Section Chief, Critical Care, and Medical Director, Medical ICU, ChristianaCare’s Christiana Hospital, Newark, Delaware
“I serve on ChristianaCare’s COVID-19 Steering Committee, which meets daily to determine
clinical guidelines for the health system’s intensive care, respiratory care and dialysis
units. We embrace all the evidence out there, including the experience of our patients
and publications from other national and international cohorts. We are consistently
looking for new ways to tweak our guidelines. We learned from the Italian cohort.
We learned from the Seattle cohort. We learned from the New York cohort. And then
we pivoted our care. … The mantra early in the coronavirus outbreak was to intubate
right away. We followed that protocol in mid-March. Then we looked at our situation.
It just seemed like we were using up our resources, which were finite. We had to make
sure we had room if we experienced a surge. … We learned from the Italians that the
disease isn’t your run-of-the-mill respiratory distress syndrome. It’s a different
beast. We stopped early intubation. Instead, we used high-flow oxygen, with patients
on their stomachs, awake prone position. We had success with steroid anti-inflammatory
treatments as well as monoclonal antibodies. There’s lots of doom and gloom about
coronavirus; you have to celebrate your wins. It feels good to have positive outcomes.
And that is good for everybody’s morale. … We found that if you are younger and just
your lungs are involved, we have been able to get patients through it. Unfortunately,
many patients who are older have kidney failure and require dialysis. Combine that
with acute respiratory distress, and that’s usually fatal. … We have layers of care
for our caregivers. Our work schedule for physicians in the ICU helps too. They work
five to seven days in a row, then have five to seven days off to recover and recharge
and get back in the mix. That translates into 16 shifts a month, which they get to
select. It helps prevent burnout. At the beginning, we were unsure of what we were
dealing with—from the infectious nature of the virus to whether we’d have a shortage
of PPE. … I feel blessed to work for a health system that supports its frontline staff.
Donations of PPE came in from businesses around us. We’ve had tremendous support from
our community. Every day, lunch is gifted by a local restaurant. Acts of kindness
go a long way in times like this.”
As told to David McKay Wilson
April 14, 2020
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