Washington (AFP)
Daniel Brenner's week in the emergency room at the largest hospital in Baltimore was more intense than normal: the peak of the Covid-19 epidemic has not yet been reached here, but his department has already received dozens of patients with the new coronavirus.
The doctor at Johns Hopkins hospital told AFP that thousands of other caregivers have been living for weeks to adapt to the first pandemic of their career, improvising a manual in real time, here are some entries.
- Difficult choices -
Maryland, the state of which Baltimore is the largest city, has so far suffered around 30 deaths and about 2,000 cases. Hospital capacity is not yet overwhelmed, but should soon be.
The coming influx of hundreds of additional patients will make it "very complicated to sort out those who need to be hospitalized because they are at risk of developing severe symptoms and need oxygen", unlike those who can go home to recover, says Daniel Brenner, 36.
The problem is that doctors still lack reliable data to make these decisions.
"Are these elderly people? Those with a medical history?" Wonders the doctor who, like his colleagues, tries to read every day the impressive medical literature published on the coronavirus and the disease that it produces, the Covid-19.
To date, "there is no consensus in the country or the medical community on the best approach, because this disease has only been studied for two months".
"We all learn on the job," he admits.
- On the window -
The most serious complication of Covid-19 is acute respiratory distress syndrome, when the inflammation of the lungs is such that the body lacks oxygen for its organs, which requires the use of artificial respirators.
Daniel Brenner explains that the doctors finally understood that placing the patients on their stomachs helped reduce the accumulation of fluids in the back part of the lungs, which he said was healthier.
The technique is used in newborns who need a respirator, but is heavier in adults, because you have to constantly watch that the tube does not dislodge.
- Infection prevention -
The shortages of protective equipment such as masks and gloves, which are undergone by regions like New York, have not yet reached Baltimore, but caregivers have already changed their practices.
In the United States, oxygen machines called CPAP and BiPAP, which are lighter than respirators and deliver oxygen through the nostrils, are not used for coronavirus sufferers for fear it will create "a giant cloud virus "by spraying the environment with droplets from the mouth and nose of patients, says the intern.
Respirators do not pose this problem because the mouth and nose are covered and the exhaled air is trapped.
The problem is that BiPAP machines are usually used on people who have had a cardiac arrest, on which respirators must now be placed instead.
- The other patients -
"We continue to receive all the other people in serious condition: heart attacks, strokes, road accident victims," said the emergency physician.
As a precaution, many are considered to be potentially carriers of the virus: if the person who has had a heart attack coughs, or if he is unconscious, he is presumed to be contagious, and the caregivers must then put on masks, gloves, gowns ... What makes you lose precious minutes.
"Our instinct is to rush to help a patient, we tell ourselves that we don't have time to put on protective equipment, but we never stop reminding everyone that if we are infected, we cannot no longer help anyone. "
- Eat -
Morale remains good in his hospital, ensures Daniel Brenner, despite contaminations in the nursing staff, fortunately without serious cases to date.
Nurses and doctors are comforted by the signs of support from locals and local businesses, who send food.
"Sometimes you just have to eat a sandwich to become a better doctor," he says.
© 2020 AFP