FEATURE
A Steadfast Approach to the COVID-19 Pandemic By Amy Souers, MD
EMS Fellow at Orlando Health/Orange County EMS System
Adaptability and agility: two words that describe one aspect of emergency medicine, and two qualities that we, along with all physician specialties, must continue to exercise on a daily basis in this COVID-19 pandemic. Over a month ago, we were looking at an outbreak in China, Italy, South Korea, and Iran. Thirty days ago, the number of cases in the U.S., including those repatriated from the Diamond Princess cruise ship, was in the double digits. As of this writing, there are over 385,000 cases in the US.1,2 A state of emergency has been declared, and “shelter-inplace” and social distancing are the norm. Powerhouse companies such as Hanes, Ford, and General Motors have converted to manufacturing ventilators and masks. Our country is adapting. On the front lines, we are also adapting. Daily, our inboxes and online meetings are full of new testing procedures, new PPE requirements, new emergency department patient flow diagrams, and new respiratory isolation policies and procedures. Our innate adaptability and agility, in the field of emergency medicine, are key components of our endurance and success in fighting this virus. We cannot forget: we are adaptable and agile human beings. 6
We have learned a great deal about the virus already. Before SARS-CoV-2 was even known, we had all heard frequently of novel viruses morphing via antigen shift and drift. Mutations allowing viruses to move from animal hosts to humans is not a new or novel concept. We all knew, from microbiology classes many years ago, that given probability and time, once in a great while a virus will succeed in shifting its RNA in such a way that the virus is “optimized” for human survival. This is one of those times. The “ideal virus” would spread human-to-human readily, replicate quickly, and avoid making its host too sick before being exposed to many other human hosts (along with asymptomatic carriers that are difficult to identify). The ideal virus is not overly deadly, and it is easily transmissible. Strains of influenza such as H1N1 caused a pandemic in such a way. Similarly, the novel strain of coronavirus reached a pandemic phase just 2-3 months after the pathogen’s emergence. Healthcare EMpulse Spring 2020
professionals and researchers already have had great experience in dealing with viruses, including those that are easily transmissible as well as dangerous. The flu is a great example. But in these times, we have challenged our knowledge, pushed the boundaries on antiviral therapy, applied old knowledge to new situations, and have made great strides in determining how this virus is transmitted, how to treat it, and even the beginnings of a vaccine to mitigate its effects. We are grateful to the many researchers and clinicians who are sharing their knowledge and experience—from N95 reuse and sanitation, to drug combinations to combat the virus and safe intubation strategies. We as clinicians will remain adaptable. We will stay up hours after our tiresome shift to read more about the virus, gain new knowledge, and work with healthcare leadership to advocate for the best practices. The virus first emerged in humans as early as December 2019 in Wuhan,
