HCMC physician: ‘We’re all pleased with the access we have to COVID testing now’

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

Things during the workday now feel a bit more like the normal conditions that we remember from 2019. This coronavirus is still everywhere and we still assume everyone we meet has it in the hospital and we’re still seeing a lot of folks come in with viral infections. But we’ve been forced to adapt to how this is and go about the rest of our business. Volumes are back up and our balance of cases is no longer dominated by the coronavirus, though we still have a few spectacularly ill community members. 

The number of patients in an ICU statewide has been somewhere in that 100-150 range for quite a while. We’re all holding our breath wondering if the high plateau of positive test results will eventually lead to more people developing serious illness and needing to be in the hospital or ICU. But so far at HCMC, we haven’t seen that kind of surge this fall. 

So much of that first surge in cases in April to June sickened a lot of our most vulnerable people in the community — it just ravaged the nursing homes and other congregate care settings. Those folks had a big burden of disease to begin with, and I worry they were disproportionately affected, which led to a big portion of the mortality. 

Now the folks who are increasing behavior and choices that put them at high risk — spending time around other people, not masking, etc. — those are the people we [seem to] be testing and diagnosing now. It’s possible the people now being exposed are from a healthier population. The nursing homes we work with have done an amazing job at protecting their staff and their clients, and we’re benefiting from it in the hospital. 

We’re all pleased with the access we have to COVID testing now. Our short turnaround times are great for me as a doctor because I know what I’m dealing with and I can either rule in or rule out coronavirus very quickly. We’re looking at under 24 hours for all tests and we have access to about 100 ultra-rapid tests a day for which we can get results in a half hour or an hour.  The ultra-rapid tests are great for emergency situations where a patient needs to visit multiple areas of the hospital in quick succession, such as after a car accident. Their test result determines quickly what part of the ICU they’ll go to.

As far as treatment, we’ve developed a lot more nuance in our supportive care — like how to use oxygen and like when, how and in what dose to start steroids when the lungs get involved. As part of government study trials, we’re testing hyperimmune globulin and monoclonal antibodies, which are real cutting-edge treatments for coronavirus. In another trial this winter, we’re going to be looking at how we thin patients’ blood preventatively when they come into the hospital. They spend a lot of time in bed, and we don’t want them to get clots. 

We’re fully stocked with PPE now. We’re not having to ration equipment. But it’s a new normal. I’m in a mask all day long. I haven’t seen anybody’s mouth in months. So you learn to communicate with eye contact quite well, especially in emergency situations. 

A number of my nurse and physician colleagues have had to miss work for coronavirus. I’ve worked closely with Dr. Nyan Pyae, a kidney specialist in training. When he fell sick — something that’s been widely reported — it was hard on our group to make those tough decisions like “When do we go on the ventilator?” and “What do we do when there are complications in the process?” It was pretty amazing — 80 days in the hospital and almost 30 days on ECMO. It was an intense case.

But for the most part, we’ve been pretty lucky. The number of severe cases among coworkers has been very small. The biggest burden has been a lot of my health care worker colleagues have had family members get very, very sick — whether it’s elderly parents or others with comorbidities — and we’ve cared for them. That’s been really difficult; you have a worker trying to focus on their work during these stressful conditions, while down the hall or on a different floor is a sick family member. So they’re pulled both ways. We’ve had to support them and their family. It’s an uncomfortable position to be in. 

Home life is good. Fall is a fun time; the season’s changing, everybody’s settling down a bit.

Our kids are all distance learning, like other Minneapolis students. We’ve set up desks for them in different corners. The main level of our house has kind of exploded into a classroom: We’ve got cardboard bridges, and we’ve got a scale out that measures stuff in grams. 

We try to have it like a library inside. We’re constantly shushing kids: “Hey, you’re sister’s on Zoom. Be quiet.” But they’re kids, so we try to hold their attention as long as we can. 

We’re lucky to have the paychecks still coming, so we’ve had some in-home help, a tutor, come to make sure the kids are doing their schoolwork and to try to teach them some extra things. They’re there when Fran and I are working, especially day shifts, and it helps that I can get the rest I need to for at least part of the day.  

We’ve done some gardening in the backyard, and the Prekkers are going to be the proud owners of a pandemic puppy in about a month. We chose a bernedoodle; it’s a Bernese mountain dog and poodle mix. With allergies, we wanted something with minimal shedding. We haven’t been dog owners for 15 years, but the kids just broke us down. A stress reliever, almost like a family-therapy dog, is what we’re looking for. I don’t know if that’s wishful thinking.


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