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Guest opinion

Arizona COVID doc: Rapid reopening without mask mandate is catastrophic

'COVID does not care who you are. I am scared and you should be, too.'

This week I was one of the COVID-19 doctors in the hospital. Before I went on service, I had planned to share my experiences when I got home after my last shift. That didn't happen because I was mentally and emotionally exhausted after being at the hospital for 15-plus hours.

I am going to try to break things down so that the general public can understand, because I want everyone, not just my fellow healthcare workers, to be as scared as I am.

This is going to be long, but hopefully will be worth the read for someone.

For references purposes, I am a hospitalist, which is sort of like your primary care doctor when you're in the hospital. We manage your chronic medical conditions and most of your acute issues in the hospital and consult specialists when we need additional help with complex decision-making or a specialized procedure to be performed. We are also the primary point of contact for your nurse on most issues.

I live in Arizona, the current COVID-19 hot spot. Arizona never really closed. Any level of closure that we obtained was the result of petitions with thousands of signatures from physicians. Despite pretty much being able to do anything you wanted to do except get your hair/nails done or eat out at a restaurant (carry-out stayed open), people protested the state being closed. The state reopened immediately when criteria were put out to guide how and when states should reopen. To be clear, Arizona did not meet a single criteria for reopening. In addition, masks were not mandated. Gov. Doug Ducey avoided mandating masks and made it the responsibility of city mayors to make any mandates. Mandatory masks were just implemented a few days ago.

As you have almost certainly seen in the news, the rapid reopening without mandated masks has been catastrophic. In a couple of weeks we have gone from a few hundred cases per day to around 3,500 cases per day. A few weeks ago, I was working at the COVID-free hospital designated to be the primary elective surgery campus within the network. The past few days, our recently reopened coronavirus unit has been near or completely full. I shared the patients on the unit with one other hospitalist.

Before I went on service this week, I read anything and everything I could to prepare myself to be the COVID doc. I was up to date on all of the latest recommendations. I was a little nervous, but felt like I was armed with the information that would allow me to help my patients.

I quickly learned that there is no possible way to prepare for how to treat a COVID patient. There is no rhyme, reason, or pattern. There is no possible way to predict what will happen with your patient.

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In my sign-out to the doc taking over for me today, I prefaced the individual patient sign-outs with, "one slightly improving, one with less oxygen requirements but possible new liver failure developing, everyone else getting worse."

I have never seen anything like this. None of us have.

We have no idea what we are doing. We are sharing evidence from small studies that could help and utilizing treatments that we think and hope are helpful. Of course, we also thought hydroxychloroquine was helpful a couple of months ago.

So, we're hopefully helping people, maybe hurting them, and trying our best. We are flipping people on their stomachs while wide awake on a machine pushing oxygen into their lungs to try and help; this is called the prone position, and it works, but you're stuck in that position for as long as we can keep you there. The longer the better. Anyone on supplemental oxygen is receiving dexamethasone based on the European study that came out last week.

We were using Remdesivir, but a patient I admitted two days ago is the last one that will receive it from our current stockpile. Convalescent plasma from patients that had COVID, recovered, and donated plasma is being administered, but studies suggest that antibody concentration diminishes by up to 90% within 2-3 months, so who knows if that's even doing anything.

I realized in the past two days that oxygen saturation numbers that you see on the machines are completely worthless in many COVID patients.

So, the one thing we thought we knew, that COVID causes profound hypoxia, was true, but it's actually much worse than we thought. In order to figure out if you are hypoxic (low blood oxygen levels), a needle is stuck into an artery in your wrist as often as is needed.

It hurts. A lot. I will have a needle stuck into your artery as often as I need to. I'm sorry, I know it hurts, but it's for your own good.

In any other time, most of my patients would already be intubated on a ventilator. We are managing so many critically ill patients on regular hospital floors. If we sent everyone to the ICU that would normally be there based on their current status and put them all on ventilators, all resources would be depleted in a day.

The patients I cared for the past few days were the most miserable, uncomfortable, terrified patients I have seen in the past four years.

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I sat with them while they cried because they are scared that they will get worse and get intubated and die without ever seeing their loved ones again.

I can't comfort them by saying they'll get better soon, because I don't know that they will.

All I can tell them is that we're doing everything we can and I really hope they improve. I held a patients hand while she cried and screamed, "Oh my god, I'm going to die, aren't I? I'm dying" when I told her we couldn't give her more oxygen without intubating her and putting her on life support.

I then tried to comfort her children over the phone after I informed them they were not allowed to come in to the hospital to be with her.

They asked if someone could be there to comfort her if she is going to die.

Many of my patients were young. Many have no underlying conditions that predispose them to a bad outcome, yet are one bad blood oxygen reading away from needing to be intubated.

COVID does not care who you are.

I am scared and you should be, too.

All of this is to send the following message:

Please, please, stay home if you can. If you need to go out, WEAR A MASK! Do not touch your face. Wash your hands and sanitize often. I can't promise you won't end up in the hospital with COVID-19 even if you do all of these things, but I promise it's the best shot you've got.

To be clear, COVID-19 is caused by a virus. This is a PUBLIC HEALTH CRISIS. It is not, never has been, and never will be a political issue. Politics have played a huge role in getting us into this mess, and it's time to cut them out. COVID doesn't discriminate, and it definitely doesn't care who you're going to vote for. When you see/hear/read anything related to COVID-19, pay attention to who is posting the information. If it is not coming from a medical professional, question your source.

P.S. THANK YOU to all the amazing RNs, RTs, PCTs, pharmacists, pharmacy techs, lab techs, physical and occupational therapists, social workers, case managers, environmental service workers, and everyone else that makes it possible to care for these patients in the best way we know how. You don't get enough credit. You all are the real MVPs.

Dr. Brandon Bikowski is a hospitalist in Arizona.

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