34justice

This is the continuation of a series of journal entries depicting what it’s like to be a part of the COVID pandemic from the medicine resident perspective.

With my office hours consolidated and no longer attending morning and noon teaching conferences, I find myself wanting to get back in the action. During my self-isolation I signed up for the Philadelphia Medical Reserve Corps. I signed up to be a “swabber” (obtaining samples from the back of the throat) at the South Philly screening site in the parking lot of Citizen’s Bank Park. I have Phillies tickets for a game that was supposed to take place this weekend. But instead I arrive at the stadium parking lot to see swathes of asphalt without cars. Instead they’re filled with tents, traffic cones, and people gowned from head to toe in PPE rather than tailgaters. This screening site is a joint venture between the Philly Department of Health, the Commonwealth of Pennsylvania, and the Federal Emergency Management Agency (FEMA). There is plenty of PPE to go around and I suspect this is due to FEMA’s presence because right now nobody seems to be overly concerned about limiting volunteer access to equipment.

I’m interested to see who comprises the volunteer corps because there is a wide variety of people in the Delaware Valley that suddenly have nothing to do. There are retired physicians, nurses, medical students (suddenly without any clinical duties), as well as people not at all involved in medicine who just want to help. Everyone is eager and energetic. You couldn’t tell there was a pandemic about to make its way to Philadelphia and the people that are most concerned they have an infection are driving to your current location.

There are multiple large white tents set up to receive cars to drive through. Each tent has the capacity to test about 100 people per day. The decision on how many tents to open each day is dictated by the number of volunteers available and the weather. On my first day it’s windy—very windy in South Philly. So windy in fact if you dropped a glove or a face shield you better start running because it would be 10 yards away before it hit the ground. Mornings start with huddles of teams where we begin the process of assigning volunteers to different stations and assign roles for the day. A woman in a vague military ensemble and standing up perfectly straight, presumably from FEMA, calls our medical director over after our huddle. There is a line of about 30 cars waiting for the entrance gate to the parking lot to be lifted to signal we’re ready to start testing. We typically start at 1pm on the dot but today things are dragging along. The Medical Director slowly walks back to the “swabbers” tent, facemask in hand, and dejectedly says that we have to close the operation today due to high winds which are anticipated to become worse as the day wears on. This is because the specimens may blow over and be scattered in the wind, putting Philly on the map as the first city to accidentally infect its own citizens with coronavirus. We have to go car by car to notify the inhabitants that if they are truly sick they should go to the nearest ED or come back at a future date. Demoralizing indeed.

Our positive rates with the nasal swab at the testing site are between 25% to 30%. If we had tested only 200 people that day, that’s still at least 50 people we would have identified as being COVID-19 positive. Who knows how many had to take off from work to come in or might not get the chance to come in tomorrow. The volunteers are pretty disappointed.

The screening site is a well-oiled machine by the time I arrive in late March. Through intake, data collection, verification, swabbing, etc. it takes about 8 to 10 volunteers to run one “lane” of cars. Ultimately the car completes its journey at our site in the swabbing tent where the specimen is collected. The more volunteers present, the more tents and lanes can be open,  which will greatly decrease wait time for the public to get screened—therefore enticing more people to receive testing. There are times when I volunteer and only two tents are open due to staffing issues. Additionally, I’m told by the Medical Director at the site that samples are now taking closer to 10 days to process, not the 5 to 7 that we had been telling the patients. Lastly, something that I find somewhat incomprehensible is that the FEMA guidelines for eligible patients to get tested do not align with those of the Philadelphia Department of Health. This leads to some people being taken out of line by FEMA representatives even though they’re eligible for testing according to the Department of Health. It never occurred to me that things like this can affect an overall city’s number of cases. Closing or decreasing screening capacity as well as delays in reporting can make numbers artificially lower.

I’m trying to find silver linings to come from the pandemic. Some are that the people being screened are overwhelmingly appreciative of our efforts. Local restaurants provide free lunch and dinner to the volunteers so it very much feels like a community coming together. I’m fortunate to observe the way people are supporting one another during these stressful times. Philadelphians are responding positively—for now. It likely won’t stay like this for the entirety of the pandemic as economic and other life-changes will exacerbate the anxiety that many people are feeling. I take comfort in knowing that there is potential for a lot to change in our society as we emerge from the pandemic.

It won’t be a surprise that our lives will be markedly different in the coming months and most likely years. For the foreseeable future,  society will no longer run as “business as usual” following the first wave of the pandemic. The way our healthcare system functions is something I’m most looking forward to seeing evolve as people realize that our employer-based model leaves millions behind is not equipped for delivering the most care to the most people. A new awareness of what we find important in life will also develop. This may entail rethinking the significance of the local community and each person’s role. We’ll be forced into introspection – things like where we get our food how we view work, and how we spend our free time will require reflection and evaluation – whether we like it or not.