HCMC physician: After months of low volumes, trauma center was ‘back to business’ during protests

Dr. Matthew Prekker

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.

This interview was conducted over the phone and has been edited for length and clarity.

Matthew Prekker, critical care physician, Hennepin County Medical Center

What we see in the hospital has lagged a bit behind what’s going on in people’s homes in the community. We’ve been watching case numbers closely and have seen an unexpected plateau, or even the start of a decrease, in Minnesota, though we’re not feeling that drop yet in the hospital. We’re very busy and still have a lot of people who need critical care. 

ICU volumes are still very high. Fortunately, we’re not having to do any rationing of ventilators, but we’ve realized what an asset our skilled critical care nurses are. Personnel shortages have limited our ability to expand services and we’ve had to partner with other hospitals to share the burden of critically ill COVID patients who need ventilators. This is not because we don’t have machines but because we need the correct teams to take care of patients. 

To my knowledge, we haven’t seen many health care worker infections — certainly not serious infections. [HCMC is not publicly disclosing the number of staff who’ve tested positive for COVID-19. Prekker said the hospital hasn’t shared the number with staff internally. As of June 11, nearly 1,900 health care workers had tested positive for COVID-19 statewide after a workplace exposure, according to the Minnesota Department of Health.] Our personal protection equipment [PPE] is working. That’s a credit to our infection-prevention team and others for setting up a system that really protects people.

As the weather has gotten warmer and more people have gone outside, there have been more serious injuries and trauma cases needing ICU beds. Serious car and motorcycle accidents, watercraft injuries. Partner hospitals around the metro and the state have helped by taking some patients with coronavirus so we have room for these patients. We’re still not seeing patients with illnesses like strokes, heart attacks, serious bacterial infections and sepsis in the numbers we normally would, though that caseload does generally tend to taper off some in the summer. My work is still dominated day in and day out by patients with acute respiratory distress syndrome due to COVID. 

[George Floyd’s killing] has been something my wife and I have reflected a lot on and is something I think about every minute of the day at the hospital. It’s an absolute tragedy, and I can’t come up with words to describe the pain I see in my friends and family and community. I’m relatively sheltered in where I live [in Linden Hills] from the worst of the civil unrest, but I understand where it comes from and we’ve been able to support the peaceful protesters and hope for change in the community. 

I’ve thought more and more about our neighborhood and the city of Minneapolis and a way forward in government and policing and public health. I think those are the risks in our community that need the most attention right now. I want things to be better at the end of all this.

I’ve felt a very profound sadness about what’s been going on. It’s really a bizarre situation to have a surge of patients who are injured and otherwise very upset amidst us in full PPE and masks working during a pandemic. It’s not something I ever imagined I’d be doing. 

We treated injuries from exposure to crowd-control measures like tear gas. There were falls and broken bones and injuries from rubber bullets. The mood at the hospital was pretty tense. Through the spring, our volumes as a trauma center and a very busy emergency department were down 20% to 30% based on people sheltering at home, but during those days our volumes were picking up. It did feel like: Now we’re back to business. 

This virus has an incubation period of, we think, one to two weeks. So we need to watch carefully to see what happens. The patients we see affected at HCMC are disproportionately folks of Hispanic and East African descent. We haven’t seen a lot of the folks we watched protest downtown come to the hospital yet, but I am worried there may be viral transmission. A lot of testing and contact tracing is hopefully how the state is going to get over the hump of the pandemic.

My wife and I haven’t returned to restaurants or fun things we used to enjoy yet. We’re keeping our kids very close to home. It’s been a long time since I’ve gotten together with my parents, who are in their 70s. So we’re still being very careful. 

I think the reopening that’s gone on has been very thoughtful. In our neck of the woods, people are wearing masks and sitting outdoors to eat, which makes me feel very good. I believe there is asymptomatic spread of the virus, so during an incubation period people can go about their lives and still infect others.

The majority of folks we’re seeing with unfortunate outcomes from COVID are folks who are later in life and have comorbidities. The toll this has taken on our nursing homes and group homes and structured care settings has been remarkable, especially in terms of death.

I direct the ECMO [extracorporeal membrane oxygenation] program at the hospital. ECMO is a specialized form of life support — the last step beyond a ventilator to keep someone alive. It uses a small portable heart-lung bypass machine to take lots of blood out of someone’s core, adding oxygen and removing carbon dioxide before returning the same blood back to the patient. It’s essentially a dialysis machine for the lungs. 

It’s been very helpful for our sickest patients who have COVID. People with acute respiratory distress syndrome who we think have a risk of dying in the ICU of 50% to 80% are candidates for ECMO. It’s for people whose action levels are critically low despite all our conventional means of supporting their lungs and body — giving them mechanical ventilation, flipping them to their stomachs, paralyzing their muscles. We have strict criteria to ensure we’re not using ECMO too early, when it’s not actually needed, or too late, when the patient’s actively dying.

There’s a small community of ECMO centers across the state with a total of 50 to 55 machines. We’ve had a couple times when we’ve used all four of our ECMO circuits, so we were able to arrange transfers to other centers. We’ve had well over 100 patients on ventilators at HCMC so far and have done seven ECMO treatments. Just a fraction of ventilated patients are able to benefit, but for those few, I believe, a lot of them would have died without it.

In treating most COVID patients, we’re still using the fundamental principles we’re trained to use in critical care. We’ve had to learn to be very patient. The lung’s a very fragile organ. It’s the organ that’s exposed to the environment continuously — unlike the heart, the liver and everything else. When it gets injured from a viral infection, it takes time to get better. Without a proven treatment, we spend a lot of time waiting.