2020 the year that halted due to COVID - 19
COVID 2019
2020 was going to be an amazing year. 2019 ended with a call from the USOPC asking if I was available summer of 2020 to help support Team USA at the 2020 Olympics. I was ecstatic to stay the least. An opportunity to support my team, was a dream come true and something my heart always desired. I created an online blog to help me document and remember the 2020 Olympics and my own personal journey to get there. Unfortunately, COVID - 19 had its own agenda. Our entire way of life was changed in the blink of an eye as a virus, never experienced by man made its debut in Wuhan, China in late 2019 and made its way around the world by early 2020. It has been over a century since the 1918 Spanish flu had impacted the world and lasted for several years, infecting over a quarter of the earths population. Countries continue to fight to contain COVID-19, and prevent overwhelming healthcare systems, our day to day lives have changed and there has been much uncertainty regarding the future. China and Italy were the first in which the exponential growth of the virus greatly impacted their countries by overwhelming resources. Gabriel's cousins, continue to be in a shelter in place for months, stationed in Northern Italy with the US Air force. Can you imagine, entire countries shut down? Non essential businesses closed, schools closed, families furloughed at home. President Trump placed restrictions on flights from China February 2020 and as the disease became more widespread, placed travel restrictions on Europe, and Canada. Our US judo athletes, all over the world faced the challenges of traveling and risking exposure, quarantine in foreign countries, or forfeiting precious Olympic Qualification points. In the US, the spread of the COVID-19 began in Washington and California and the states made every effort to promote social distancing to "flatten the curve". New York prevalence of COVID exponentially has become the dominant source for COVID cases in the US. The Federal government has deployed the Mercy ship "Comfort" to Manhattan, New York to help lessen the burden on the Hospitals.
What is it like for me? Well, as you may know I am an Emergency Physician. The unfortunate truth is I head to work everyday to face the unknown. Chest Pain, Trauma, the undifferentiated patient in shock, the unknown ingestion...... I've trained for this for years in medical school and residency. As an Emergency Medicine physician, we are some of the most adaptable medical professionals in the world, the "Swiss army knife of medicine". Hospital protocols change daily, sometimes hourly to adapt to the changing data, what you do and who you tested today was different from tomorrow and the next day. The lack of supplies, protective equipment and testing is challenging. We initially focused in the ED on testing those who were at greatest risk of getting the disease and placing other hospital patients and staff at risk. As more testing supplies become available, we continue to expand who we test.
Of course there is PPE or "Personal Protective Equipment" shortages. Physicians and hospital staff are dying doing the thing they are most passionate about, helping others and saving lives because they are being exposed to COVID-19 and often times run out of PPE. After a series of sleepless nights due to nightmares, my husband handed me his N-100 respirator he uses as an engineer to make sure I had the equipment I needed at work. You would think that this would never be the case in "The Greatest Country in the World" but that is not true. Hospitals systems, counties, states, the federal government, and countries continue to grasp for more PPE in a time that the supply is not meeting the demand. Hospitals try to be innovative, allowing surgical masks to be worn all day to protect patients from asymptomatic healthcare workers who may be carriers, N95s are used all day and often recycled to use (UV light) in the event that supplies ran out. The Federal Government asks that the general population used cloth masks in public, and many of those at home have been sewing masks for others (including my mother in law Sue). Hospital volumes in Colorado are down (in contrast to harder hit areas like New York), we see less of the Emergency Medicine we used to see, and more COVID. Many Coloradans heeded warnings to only use the Emergency Departments for life threatening emergencies, and I am sure many fear going to the ER to not contract COVID-19. Our