Dr. Richard Vu and his wife Dr. Shabnum Matthews-Vu talk about the risk every night. As the novel coronavirus, which causes the sometimes-deadly condition COVID-19, continues to ravage El Paso County, the physicians are very aware they could pick up the virus and bring it home to their family. But at the same time, they are physicians motivated by a longtime commitment to mission-driven medicine.
“Yes, we have that concern,” said Vu, an internal medicine specialist and founder of the Matthews-Vu Medical Group. The group includes a multi-specialty clinic in Southeast Colorado Springs. “That is why we are very careful to protect ourselves and our staff at work, [with] appropriate personal protection equipment, frequent hand washing, etcetera.
“But above that, however, my wife and I talk about almost every day: This is what we signed up for. This is what we decided to do many years ago when we entered medical school, and this is when the rubber meets the road. When the rubber meets the road, who’s going to rise up and do what we signed up for?”
In the midst of a global pandemic, health care providers throughout the region are bracing for the challenges of responding to a crisis that still wields its share of questions — when will it end? What will the world look like after it ebbs? How do we get ahead of it, rather than just respond? What, if anything, is the pharmaceutical solution?
There is a well-documented global shortage of personal protective equipment (PPE) such as face masks and gloves, and ventilators necessary to treat the profound respiratory illness.
In Colorado, we have been under a stay-at-home order since March 25, prohibiting unnecessary travel and encouraging non-essential employees to telecommute. Schools have been out of session since March 16, with a gubernatorial order issued April 1 keeping them that way through at least the end of the month.
The entire point of all the isolation is to slow the spread of COVID-19, which disproportionately impacts adults over the age of 65 and those with underlying medical problems.
While El Paso County Public Health information suggests about 80 percent of patients could be expected to recover from the condition without major complications, there is still something called the R0 (R-naught factor) at play. Basically this reproductive factor means that every contagious carrier of the virus has the potential to infect about three other people, whether or not the carrier is sick.
So closed schools and strict shelter-in-place policies reduce the likelihood of an asymptomatic carrier coming into contact with an at-risk person.
And it appears to be working. “The most effective way to reduce the spread, absent mass testing and tracing and quarantining, which are not yet in place, is to limit person-to-person interactions,” Polis said in a press conference on April 1. “That’s what we’re doing as a state. That’s what you’re doing. To save lives, you’re staying at home except when absolutely necessary to go out.”
Still, as Polis put it, the virus is “extremely contagious” and the general population has accumulated few-tono antibodies to combat it; meaning medical providers are bracing for the onslaught.
The Laurel Manor Care Center, a senior health care community in Southeast Colorado Springs, had six confirmed cases of COVID-19 within its walls, El Paso County Public Health announced March 19. It was not clear whether the illness was among staff, residents or a mix of both.
“Our team became aware of these additional cases late this afternoon and took immediate action to coordinate efforts with Laurel Manor Care Center and state partners to assess the situation and respond appropriately,” El Paso County Public Health Director Susan Wheelan said in a statement released that day.
And David Burch, communications director for Volunteers of America, which operates Laurel Manor, wrote in an email at the time that the agency was working closely with the county health department and had been strictly following Centers for Disease Control and Prevention protocol.
“Our hearts go out to our residents, our employees and the families of all,” he said in a written statement.
While he did not go into detail regarding the Springs facility, he added in a subsequent email that Volunteers of America had put in place some stringent policies at all of its facilities. Those include:
• Providing necessary PPE;
• Screening all residents and monitoring them for symptoms and fever throughout the day;
• Screening all employees for fever and symptoms immediately upon entering a site (employees with any symptoms are to be sent home);
• Restricting outside visitors to endof-life situations;
• Screening those visitors who are allowed in for any symptoms or fever, and preventing those with symptoms from entering; and
• Increasing the frequency of disinfection of surfaces, equipment, resident rooms and other areas in the buildings.
Vu said on March 24 that his clinic had seen an uptick in the number of patients visiting with respiratory issues, and that “a handful” as of that time had tested positive for COVID-19. His medical group has stepped up telemedicine options to accommodate patients who don’t feel safe leaving, or don’t need to leave, the comfort of their homes. Vu also implemented mandatory mask use for all patients and staff.
