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'Towards and into the fire'

Local doctors on the front lines of the COVID-19 pandemic are changing everything about how they work and live as they battle the virus.

“As part of preparing for my next set of shifts on the front line, I am making sure my will is up-to-date, my life and disability insurance policies are paid up. Many front line medical professionals are doing the same,” said Dr. Ee Lin Wan.

As an internal medicine hospitalist practicing in Medford, she cares for patients who’ve been admitted to the hospital.

“We honor our Hippocratic oath and walk ‘towards and into the fire,’ so to speak,” Wan said.

But doctors in the Rogue Valley, across America and throughout the world are struggling with a shortage of face masks, face shields, gloves, gowns and other personal protective equipment.

Ventilators that can save the lives of people who can’t breathe on their own are also in short supply.

The situation is making National Doctors Day today more poignant. Started in 1933 and observed every March 30, the annual observance is meant to show appreciation for physicians.

Wan said one of her biggest fears is a lack of personal protective equipment to keep herself, her patients and her family safe.

“Information from areas hardest hit show that medical professionals are disproportionately falling seriously ill and dying at much higher rates than the general public,” she said. “This, compounded by the lack of personal protective equipment, is making the situation more dire.”

Wan said she has “a sense of impending doom, a surreal feeling of calmness before the big storm hits.”

But she said local health care providers are bravely facing the COVID-19 pandemic.

“I have been in practice in Medford for 12 years and have never been prouder of our local medical community — physicians, nurses, respiratory therapists and other ancillary staff,” Wan said.

Dr. Alicia Welder, an emergency medicine physician with Asante, said working moms gravitate toward work in hospital emergency departments because of flexible scheduling. A mom who needs to go to her kid’s soccer game can switch shifts.

Welder has two 4 and 6-year-old girls. Her husband works long hours as an ophthalmologist, taking care of patients with serious vision problems.

Doctors are now worried about infecting themselves and their families with the COVID-19 virus.

“It’s scary as a mom — especially if you are the primary caretaker,” Welder said.

She has a new routine after every shift.

Welder takes off the scrubs she wore at work and puts them in an area for soiled hospital laundry. She showers, then changes into clean scrubs for the drive home. Once there, she changes out of those scrubs in her garage, tosses them in her home washing machine, bleaches her shoes and hits the shower.

“We try to limit exposure and not bring it home,” she said.

Some doctors and nurses are going even further in an effort to keep their families safe.

They have moved into hotel rooms, campers or their backyards.

“One of our colleagues has moved into his camper and is isolating himself completely from his family,” Welder said. “It’s difficult because he’s a very involved parent.”

Health care workers are exposed to high-risk patients with high viral loads, she said.

Welder said local hospitals are taking aggressive steps to reduce the risk of infection. People with respiratory symptoms are getting initial assessments done at a triage tent in a parking lot when they come to Asante Rogue Regional Medical Center in Medford.

“We want to get patients tested and masked to prevent exposure to the rest of the hospital,” Welder said.

Other steps include limiting visitors for patients, ramping up COVID-19 testing and tapping the community for donations of personal protective equipment.

Welder said health care workers can’t help the community if they go down themselves.

“Keeping ourselves protected and safe is critical to manage the numbers of patients we could be seeing,” she said.

Asante Ashland Community Hospital has been designated as an isolation hospital that will care for COVID-19 patients who need hospitalization, local doctors said.

Other regions have designated their own isolation hospitals, doctors said.

The Ashland hospital has worked since the deadly Ebola outbreak in Africa several years ago to take on the critical role of handling an infectious disease outbreak, Welder said.

“They’ve been working really hard on protocols to manage that,” she said.

Welder said she hopes researchers soon develop ways to test for COVID-19 antibodies to find out who already had the virus and survived.

A severe respiratory illness swept many people in the Rogue Valley medical community in January, including Welder. But testing for the COVID-19 got off to a slow start in America, so most weren’t tested while they were sick.

“I’d never been so sick with a respiratory infection before,” she said. “It will be interesting to see if people have had it when we have antibody testing. We do wonder how long it’s actually been here and how many people have actually had it. We know that it’s already here.”

Welder said scientists still have much to learn about the virus that jumped from animals to humans, including whether people who survive the virus develop immunity or if they can be infected again.

One bright side of the COVID-19 crisis — at least so far — is that inappropriate use of emergency rooms is down. People are no longer dropping by for minor problems that should be treated by primary care doctors.

“Before, we would ignore the overcapacity warnings for the emergency department because they were always going off. People who didn’t have urgent problems would have to wait for several hours. We have better flow through the ER. We’re not bedding people in the hallway for lack of space,” Welder said.

That situation could change quickly if the Rogue Valley sees a spike in people needing emergency care and hospitalization for COVID-19 infections.

The health care system is mobilizing to identify doctors who work out in the community and retired doctors who could be tapped to lend a hand in overloaded hospitals.

For now, Dr. Steven Hersch, an internal medicine physician, is doing his part to reduce the spread of COVID-19 to his family and patients at his clinic.

He’s sending his work clothes to a laundering service, showering when he gets home and changing into fresh clothes.

Hersch spends up to an hour each day updating himself on the rapidly evolving situation by talking to colleagues, reading medical newsletter updates and checking with the Oregon Health Authority. Patients are feeding him information, too, such as data they gathered from their contacts who model the spread of infectious disease.

Hersch and his wife, a psychotherapist, are using telemedicine to meet virtually with patients whenever possible.

But since senior citizens and people with underlying health conditions are at elevated risk from COVID-19, Hersch is urging people not to neglect their own physical and emotional health during the pandemic.

“It’s a reminder for people that they still have to continue to take care of themselves,” he said. “Your own health issues cannot be abandoned or put aside. Stopping smoking, eating healthy, getting exercise, getting out and walking and getting enough sleep are more important than ever.”

Hersch said he’s been encouraged by the show of support from the community.

“I greatly appreciate the number of patients who’ve called and written to express support and concern,” he said.

Hersch said the No. 1 thing the public can do to back doctors and other health care workers is to follow social distancing rules and help slow the spread of COVID-19.

Retired registered nurse Marilyn Kaufman said residents of some cities are safely showing their support for health care workers by going out on their front porches, decks or the street and waving their cellphone flashlights in a “Light for Doctors” display at 8 p.m. every night. Others are clapping their hands, singing or cheering.

She and her husband, Dr. Robert Kaufman, are encouraging people who live near hospitals in Medford, Ashland and Grants Pass to shine their cellphones at the hospitals.

“Let’s show our health care workers how much we appreciate their dedication and their exposure to this deadly virus,” the couple said in an email.

Like Hersch, Welder is begging the public to protect health care workers and themselves through social distancing.

She has colleagues in hard-hit parts of the nation who have already had to decide which patients get ventilators.

“For Americans used to getting medical care, the thought of it not being there for us is hard for us to put our heads around,” Welder said. “That is the reality now. That will be the choice we have to make. Who do we put on a ventilator — and who do we not?”

As hard as the economic turmoil and social isolation have been, she said there are worse things.

“It’s not as bad as having to watch a loved one die who could have been saved with the right equipment,” Welder said.

Reach Mail Tribune reporter Vickie Aldous at 541-776-4486 or valdous@rosebudmedia.com. Follow her on Twitter @VickieAldous.

Dr. Ee Lin Wan adjusts a face shield at her Medford home. (Andy Atkinson / Mail Tribune)
Dr. Ee Lin Wan wears multiple layers of protection at her Medford home. (Andy Atkinson / Mail Tribune)