volume of COVID patients increases, our acuity and critical care patients increases, our ICU volume increased and took over much of the hospital. Many patients in the hospital are on ventilators, with COVID-19 causing a rapid progression of respiratory failure similar to an Acute Respiratory Distress Syndrome or a Non-Cardiogenic Pulmonary Edema thought to be caused by a cytokine storm. Our need for more ventilators matches the exponential growth of the virus and the death toll of the virus. As was seen in Italy, as the hospital systems in the US have become overwhelmed and ran out of ventilators, people began to die. Jared Polis, The Governor of Colorado, made decisive moves early to keep Coloradans at home, which to date, has helped flatten the curve to prevent our resources from being the cause of the virus' increase in mortality. In the emergency department, protocols to take care of patients change daily. Initially testing those with direct exposure or travel, to then only testing those admitted to the hospital, then including the immune compromised, healthcare workers, or those living in close facilities with large numbers of people. There are shortages of tests, there are shortages of medications, there are shortages of staff as healthcare workers on the front line, became infected and needed to be quarantined at home. Day to day I see increasing numbers of COVID patients, needing to be hospitalized, needing intubations and ventilator support. The most difficult thing is suppressing our first instinct which has been to run towards the fire. Now the importance of PPE and protecting our personal health and health of our staff is imperative to the communities health. The coordination of entering and exiting a COVID patient's room required time, often one that our patients lives do not have. Donning and doffing PPE improperly risks exposure, we attempt to minimize staff in the room which means coordination of resources before entering the room and not open and close doors and risk exposing the department to the Aerosolized virus. What makes things worse, precautions due to the aersolization of the virus with certain interventions (non invasive positive pressure CPAP/BIPAP, Nebulizer treatments and even oxygen therapy), make it difficult to care for this respiratory virus as these interventions which generally help save lives can put an entire department at risk due to the spread of the disease. Hospitals have since limited the number of visitors to the Emergency Department to one and no visitors were allowed in the Hospital for their own protection and the protection of the patients and staff.
As an Emergency Physician, we are at the greatest risk for exposure. The undifferentiated patient coming in for ankle pain, or abdominal pain generally has failed to mention their cough, has ended up being COVID+ and going into respiratory distress before our eyes. We face our own mortality every time we walked into the emergency department to do our lifes work. We decontaminate ourselves before entering homes, stripping down outside of our homes, showering, to not infect our families. Some emergency physicians opting to physically separate from their families during the pandemic. Families with dual family members in healthcare deciding who would take care of their children if both are on ventilators, deciding who would take custody of their kids if they are one of the 50% who do not make it off the ventilator. Wills were written and Power of Attorneys signed.
In the wake of uncertainty for the future, there are things that have held constant. I work everyday with an amazing group of people, who would rather "run to the fire" any day of the week. Communities, sacrificing everything, have been put on hold to protect public health have risen to the support hospitals. By staying home and flattening the curve, communities are saving hundreds and thousands of lives and protecting our way of life and our most vulnerable populations. PPE sent in from the community sewn with their own hands, businesses refocusing to create more protective equipment for hospital staff and essential workers, there are daily messages of encouragement and appreciation from friends and family, meals sent to hospitals home made or supporting local businesses, even howling for healthcare at 8pm on a nightly basis has lead to my daily inspiration. In the end, when I look back, these are the things that I will remember, for this I am grateful, and these are the things that bring HOPE.
