. How do you communicate to them when that door is closed? We put our phones on speaker but there’s ambient noise and multiple people talking and it gets jumbled, so it’s hard to tell a specific person saying, “This is what I need now.” We’ve tried different methods. We have these little Vocera communicators, and we’ve tried Bluetooth headsets. But it’s an imperfect setup that detracts from the ability to care for people.

We’re using a ton of personal protective equipment [PPE] to deal with COVID. We haven’t yet felt a big pinch, but we’re running at pretty low volumes, and if this picks up, there’s a potential we’ll run through it pretty quickly. You have to throw away N95 masks if they get soiled, if a strap breaks or if you don’t use a face shield in an aerosolized procedure. But otherwise we’re not discarding them.

We’re looking at how to extend PPE, including our N95s, and seeing if there are ways to reprocess them for reuse. If you leave things standing for a while and don’t touch them, the COVID virus will die, so you can place your personal N95 in a paper bag and let them sit. We may also be able to use UV light to disinfect them. And people are getting creative with Tupperware, finding a way to take them off and put them on without touching the mask or straps. 

I’m in a situation at work where I have more potential exposure to COVID than most people.

I’m divorced and my 15-year-old daughter is with her mom. I haven’t seen her for more than five minutes in two-plus weeks, and that’s difficult to deal with. 

My fiancée, Karen, also lives in Linden Hills and she has two boys who stay both with her and their father. Karen’s kids are at her place and if I expose them, then they go to their father’s place — and he also has another marriage and his kids also spend time with their dad. So now all of a sudden there’s a chain of connection. 

So we figured the better thing is for Karen and I to limit our contact. We interact once a day when we can by going on walks and that’s about it. We try to keep our distance to 6 feet. We don’t eat together, we don’t do anything else together. So it’s a bit tough from that end of things.

At my home, my 19-year-old son is staying with me with his college closed. He has basically self-quarantined himself in the house by isolating himself in his room. We still interact and have dinner, but we’re conscious of everything, keeping some road distance, and I’ve been pretty diligent about cleaning.

I’ve been dealing with the stress pretty well. I’m focusing on researching more about the pandemic. I’ve been debunking certain ideas on Nextdoor, such as explaining that there’s [limited] data showing the effectiveness of taking zinc or Vitamin C. 

I’ve also been looking into things more related to my work such as UV-C sterilization of PPE and the utility of the sort of HEPA filters you might use to purify air in your home. Can I incorporate a HEPA filter to help the guy with emphysema? Can we isolate him in the room by putting an enclosure over his head and then run the BiPAP to him and create a vent out of that enclosure that will run through a HEPA filter that will blow air back into the room, essentially creating a negative-flow isolation area? I’m trying to find the data behind that and whether it will work or not. There’s a lot of MacGyvering going on in the medical field right now.

This is a community-wide project and people are generally doing the right things and socially distancing and sacrificing. That’s pretty uplifting and great to see in this world where we’re always yelling and screaming at each other. It’s good to know we’re all pulling in this together. And, selfishly, it’s going to make my life a lot easier.


VOICES FROM THE PANDEMIC

 You can read all of the stories here.