HCMC physician: ‘We’re capable of testing up to 2,000 patients a day’

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

Everyone’s been able to take a bit of a step back and take a breather from COVID. The mix of patients in our ICUs has changed and gotten back to more like we’d expect for our usual practice. The amount of critically ill COVID patients we’re seeing is much lower than our peak in April and May. 

It tracks with the statewide trend of cases and hospitalizations dropping. Though knowing what’s going on in other areas of the country, we’re wondering if we’re going to pick up again and be back in that mode we were before. 

What still gives me pause with things reopening is that there are still very sick patients with COVID being admitted every week. We just put a critically ill patient on ECMO  [extracorporeal membrane oxygenation] this morning who was young and otherwise healthy. Even though there’s a bit of a lull, the severity of the virus for certain people has not gotten lower.

Everybody in the hospital — physicians, nurses, support staff, therapists — is much more comfortable with coronavirus patients, both on the hospital floor and on the ICU. We sort of know generally how the disease works now and how long it takes people to get better. If you are a patient who needs to be hospitalized, I think you’ll have a different experience than you would if you came at the peak of our numbers. 

Day-to-day, my colleagues and I talk about what a stress it is and how we’d love life to get back to normal, but I don’t see that happening for, oh boy, many months to a year. We have to hunker down and do the best we can and do the right thing as a community and wear masks and wash hands and stay away from vulnerable people. 

We might not have big randomized trials for all aspects of care of COVID patients, but we certainly have some data and a lot of anecdotal experience about what works. Steroids are now a routine and recommended treatment for anyone on oxygen with COVID. 

We’re going to be participating, within the next month, in some high-level scientific work: a large collaboration between our federal government and industry to get potential COVID treatments tested in patients quickly to see if they’re effective. We’re starting with molecular biologic treatments using monoclonal antibodies. That plays on the convalescent plasma idea — you know, people who’ve had the virus donate their plasma — but it’s not just giving people plasma; it’s focusing on which parts of the plasma are most helpful to quiet down the immune system during COVID.

A second set of investigations will focus more on blood clotting that goes along with COVID, testing different regiments of blood thinners — durations and doses and drugs — to figure out what’s best for these patients. 

At the end of April, we did our first blood draw in a study surveying how many health care workers are producing antibodies against COVID, which tells you how many have been exposed. The pandemic was just getting started in Minnesota in April, but we found that 4% of our frontline health care workers at Hennepin — primarily nurses — had antibodies at that point. We did follow-up testing at the end of June, and we’re waiting for those results to see if the rate went up over those few months and, if so, by how much.  

We’re seeing a survival rate in our ICU of about 65% to 70% for patients who end up on a ventilator. We’ve been working with the CDC to do telephone follow-up calls with patients to figure out how they’re doing afterward. We don’t have a good sense for the recovery part of this equation. In terms of returning to your baseline functioning and quality of life, it doesn’t matter if you’re old or young: If you’re sick enough to be on a ventilator in an ICU, you may have persistent pulmonary systems and there’s been a lot of talk about the neurological and psychiatric effects. 

We’re capable of testing up to 2,000 patients a day on site at Hennepin. But some of the most basic parts of testing — the plastic equipment used to transport these things and run the test — is in shorter supply, so we’re down to 500 to 1,000 tests per day. Most are used for initial testing of new patients and those who’ve been exposed. Turnaround time for results is less than a day in most cases. Asymptomatic staff are not tested routinely; it’s driven more by symptoms and exposures. 

At home, my wife and I have been handling the risk that we’re exposed to each day by just doing things with close family. The kids are squirrely, that’s for sure. We don’t know what’s going to happen with school, which is a stressor, but we’ve enjoyed the good weather of a Minnesota summer. 

Our 3-year-old now thinks it’s totally routine to wear a mask, which is pretty amazing. I would have freaked out if I were that age. We’ve held the older kids back from their summer camps, not wanting to take excess risks. 

If schools reopen, I want a system where it can be safe for the students and the teachers. I don’t have a great solution — that’s the million dollar question. 

I believe kids learn more and do better and are better socialized when they’re in the classroom, but of course I’ve never had to do that during a pandemic. We’ll be comfortable to send our kids if there’s a system in place and our teachers are eager to have them back. 


VOICES FROM THE PANDEMIC

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