Links:
Of course there is PPE or "Personal Protective Equipment" shortages. Physicians and hospital staff are dying doing the thing they are most passionate about, helping others and saving lives because they are being exposed to COVID-19 and often times run out of PPE. After a series of sleepless nights due to nightmares, my husband handed me his N-100 respirator he uses as an engineer to make sure I had the equipment I needed at work. You would think that this would never be the case in "The Greatest Country in the World" but that is not true. Hospitals systems, counties, states, the federal government, and countries continue to grasp for more PPE in a time that the supply is not meeting the demand. Hospitals try to be innovative, allowing surgical masks to be worn all day to protect patients from asymptomatic healthcare workers who may be carriers, N95s are used all day and often recycled to use (UV light) in the event that supplies ran out. The Federal Government asks that the general population used cloth masks in public, and many of those at home have been sewing masks for others (including my mother in law Sue). Hospital volumes in Colorado are down (in contrast to harder hit areas like New York), we see less of the Emergency Medicine we used to see, and more COVID. Many Coloradans heeded warnings to only use the Emergency Departments for life threatening emergencies, and I am sure many fear going to the ER to not contract COVID-19. Our volume of COVID patients increases, our acuity and critical care patients increases, our ICU volume increased and took over much of the hospital. Many patients in the hospital are on ventilators, with COVID-19 causing a rapid progression of respiratory failure similar to an Acute Respiratory Distress Syndrome or a Non-Cardiogenic Pulmonary Edema thought to be caused by a cytokine storm. Our need for more ventilators matches the exponential growth of the virus and the death toll of the virus. As was seen in Italy, as the hospital systems in the US have become overwhelmed and ran out of ventilators, people began to die. Jared Polis, The Governor of Colorado, made decisive moves early to keep Coloradans at home, which to date, has helped flatten the curve to prevent our resources from being the cause of the virus' increase in mortality. In the emergency department, protocols to take care of patients change daily. Initially testing those with direct exposure or travel, to then only testing those admitted to the hospital, then including the immune compromised, healthcare workers, or those living in close facilities with large numbers of people. There are shortages of tests, there are shortages of medications, there are shortages of staff as healthcare workers on the front line, became infected and needed to be quarantined at home. Day to day I see increasing numbers of COVID patients, needing to be hospitalized, needing intubations and ventilator support. The most difficult thing is suppressing our first instinct which has been to run towards the fire. Now the importance of PPE and protecting our personal health and health of our staff is imperative to the communities health. The coordination of entering and exiting a COVID patient's room required time, often one that our patients lives do not have. Donning and doffing PPE improperly risks exposure, we attempt to minimize staff in the room which means coordination of resources before entering the room and not open and close doors and risk exposing the department to the Aerosolized virus. What makes things worse, precautions due to the aersolization of the virus with certain interventions (non invasive positive pressure CPAP/BIPAP, Nebulizer treatments and even oxygen therapy), make it difficult to care for this respiratory virus as these interventions which generally help save lives can put an entire department at risk due to the spread of the disease. Hospitals have since limited the number of visitors to the Emergency Department to one and no visitors were allowed in the Hospital for their own protection and the protection of the patients and staff.
As an Emergency Physician, we are at the greatest risk for exposure. The undifferentiated patient coming in for ankle pain, or abdominal pain generally has failed to mention their cough, has ended up being COVID+ and going into respiratory distress before our eyes. We face our own mortality every time we walked into the emergency department to do our lifes work. We decontaminate ourselves before entering homes, stripping down outside of our homes, showering, to not infect our families. Some emergency physicians opting to physically separate from their families during the pandemic. Families with dual family members in healthcare deciding who would take care of their children if both are on ventilators, deciding who would take custody of their kids if they are one of the 50% who do not make it off the ventilator. Wills were written and Power of Attorneys signed.
In the wake of uncertainty for the future, there are things that have held constant. I work everyday with an amazing group of people, who would rather "run to the fire" any day of the week. Communities, sacrificing everything, have been put on hold to protect public health have risen to the support hospitals. By staying home and flattening the curve, communities are saving hundreds and thousands of lives and protecting our way of life and our most vulnerable populations. PPE sent in from the community sewn with their own hands, businesses refocusing to create more protective equipment for hospital staff and essential workers, there are daily messages of encouragement and appreciation from friends and family, meals sent to hospitals home made or supporting local businesses, even howling for healthcare at 8pm on a nightly basis has lead to my daily inspiration. In the end, when I look back, these are the things that I will remember, for this I am grateful, and these are the things that bring HOPE.
