When the first COVID-19 case in the U.S. was confirmed on Jan. 21, 2020, most of us never would have imagined that one year later, we would be approaching 100 million global cases, 25 million U.S. cases, and almost 420,000 deaths in the US alone. We could not have predicted the pending public health emergency or how a tiny virus particle could become so politicized and cause divisiveness among us, bringing our economy and our world to a screeching halt.
Those of us who work in emergency medicine and emergency medical services were paying particularly close attention, as we tried to understand what exactly the SARS-CoV-2 virus and the associated COVID-19 illness were.
In Dallas, Texas, where I currently work as an emergency medicine and EMS physician, we were on high alert. After all, we were in the world’s spotlight in 2014 when Ebola first appeared in the U.S. in our front yard, and we didn’t want to be caught unprepared.
We scrambled to learn as much as we could, as fast as we could; change up processes; write new protocols and EMS alerts; and obtain personal protective equipment. We watched COVID-19 slowly spread across the U.S. in certain hotspots. Then, not unexpectedly, the first case appeared in the Dallas-Ft. Worth metroplex on Mar. 9, 2020.
Between March and November, I worked dozens of shifts in the busiest emergency department in the country and had more than my fair share of critical COVID-19 patients, including intubations and cardiac arrests. I, like many others, initially used recycled and sterilized N95 masks, and felt lucky to have any form of protection. My physician partners and I worked tirelessly to advocate for our EMS agencies as well, making sure they were protected.
My wife and four children initially stayed with family out of state for the first four months of the pandemic, because there was so much we didn’t yet know, and I considered myself a risk to their health and safety. I would come home from work, immediately strip in the garage, and then quickly streak through the house to decontaminate in the shower without touching anything.
I’d talk to my family via FaceTime daily, and I often found myself working 80-90 hours per week between the emergency department and my EMS work. At one point in late summer, I had officially worked 99 days in a row without a day off, and I didn’t care to work one more day to make it an even 100 days. I was exhausted, depressed and I missed my family terribly. As if it wasn’t enough to battle COVID-19 in the community by itself, I was also fatigued from battling misinformation daily along with many of my colleagues in the public health and frontline healthcare sectors. We still fight these same battles today.
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I still enjoyed going out into the field and doing some EMS and tactical EMS work occasionally, but there was a distinct difference in the level of caution with working a shift in the ED and working out in the public safety arena. In the ED, mask compliance and other precautions were nearly 100%. In the public safety world, it was much less. After all, these are the untouchable, invincible, true frontline workers. They’ve seen and conquered much worse in their line of work. I would often encounter lackadaisical attitudes regarding masking and precautions, and despite my best efforts at encouragement and providing real-world examples and stories from the ED, I would often be unsuccessful in changing behaviors. Needless to say, with this most recent third surge, infecting hundreds throughout our local police and fire departments, many of these attitudes have changed over the past few months as colleagues experienced COVID-19 firsthand, and precautions and safety are second nature now.
“I started out my ER shift feeling fine in the morning, but things quickly changed”
In my particular case, after months of being careful, not going out, keeping my distance, and following all the precautions, it finally happened. After all, why wouldn’t it? My county currently has the eighth highest case total and ranked seventeenth highest for COVID-19 deaths in the country. The week before Thanksgiving was particularly long and rough. The ED was surging with COVID-19 cases, patients literally all around me, overflowing out of rooms and sitting in congregated but secluded areas where I would attend to their care and needs. I also had a particularly busy week in the field with EMS and TEMS. I can’t tell you exactly where or how I was exposed, I only know that on Monday, Nov. 23, I started out my ER shift feeling fine in the morning, but things quickly changed.
On my drive home, I noticed I felt a bit more fatigued than usual. By 8:00 p.m. that night, I had a fever of 101°F, chills and body aches. Luckily, my family had left 2 days earlier for a Thanksgiving hiking and camping trip in the secluded Zion National Park while I was scheduled to work over the holiday. I called to let my wife know, and then called to schedule a COVID-19 test the following day. It came back positive. For the next week, I had constant fevers, up to 103°F, strong body aches, a splitting headache that wouldn’t go away despite medications, overwhelming fatigue, incessant cough, and my throat felt like I swallowed a million razor blades. I couldn’t eat, due to pain and nausea, and I had what can only be described as a gastrointestinal apocalypse.
I lost 9 lbs, or 6.5% of my body weight. Despite being only 39 years old and very healthy with no medical problems, I couldn’t stay upright for more than 20 minutes and couldn’t walk from one room to another without feeling breathless. I watched my resting pulse oximetry hover in the low 90s and heart rate in the 120s-130s and didn’t dare try exerting myself at all, for fear of decompensation.
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The bulk of the serious symptoms lasted for 4-5 days, and luckily, I never developed worsening difficulty breathing beyond becoming temporarily breathless with upright activity. The next 4-5 days after that were spent with an excessive and persistent cough and fatigue, and it took nearly 2 weeks for my endurance to grant me permission to complete my basic activities of daily living. I went back to work after 2 weeks with about half of the endurance and stamina that I had before, along with a constant heaviness in my chest that is best described as feeling like I was wearing a tight vest and straining to expand my chest and take a deep breath.
Now, two months after my symptoms first started, I count myself lucky and blessed to have avoided similar chronic respiratory symptoms as some COVID-19 “long-haulers,” but am still just working to get back to my original endurance levels. Don’t get me wrong, I’m grateful to have avoided the serious complications, but this illness changed me, and I’m not the same person I was prior to becoming sick. I don’t know if this is temporary or long-term. Only time will tell.
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I have also received both of my COVID-19 vaccine injections. I continue to wear my mask and do my part to limit exposure or become a potential asymptomatic carrier to others until we know more about to what degree the vaccine can protect us in those regards. My EMS physician partners and I have advocated for vaccines for all of our public safety workers and are proud of the local work to get this done.
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With 19 years in EMS and 7 years in emergency medicine, I can honestly say I’ve never seen, nor probably will ever see again, something of this magnitude. I implore all readers and my brothers and sisters in EMS to continue exercising precautions to curb the spread of COVID-19 and do your part and get vaccinated to help us return to our new normal, whatever that may be. I’m not sure about you, but I miss hugs and visits with extended family, the handshake of a friend or business partner, dining in restaurants, traveling, gyms and singing in church. We’ll be back there soon enough, although with fewer of our friends, family and neighbors than we had before. We have no choice but to figure it out and succeed, because that’s what we do in EMS and in healthcare.
This article is dedicated to the memory of the ~420,000 U.S. citizens who have lost their lives and the millions of others whose lives have been turned upside down due to COVID-19.
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