Massachusetts is expecting a surge in coronavirus cases to begin by the end of the week. WGBH Morning Edition host Joe Mathieu spoke with state Rep. Jon Santiago, who works as an emergency room doctor at Boston Medical Center, about his perspective from the frontlines of the pandemic. The transcript has been edited for clarity.
Joe Mathieu: I hope you're not coming off an overnight shift. I'm sure you're exhausted at this point.
Dr. Jon Santiago: Oh, I worked Saturday overnight [and] Sunday overnight, but I for the most part slept most of the day Monday, and [caught] up on some phone calls and some statehouse issues.
Mathieu: Doctor, we were taken by that video you posted on Twitter about 24 hours ago. What is it like to come home from work at this point?
Santiago: Well, it's exhausting. I think over the past couple weekends, the overall volume has been low, but dealing with patients who [have] COVID-19 or suspected of having COVID-19 has been particularly challenging. And as the surge is no doubt to make its way here — estimated between April 10 and 12 — I think we in Boston, and I can say this for many folks in the health care industry and providers like myself, are feeling a bit of a pinch right now. So it's difficult. All I know is that things are going to get significantly worse, but people are going to be sick, people are going to need our help and we're going to be there to provide it.
Mathieu: In your tweet diary that we've been following, you mentioned over the weekend, Doctor, that people are beginning to return for a second time with symptoms with COVID-19 and their symptoms in many cases are worse.
Santiago: Yes, it's true. This is anecdotal, but this is what I'm hearing from colleagues and friends. Over this past weekend, I'd seen a number of patients who were diagnosed either at a community health center or some sort of clinic. And it's come back with worsening oxygen saturation, more fever and have required admission to the hospital, sometimes the ICU.
Mathieu: Doctor, I don't get a chance to speak with people who are on the front lines to the extent that you are very often. What is it like when people come in? What level of symptoms do you tend to see or is it across the board? And what kind of fear do they express when they meet you?
Santiago: Well, it's really all over the board. I think initially people thought the symptoms would be traditionally viral, such as fever, chills and cough. But I'm admitting people who pass out or had diarrhea, nausea and vomiting, and it turned out to be COVID-19. And so right now, I think physicians and nurses and the like have to just assume that most people at the emergency department might have COVID-19. So you should prepare for that, whether that's wearing a mask when you enter a room or donning PPE.
Mathieu: That's going to become very difficult news to deliver. Is it at that point that you begin testing where you recommend someone go through the test?
Santiago: Often so. We're seeing patients come in particularly from nursing homes. I had a patient that Saturday night. I think I told that story. What's sad to me is that because the hospitals are not allowing visitors anymore, we're often admitting these people and who knows if that's a last time they're going to be able to see their families and friends. That's particularly draining. It can be emotionally exhausting, but I think the workforce is in it for the long run. I think in the emergency department, we just increased our capacity, and you had a number of doctors, including myself, who volunteered for more shifts in April and May.
Mathieu: What kind of hours are you working, Doctor?
Santiago: So I typically work the State House Monday through Friday, and I try to work Friday, Saturday, Sunday nights in the emergency room. As things got busy in the emergency department, I'm planning to spend more time there because they need us working clinical hours. So I typically work eight-hour shifts. Full time for an emergency room doctor is about three to four days a week, but we can expect things to pick up significantly as the surge gets here in a week or so.
Mathieu: Has the protocol changed on how to treat presumptive positives since you've been doing this the last couple of weeks?
Santiago: Well, the procedures and protocols with respect to how we go about treating patients suspected of having COVID-19 has changed dramatically. I remember four weeks ago where things were on the fly and I was coming up with protocols there and really looking for guidance. But the hospital's done a tremendous job of really creating protocols and procedures, whether that's having people coming to a tent during the day, get tested [and] being sent home, or having people sent to specific rooms in the emergency room to get tested, or they can be put in rooms and protect staff from potentially exposing them. So we've made some significant strides with respect to that.
I think right now we're in the midst of planning for the surge. So just to give you an idea, at Boston Medical Center, right now we have about 70 ICU beds, a little more than half of which are being used right now with people with COVID-19 and a good number of others are with people suspected of having COVID-19. Now, the plan is to scale up significantly over the coming days and weeks, and I think that's going to be up to anywhere [to] about 200 ICU beds. That's what we're estimating. Boston Medical Center, because it treats a largely vulnerable community [and] some of the biggest shelters in Massachusetts are located right around BMC, that's been particularly challenging. You might be aware, but over the past three [or] four days there's been a significant uptick in the number of COVID-19 cases in the homeless community. A lot of them come the emergency department. I've been working the overnight shifts, and if you have symptoms as a homeless person, you're not allowed to enter the shelter because you could potentially infect those you're around. So I'm in the emergency department either admitting these people or holding on to them and trying to figure out the safest position so they can be quarantined and not infect other people.
Mathieu: Doctor, how are the nurses dealing with this ICU at capacity?
Santiago: I think I speak for many doctors. As a person who's gone through training and through residency program, nurses taught me so much about medicine and they really create the bedrock of a hospital. They're some of the strongest characters and personalities that I know. They've taught me so much about medicine, and they're up for this. They provide so much guidance. It really is a team game in the emergency room. You're the doctor, but the nurses play such an important role. And in fact, it's important to note that the nurses often spend much more time with the patients than the doctors. And so they're donning and doffing the PPE and having to deal with all those situations and concerns for exposure. So I give them tremendous credit.