Links:
USA Judo fight COVID
COVID-19 Images
Surgical Masks for presumed asymptomatic healthcare carriers
Gabriel's N-100 Donated to protect me in event of PPE shortage
Lifelong friend Theo Caracostas at Costco, Toilet Paper Shortages in Stores
Just another update from your local Emergency Physician in Colorado.
Thank you all for doing your part to "flatten the curve" and promote "social distancing". The current models show the US trending increase in COVID-19 cases lagging approximately 12 days behind some of the countries that have been devastatingly impacted. We truly need individuals to do what they can to help slow the progression. Though the prevalence of the disease appears low, the public should understand that number is based off of TESTED cases. We in the healthcare front lines have strict guidelines on who we can test (a person displaying symptoms, who is ether in direct contact of COVID, travel, healthcare, or immunocompromised), many with symptoms do not fit testing guidelines. Understand that the reported prevalence reported in the US is likely falsely low, and that the mortality rates are therefore unclear. A Majority who are infected with COVID-19 will have symptoms similar to the common cold and will survive. Many are infected with the disease and are asymptomatic, therefore do not know that they are viral shedding to our most fragile populations. With that being said, there are still many people who are becoming very ill from this virus, the elderly, immunocompromised (ie cancer patients-my mom and likely someone in your family), and patients with lung issues (ie. COPD, Asthma) and even healthcare workers as I have previously posted.
Healthcare workers are on the front lines. I can tell you that though here in Colorado we have not seen the impact Italy is facing now, but we are preparing for it. Going to work there is a sense of impending doom of what is to come. Our families are concerned for our personal well-being and safety as we do the things we went into medicine to do - Save lives. Hospitals have created incident command centers and disaster preparedness physicians are helping to lead the way with collaboration with the CDC. We are rationing protective equipment and always need more to help protect those who are protecting your families. As in Italy, we are forming ethics committees to decide in the event we run out of ventilators who should be saved. We NEED protective equipment for healthcare workers, we NEED more lab and testing supplies, we NEED to continue to build an appropriate system of testing to get a handle on COVID-19s progression and we NEED child care resources for essential staff. As an emergency medicine physician, we ask that you use the Emergency Department for true emergencies (Chest pain, feeling short of breath, feeling lightheaded/ dizzy, stroke like symptoms, traumatic injuries etc). If you have symptoms of a cold, please self quarantine, call your primary care physician for further recommendations or utilize telemedicine.
Most importantly this is not a time to panic, we are all in this together. We can ALL do our parts to save lives. Wash your hands, stay home if you are sick. Promote social distancing. Think of others, buy what you need, and do not hoard. Support local businesses who are desperately trying to stay afloat and support their employees by ordering take out. Recognize many are making sacrifices to protect our way of life. Get outside, spend time with your loved ones and re-connect with your families.
Together, we can flatten the curve.
#flattenthecurve #socialdistancing #doyourpart #doingmypartCO
The difficulty in Social Distancing in Combat Sports
Please refer to these websites posted below for COVID-19 information. Information is changing daily. Please refer to your state and local health departments for local guidelines.
COVID-19 presents like a cold (cough, fever, muscle aches etc), and for most people will run its course similar to a cold, please self quarantine if you are sick and call your primary care physician. *Patients who do not need Emergency Services (chest, pain shortness of breath, lightheaded/ dizziness, low blood pressure etc) are treated as an outpatient (drink plenty of fluids, rest, wash your hands, stay away from others etc). The hospital and emergency department will ONLY test patients for COVID-19 who meet admission criteria (low blood pressure, low oxygen saturation, complex/ high risk infected patients etc).