Patients who don’t have respiratory issues, he said, are asked to wear fabric protective masks, those who have breathing complaints are to wear surgical masks and staff wear surgical or N95 masks — those widely sought respiratory mask that boasts 95 percent efficacy at filtering particles from the air.
“Our practice for the past week or so has been experiencing a shortage of masks,” he said.
So the group put out a creative call: It asked healthy patients with the know-how to make and donate fabric masks for those patients who don’t have respiratory problems.
“With the understanding,” Vu said, “that fabric masks may not protect as well as surgical masks, but better than no masks at all.”
Hospitals at the ready
Hospitals within the UCHealth system have been taking several measures to prepare for the worst of the pandemic, including a potential influx of patients.
UCHealth Memorial has already implemented visitor restrictions. Visitation is mostly prohibited, save for exceptions like laboring mothers or visits to the neonatal intensive care unit (NICU).
The hospital has also postponed elective surgeries to free up beds that could potentially be used for patients who are ill enough to warrant hospitalization.
“These decisions also allow us to conserve personal protective equipment … for staff,” said UCHealth spokesperson Cary Vogrin.
Though the hospital has not needed to do so thus far, Vogrin said UCHealth Memorial also has surge plans in place, should it become necessary to room COVID-19 patients in isolated units.
Tents have also been erected at UCHealth Memorial Central, Memorial North and the UCHealth freestanding ER in Fountain.
“These tents can be used to screen and treat patients with possible COVID-19 symptoms, including fever and cough, and keep those patients out of our main emergency departments,” Vogrin said. “This is part of our plan for the future, and they will open as necessary. As of now, one tent — the one at Memorial Central — is being used.”
At Children’s Hospital Colorado, Colorado Springs, team members have been meeting regularly to develop the hospital’s preparedness and response plan, and building upon current processes to screen for contagious illnesses, according to spokesperson Leila Roche.
Some of its current measures include:
• Effective March 18, it closed select locations to consolidate clinical services and limit appointments and elective procedures, surgeries and diagnostic radiological studies.
• To support social distancing, the hospital has shifted many of its outpatient appointments to telehealth.
• All patients, family members, visitors and staff arriving at the hospital are screened daily for temperature and other COVID-19 symptoms and risk factors.
• Personal protective equipment conservation strategies have been implemented, due to global shortages and the hospital’s increased usage of PPE.
• Surge planning protocols have been updated as the hospital plans for a spike in admissions.
To help prevent the virus’ spread, Children’s is having non-essential staff work remotely, and Roche said it is “working to reallocate staff who were affected by temporary closures.”
It, too, has implemented visitor restrictions.
“Each patient/family can identify a total of two individuals who can visit the patient,” Roche wrote in an email. “[They] must be the patient’s parents, legal guardians and/or partner/spouse. We’re encouraging other family members who aren’t able to visit, to show their love and concern a different way.”
Those who wish to do so can: call a loved via the hospital’s main line at 719-305-123; use one of the hospital’s free iPads to keep in touch using Skype or Facetime; send an email or greeting card; and send balloons (mylar only) or other gifts from the hospital’s gift shops.
An uncertain future
Despite the uncertainty of the immediate future, Dr. Vu remains optimistic. A devout Christian, he tapped both his faith and humanity’s history of resilience when asked whether we can eventually beat this thing.
“The answer is, of course, yes,” Vu said. “Number one, in God anything is possible. Number two, we have overcome other situations in the past. The similar situations include SARS, the Middle East Respiratory Syndrome (MERS), Ebola. Eventually, we will be able to overcome this pandemic.
“However,” he continued, “I think that after we overcome this pandemic, the world may not be the same. The way we do things may be different. I don’t know what it will look like, but I think the way we do things, the way we travel, the way we offer health care will be different.”
He emphasized that he and other medical providers will be on-hand to help usher the community through the transition, come what may.
“It is my pleasure,” he said. “And my privilege.”