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An Iowa City Emergency Physician Details A Night Shift During The COVID-19 Pandemic

Hospital-acquired infections are a big risk in health care, especially for older or seriously ill patients.
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Public health experts are expected a significant increase in coronavirus cases after many Iowans gathered with friends and families over the Thanksgiving holiday.

Iowa continues to have one of the highest rates of new coronavirus cases in the country, according to the latest report from the White House Coronavirus Task Force. Though that rate has slowed in recent days, public health experts have warned they expect those cases will increase substantially after many Iowans ignored their guidance and gathered with family and friends to celebrate Thanksgiving in person.

Resident physician Melvin Donaldson of the emergency department at the University of Iowa Hospitals and Clinics worked the holiday shift and recorded an audio dairy of his experience, comparing waiting for the expected surge in cases to waiting for a “tsunami."

The crush of coronavirus cases is pushing Iowa health care workers and hospitals to the limits of their capacity. COVID-19 had infected more than 240,000 Iowans as of Friday afternoon, killing 2,605, including multiple married couples who died within just hours of each other.

The lack of containment measures at the state level, and lack of coordinated response at the federal level, has resulted in “unmitigated community spread” of the virus, touching even the smallest and most rural of Iowa’s 99 counties.

Still, public health experts have warned case counts will spike in the days and weeks after the Thanksgiving holiday. In the meantime, many doctors and nurses are already overburdened, with one hospital in Burlington turning to public school employees to volunteer for shifts to help with “housekeeping, health screenings and other duties.”

At the state’s largest hospital, the University of Iowa Hospitals and Clinics, Donaldson, who is training in emergency medicine and is also an epidemiologist, says the virus has already constrained the patient transfer process, which many of the state’s smaller hospitals rely on.

“Prior to this, on a normal night, we’d have like a whole list of people waiting to come into a hospital. Now we’re at least kind of forced to decline a lot of the less sick people,” Donaldson said before heading into a Thanksgiving night shift. “Other ones, I mean you accept them, but we just don’t have space. So they’re going to wait at their hospital for three, four, five, six days waiting a bed here that may or may not open.”

Donaldson has watched the virus plow deeper into Iowa communities through the patients he sees: married couples, extended family members, incarcerated Iowans, and children.

“I started to see sick kids with COVID. I remember having a discussion with my supervisor, like ‘wow this is an ominous sign’,” Donaldson recalled. “Because kids usually do not get super sick with COVID. So it seems like there have to be a lot of kids with COVID to start seeming more really sick kids with COVID.”

Epidemiologists have said they expect to see a substantial increase in cases roughly two weeks after the Thanksgiving holiday, due to the incubation period of the virus. Knowing the pressure hospitals are under already, Donaldson described waiting for the expected increase in cases as “waiting for a tsunami to wash over us."

“It feels powerful, inevitable, and with a mind of its own. Like an ocean and a tsunami. You know that you’re somewhere where this could happen. You feel the rumbling of the earth. You hear the sirens. And now I’m just kind of waiting,” Donaldson said. “I’m waiting for the water.”

Kate Payne was an Iowa City-based Reporter