‘This crazy amount of guilt.’ Sacramento doctor addresses California’s COVID-19 surge

Dear Sacramento:

Please, stay home for the holidays. I am making this plea because I’ve seen what can happen if you don’t. I’m a Sacramento Emergency Medicine doctor who volunteered in New York City after COVID-19 devastated that city. Now I’m watching the cases in Sacramento double every two weeks as our healthcare infrastructure nears a breaking point.

I’m asking you to stay home because I don’t want to see any more preventable death. I care about you and your loved ones, and I know healthcare providers like myself need your help.

Thanksgiving gatherings and quarantine fatigue have poured gasoline on the flames of the pandemic. Sacramento County recorded 280 cases of COVID-19 on Nov. 7 and 1,183 cases on Dec. 7. Nearly all of the hospitals in the Sacramento area are near or at capacity and have enacted surge plans that include opening up new Intensive Care Units, pulling staff from non-emergent services to COVID-19 units and canceling surgeries.

Last week, hospitals were attempting to transfer patients to other hospitals with open beds. This week, the beds are full so they’re sending patients to a disaster hospital in Sleep Train arena. Our options are running out.

Opinion

The soaring cases aren’t just numbers. They are neighbors, friends and family. Many of these people went to Thanksgiving gatherings and are shocked to hear they have COVID-19. A month ago I had one or two confirmed COVID-19 patients per day. On my last shift, over 50% of my 23 patients were positive — and I sent four of them to the ICU. These four people could have been you or your loved ones.

I treated a man in his 20s with asthma, a healthy father in his 30s, a person in their 60s with no medical conditions and a grandfather in his 70s who was healthier than most. That grandfather walked into the hospital and is now intubated and fighting for his life on a ventilator. During the last month, I’ve seen COVID-19 cause strokes, kidney failure, massive blood clots and septic shock. I’ve grieved with families as I tell them their loved ones are dead.

Click below to hear Dr. Alex Schmalz speak about his experience:

COVID-19 can be so much worse. In early April, New York City emergency departments were seeing unimaginable surges as their patient volumes doubled and nearly every patient was COVID-19 positive. When we arrived in mid-April, the city had been under stay-at-home orders and the emergency departments were empty, but the hospital was overflowing with sick COVID-19 patients.

A close friend described the preceding weeks as “a war zone.” The hospital we volunteered at normally had 16 medical ICU beds, but the tsunami of patients meant that there was 170 intubated ICU patients when we arrived. Nearly every patient on all 11 floors of the hospital had COVID-19 and every spare corner had been converted to a makeshift ICU.

Hundreds of staff members had contracted the virus, while others had been working for months with little to no rest. There were refrigerated trucks in the parking lot to hold dead bodies because the morgues were full. Medicines were out of stock, resources were incredibly limited, ventilators were more valuable than gold, staffing was stretched to unsafe levels and we saw people die every day because it was impossible to provide the care that they needed.

Hospitalizations with COVID-19 are heartbreakingly isolating. Family members can’t visit patients, so the only communication they have with their loved ones is via video chat. Most intubated patients die and, when they do, it is alone, in the care of strangers, with the hums of ventilators and the beeps of cardiac monitors rather than in the comforting presence of family and friends.

I vividly remember holding back tears while listening to howls and sobs of family members resonate from an iPad Zoom call echo throughout an otherwise empty hospital room as their family member passed away. These aren’t isolated stories — 70% of the patients in our ICU and over 300,000 patients across the United States died from COVID-19 in a similar fashion.

One of the most important yet often neglected aspects of the pandemic is how it impacts the other parts of healthcare. Surges of patients are stretching resources thin throughout the country. My 57-year-old uncle had a stroke in Minnesota and the hospitals were so overburdened in his city that it took more than a day to transfer him from his local emergency department to a stroke center in another city. I don’t want this to happen to you or your family, and we need to flatten our curve and preserve resources in Sacramento.

I’ve also seen the fear that surrounds COVID-19 cause worse outcomes as people wait at home with strokes and heart attacks rather than coming into the hospital to receive the time sensitive care they need. People are also seeing worse outcomes when they delay treatment for cancer, blood pressure or diabetes and other less emergent medical issues. To those of you who need medical care to manage chronic conditions or for preventive care, I urge you to seek it. We are here for you and ready to care for you.

The weight of this work crushed healthcare workers in New York City. Days after we arrived in New York, emergency medicine physician and Medical Director of New York-Presbyterian Allen Hospital Dr. Lorna M. Breen killed herself. Her father recalled her describing “the devastating scenes of the toll the coronavirus took on patients.”

“She tried to do her job and it killed her,” he said.

The resilience and dedication of the nurses, doctors, janitors, clerks and other staff at the hospital was awe inspiring, but these people are not superheroes who are impervious to human suffering and illness. These are people in your community trying to help you and they need your help.

Please stay home. Social isolation has taken jobs, affected our mental health and separated us from the people we love most, but we are running out of options and time. Staying home could save the life of you, your family members, your neighbors or healthcare workers like myself.

A vaccine is here — I’m excited to get mine next week — and I encourage everyone to get theirs when it becomes widely available. For now, the only reliable treatment we have is quarantine. Quarantine emptied emergency departments in New York City and it helped keep COVID-19 manageable in Sacramento.

To those of you who can make the sacrifice to stay at home, thank you.

Alex Schmalz, MD, is a Vituity emergency physician working in Sacramento.