*
Center for Disease Control:
CDC: https://www.cdc.gov/coronavirus/
*
World Health Organization WHO: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
*
Colorado Department of Public Health & Enviornment:
https://covid19.colorado.gov/
*
USOPC COVID (for Athletes): https://www.teamusa.org/Coronavirus-Updates it
Healthcare rising to the occasion for Americans
A Social Distancing Day in the Snow
Art Created by Physicians during the Worldwide Pandemic
We have the weight of the world on our shoulders
USNS Comfort Sails to New York
Leave it to Ricky Bobby to bring a bit of humor to our lives
That day I used my day off to get tested for COVID-19
Under this white coat, lives wonder woman
When the public needed a hero, healthcare workers rose to the occasion
My socks give me super powers
They are my morale boosters
Remind me to stay strong and always on my feet
End shift-->Decontaminate mind and body-->welcome home
Front line Emergency Staff, there are land minds everywhere
Families Separated and Sacrificing
Postponement of 2020 Olympics to refocus on the health of the world
When everyone has an opinion, this is the one that matters most
PPE scarce, community heroes rose to the occasion to protect healthcare
Hundreds of Physicians sacrificed their lives, The first US Emergency Physician who died
We are here to protect you
Prayers for PPE, Prayers to save lives
The Virus is all around you
Morale Booster
One day....
The shifting paradigm
"Flattening the Curve"
Larimer Square Denver. Colorado
Pink Super Moon Rises over a Quarantined Denver
The Daily Battle
Essential Staff
Healthcare supporting Liberty
Friends supporting my morale boosting devices
I am my families greatest risk to exposure. A social distancing Easter Celebration
Standing strong in the face of danger
No testing needed, we know who has it
X-ray on the left - Normal
X-ray on the right your lungs on COVID (this patient is intubated with a central line)
The immunocompromised and elderly are at highest risk for complications, but as I have seen and the data has proven, COVID does not discriminate based off age. Most have mild disease process. However, patients are Intubated and on ventilators in adult hospitals from their late teens to 90s and no one is exempt from COVIDs pathology. Patients arrive only needing a little bit of oxygen and rapidly decompensate before our eyes. We do everything to help them medically, but the most important thing we do is hand our patients a phone to call their loved ones before we intubate them, as we don't know if they will ever have that chance again.
#doingmypartCO #stayhomesavelives #flattenthecurve
*X-rays from radiology resource photos and not any of my patient photos
*Dr. Y Denver, Colorado Emergency Medicine Physician
A Cookie Date with a 3 year old and the Wilson Family
Zoom Birthday Party for Sue Iltis
I look forward to supporting you in your efforts and pridefully watching you succeed #Tokyo2021
And when you think you have hit a few bumps...... Listen to the link below
https://youtu.be/IdTMDpizis8
#usajudosafeandstrong
#strongmindstrongbody
USA Judo Team USA
"Bring It" ~ Sue Iltis
Alert Screen Shot Stay at Home Colorado
We CAN do this
Everyday Mantra
COVID-19 is a novel virus from the coronavirus family first detected in Wuhan City, Hubei Province, China. Because this specific virus is new, there is a lack of definitive information at this time regarding its nature, contagiousness and exact serious illness rates. The details, severity of disease and recommendations are evolving with each day. USA Judo continues to monitor this fluid situation both domestically and abroad, receiving updates from the US Olympic & Paralympic Committee’s Coronavirus Working Group who is interacting daily with the Center for Disease Control, US Department of State and Department of Homeland Security. While there is information readily available in various media outlets, we have received the following recommendations from well-known judo-doctors Dr. Robert S. Nishime and Dr. Christina Yannetsos as it pertains specifically to our sport. As mentioned, we are continually learning more about Coronavirus, but precautions are currently similar to those during flu season.
