Facing COVID-19 from the Front Lines: Understanding What’s to Come

Gregg Miller , MD

Chief Medical Officer

Published March 17, 2020

Facing COVID-19 From the Front Lines: Understanding What’s to Come

I am an emergency physician practicing in Greater Seattle, one of our country’s first and so far hardest hit areas by the COVID-19 virus. I am also the chief medical officer of a national physician group that delivers acute care across the country and have been supporting colleagues at more than 300 practices as they prepare for the coming crisis. I plan to share updates as the epidemic progresses with the hope my observations can provide guidance and reassurance during this time of uncertainty.

As an individual, I am reassured that the vast majority of people who have coronavirus have mild symptoms and will recover quickly, similar to a cold or the flu. The direct impact of this infection is likely very minor for any one person.

As a medical provider, I am more concerned for our larger population, especially for vulnerable groups such as the elderly or chronically ill. For most of us—healthy, working, living an active life—the difference between a disease with a 0.1% fatality rate (influenza) and a 0.5-1% fatality rate (COVID-19) is minuscule. However, a disease that is 5 to 10 times as lethal as the flu is overwhelming to an already overburdened healthcare system. As many have reported, we already don’t have enough ED or inpatient beds in our country, and this will push us beyond the breaking point.

Two Cases: Italy and Taiwan

In Italy, hospitals are operating at 200% capacity, and doctors are making incredibly tragic decisions about which patients to put on the last available life support machines. This dilemma has a cascading effect, as it won’t just be COVID-19 patients who can’t get care, but any individual who needs hospitalization.

Compare this with Taiwan, which was expected to have very high numbers of coronavirus cases due to its proximity to China. Instead, Taiwan has fewer than 100 cases and only a single death as of this writing. The reason? As reported in JAMA, the Taiwanese government implemented 124 actions—from case identification to quarantine and fighting misinformation—in response to the developing epidemic in Wuhan in late 2019.

A Clear Lesson for the United States

It’s too late for us to have the outcome that Taiwan achieved. But we can avoid the severe care shortages and delays experienced in Italy.

As a society we must take social distancing measures seriously. If we can slow down the transmission of the disease, it will spread over months instead of weeks. This will allow hospitals breathing room to treat sick patients over time rather than all at once. Travel restrictions, school closures, and canceled social events are happening not because of any great risk to any one of us—the risk is actually very small, even if we do catch the infection. If we can blunt the spread of this epidemic, we can ultimately save the lives of the most vulnerable among us.

What we’ve seen in Seattle is pretty tough, and it will only get worse in the coming week as patients who have recently been infected start coming down with serious symptoms. That said, it’s not too late to flatten the curve. I was relieved when the CDC announced progressively stricter social distancing guidelines late last week and again on Monday. This should be seen as a hopeful sign that we have a chance to get this situation under control and prevent further spread and infections.

I do know we will get through this. While we have certainly seen fear in our staff and patients, we have also seen tremendous resolve and courage. The work that nurses and doctors are doing on the front lines, as well as the spirit and resiliency of our staff, is incredibly impressive. I want to thank all my colleagues in medicine for your courage and tenacity in the face of this pandemic—you are an inspiration.

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