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Physicians’ perspectives: Impacts of PPE shortages, COVID-19 on Lifespan

Health care professionals in emergency medicine, cancer discuss effects of COVID-19, community involvement

By
Senior Staff Writer
Thursday, April 2, 2020

With the global development of the COVID-19 pandemic, the Rhode Island Lifespan Health System and its partners have been working with different sectors of the government, including the Rhode Island Department of Health, to prepare for and address the challenges posed by the pandemic locally. 

“I can’t remember the last time the state of Rhode Island declared a state of emergency,” said Philip Chan, associate professor in the University’s Department of Medicine and an attending physician within the Lifespan system. Rhode Island has been preparing for COVID-19 since late December to early January — long before the state’s first confirmed case in early March, according to the Providence Journal

Since then, a group of policy, public health and health care experts also issued recommendations for the COVID-19 stimulus bill passed March 27. Megan Ranney MPH’10, associate professor of emergency medicine and health services, policy and practice, helped co-author these recommendations, asking for support of vaccine-development research and a guarantee that insurance covers COVID-19 testing. Since the recommendations’ release, Gov. Gina Raimondo has mandated free COVID-19 testing. “Governor Raimondo and (RIDOH Director Nicole Alexander-Scott MPH’11) have done a tremendous job of (preparing Rhode Island to) be the best (it) can be ahead of the curve,” Ranney said. 

To protect patients and health care workers during this time, providers in the Lifespan system are being screened for symptoms, and if they are sick, they are told not to come to work, Chan said. 

While the state is undertaking measures to curtail the growth of COVID-19, The Herald spoke with health care providers in various Lifespan departments, who shared their views on the impacts of the COVID-19 pandemic. 

Outlook from the Department of Emergency Medicine 

At the emergency department of Rhode Island Hospital, “we’re starting to see a dramatic rise of patients with COVID-19 symptoms,” Ranney said. While a significant portion of these individuals have needed to be put in the intensive care unit, the majority of patients have been released to return home and self-monitor. 

COVID-19 has also indirectly impacted pediatric emergency medicine — for the better. “The volume (of patients) in the pediatric emergency units has been a lot less than we normally see,” said Frank Overly, medical director for pediatric emergency medicine at Hasbro Children’s Hospital and professor of emergency medicine and pediatrics at the Alpert Medical School. He added that this may be a result of parents and guardians keeping children home — and out of the way of other dangers — to mitigate the spread of COVID-19. 

The pediatric population has not been getting as sick as adult COVID-19 patients, Overly said. As of March 30, Hasbro had not admitted any positive COVID-19 pediatric patients. 

Cancer center and continuing care 

With the Lifespan system limiting the number of visitors that can accompany patients, the Lifespan Cancer Institute has had to adopt limits as well. “We are able to make exceptions for people nearing the end of life or for those who need a companion, but, for the most part, the restriction is for one family member,” said Don Dizon, professor of medicine at the Med School and director of women’s cancers at the Lifespan Cancer Institute. The institute is relying on therapists to provide additional emotional support. 

With these visitation regulations come difficult decisions on whether or not cancer patients should come to the clinic for care at all, or if they should instead receive care through telehealth appointments. At this point, the Cancer Institute has mostly relied on telehealth for follow-ups, prognosis and imaging result discussions. “For the most part, treatment decisions have not changed,” Dizon said. But COVID-19 has been “prompting more serious discussion on cancer care,” such as whether it is appropriate to start a new treatment for someone with metastatic cancer or initiate palliative care and hospice earlier than the institute normally would have before the onset of the COVID-19 pandemic, he added.

Providing personal protective equipment 

The concept of needing personal protective equipment (PPE) in a health care setting is not a novel one: PPE has long been required of providers treating infectious diseases such as tuberculosis, measles or influenza. Yet, with the spread of COVID-19, there is a national shortage of this equipment, partly because the number of physicians requiring PPE to treat potentially infectious patients has greatly increased within a given shift, Ranney said. “And so the supply chain is not working as it usually does.” 

Providers within the Lifespan system have felt the impact of this looming shortage. “We’re realizing that only if (masks) get damaged, should we discard them,” Overly said, noting that typically, health care providers throw their masks away after a single use. Overly notes that people have been donating things to the hospital, but that the community’s emotional support has been particularly helpful. 

Amidst everything health care workers are doing to address COVID-19, community members can also aid their efforts. To help donate supplies, including PPE, to the Lifespan Health System, Chan recommends consulting the Lifespan website. The state of Rhode Island has also set up a website detailing ways residents can lend a hand, and asking specifically for health care volunteers. Additionally, a group of medical professionals and developers have created a website allowing people to donate various PPE, including masks, gowns and sanitizer, which health care facilities can request. This is a national effort that interested students and faculty can participate in, such as by volunteering to make or deliver PPE.

“Having the community sending wishes I think is what is helping providers” emotionally get through the difficult COVID-19 situation, Overly said. 

 

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