Recommendations for Individuals
Recommendations for Clubs
Virtual Training Options
Additional Resources
CDC: https://www.cdc.gov/coronavirus/
WHO: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
USOPC: https://www.teamusa.org/Coronavirus-Updates
Homeland Security: https://www.dhs.gov/keywords/coronavirus-covid-19
U.S. Department of State: https://travel.state.gov/content/travel/en/traveladvisories/ea/covid-19-information.html
Recommendations for Individuals
- Wash hands frequently and adequately (20 secs with soap and water), or use alcohol-based cleanser/hand sanitizer
- If you develop a fever, cough or feel ill, do not go to your club or dojo for practice, contact your medical provider and stay away from others
- Seek immediate medical attention if symptoms become severe, such as being short of breath or having difficulty breathing, feeling lightheaded or dizzy
- Follow good personal hygiene after every judo practice or competition, including showering with soap and water and wash judo gis after use
- Take individual and public safety into consideration when making decisions to travel or attend large gatherings. This is an individual decision made by coaches and athletes who should be educated regarding the risks. As a contact sport, we risk exposure to viral infections with any close human (within 6 feet) interaction and the risk of transmission.
- If travelling outside of the US, exercise diligent hand hygiene, avoid touching your face, avoid countries and locations with a high number of cases and avoid public places with large numbers of people (travel precautions will continually be updated by the CDC: https://wwwnc.cdc.gov/travel/ )
Recommendations for Clubs
- Follow CDC guidelines - cdc.gov/coronavirus/2019-ncov/
- Follow your home state and local guidelines as the prevalence of COVID-19 varies widely throughout the US (Department of Public Health) ie. Colorado: https://www.colorado.gov/pacific/cdphe/2019-novel-coronavirus
- Dojos should NOT allow anyone with cough, fever, shortness of breath, or feeling ill to practice
- Provide alcohol-based hand cleaner (60-95% alcohol) before entering dojo/ mat and when exiting (or recommend hand washing for 20sec before and after practice), encourage frequent handwashing
- Athletes should be instructed NOT go to your dojo or practice if they have a cough, fever, or feel ill (likewise stay home from school, work and avoid exposing others in public places)
- Appropriately clean mats more frequently than usual, using a proper disinfectant antiviral & antibacterial (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5343532/ )
- Wipe down, clean and disinfect frequently touched objects and surfaces in the dojo (handles, tables, chairs, computers) https://www.cdc.gov/coronavirus/2019-ncov/community/home/cleaning-disinfection.html
- Avoid travel to areas with COVID-19 Outbreaks
- Avoid large public gatherings, limit spectators
- Call your primary care physician if you feel ill, go to your ER for shortness of breath, difficulty breathing, feeling lightheaded or dizzy
- USA Judo strongly recommends that organizers of its sanctioned events immediately contact their local health department for guidance on hosting activities in their communities. USA Judo also strongly recommends that event directors consider cancelling or postponing their events which are non-essential over the next 60 days until more information becomes available from the experts.
Virtual Training Options
- Many public Universities (and USOPC) have started to provide online classes and virtual classes as much as possible
- While some martial arts dojos already provide virtual training courses, this is something more clubs are trying since the outbreak of COVID-19.While it may be challenging to work with another judoka at home unless they have family members, this is an opportunity for senseis to remain engaged with their students, provide classes and drills that can be done at home, and help lift the spirits of those who may feel overwhelmed by the current state of health affairs. There are various ways you may be able to do this:
- Record courses and post on your website or send via e-mail.Note that video files are very large and may not easily be transmitted through e-mail.Posting on a website or content management system is probably your best bet.
- If you work with a third-party website provider, check with them to see if they have a content management system platform where you can upload videos and/or other information that your students can access from home.
- Facebook Live – while you can invite only your students to watch your Facebook Live Training, know that anyone from around the world may be able to access your course as well.This may be good for exposure and potentially new students but know that what you are delivering is going worldwide.
Additional Resources
CDC: https://www.cdc.gov/coronavirus/
WHO: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
USOPC: https://www.teamusa.org/Coronavirus-Updates
Homeland Security: https://www.dhs.gov/keywords/coronavirus-covid-19
U.S. Department of State: https://travel.state.gov/content/travel/en/traveladvisories/ea/covid-19-information.html
A Reminder from the community on my way to work
Support from the Community was overwhelming
Murals were painted in Denver
Afternoon Updates from the Governor and Trump Administration
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