By Dr. Katie E. Golden, MD

April 15, 2020

The last month has been difficult for us all, and everyone has experienced the life-changing challenges of this pandemic in their own way. 

It is even harder when we can’t see exactly how this virus is affecting the members of our community beyond closed businesses and long grocery lines — there is no storm outside our window or live video footage from the frontlines that we can watch. Instead, the direct impact of this virus is occurring inside hospitals with locked entrances and no-visitor policies. While there may be a lot of uncertainty about the road ahead, I want to at least shed some light on the current state of the Charlotte ERs right now. You deserve to see how your social distancing efforts are truly making a difference for patients and healthcare professionals.

 

How are we doing in Charlotte?

I am sure many of you are keeping tabs on the reported number of cases in Mecklenburg county (about 1000 documented cases as of April 14, but keep in mind this is an underestimation given only select patients are being tested). In Charlotte, we have been fortunate to have extra time to prepare for the expected peak, which is now anticipated for the end of May or early June by the latest models. Our hospitals have taken measures to maximize hospital beds and supplies in anticipation of increasing COVID patients over the coming weeks. Patient volumes in the hospital are currently low, and we have plenty of open beds. 

So if I need to come to the ER, what should I expect?

Given our efforts to flatten the curve are working, the local ERs are currently much less crowded than normal. If you need to seek emergency care, for COVID-related symptoms or not, we are currently able to accommodate every patient quickly and efficiently. This has also helped us to implement several measures to keep patients and our staff as safe as possible, which will impact your experience should you have to come to the ER.

  • During most hours of the day, we are performing triage and testing outside the ER. A medically trained professional will assess your symptoms before you enter the building, and determine if you are safe to be tested and return home, or if you should proceed into the ER for further evaluation.
  • Any patient with COVID symptoms is masked prior to entering the ER, and is then taken to a room that has been specifically marked and cleaned for ‘COVID rule out’ patients. The door is kept closed at all times, many of the rooms have ‘negative pressure’ or ‘HEPA filters’ to limit the likelihood of aerosolized particles, and every effort is made to limit entry and exit out of the room.
  • As a patient, you will notice changes to the way we evaluate a patient. Many doctors and nurses are talking to the patients by phone whenever possible and limiting touch on the physical exam to avoid unnecessary exposure for both the patient and doctor. When a doctor or nurse comes into the room, full (and clean) protective gear is worn. This includes eye protection, a mask, plastic gowns, and gloves.
  • Doctors are very mindful of your time in the ER, and making every effort to be efficient so that you are not spending any more time in the hospital than is necessary. As a patient, you may feel like you are spending most of your ED stay in an empty wind tunnel (those HEPA filters can be loud!), but know that we are working hard for you on the other side of that closed exam room door.

How do you determine which COVID patients need to be admitted to the hospital?

Many patients can be assessed, tested, and safely sent home before they even have to check in to the ER. Depending on symptoms and vital signs, some patients require a little more of a workup. After a more involved workup (which typically involves blood work and a chest Xray), many patients are still safe to be discharged from the ER and monitor their symptoms at home. If a patient requires hospitalization for the virus, this is most often because their oxygen levels are low, and they require supplemental oxygen to maintain normal levels. A patient’s age and chronic medical conditions play an important role in the decision to hospitalize a patient as well. More specifically, patients with underlying lung and heart conditions may require extra attention and monitoring.

When patients are admitted to the hospital, what kind of treatment are they receiving?

This virus has been admittedly difficult to treat, not only because of the rapid transmission but also because it is affecting patients in ways we still don’t fully understand. There is, unfortunately, no specific medicine we can give a patient to get rid of the infection. Treatment, instead, involves supporting the patient as best as possible while their immune system fights off the infection. This most commonly means respiratory support to keep their oxygen levels normal; this can be as simple as nasal prongs delivering a small amount of continuous oxygen, or as significant as putting the patient on a mechanical ventilator. There are additional adjunct treatments that some patients receive to help support their immune system and kidney function, both of which can be affected by the virus.

I want to conclude with a thank you to all the wonderful people in our community who are putting their individual needs aside and following stay of home orders for the benefit of the community. Your sacrifice is making a difference, even if you can’t see it directly. We will make it through this together, and we are proud to be serving you as your local ER doctors. We are here and ready to help if you or a loved one needs us.