Through goggles and a facemask, Dr. Cameron Wolfe watches as the patient lying in Duke Hospital’s intensive care unit struggles to breathe.
Feverish for days, the patient is exhausted from coughing—a relentless, dry cough—and breathless. Like other patients Wolfe has seen, this one is starting to deteriorate as the virus attacks the lungs and progresses to pneumonia.
There’s no approved treatment for COVID-19, the disease caused by the novel coronavirus, and doctors like Wolfe are traversing uncharted territory. There are treatments they think might work, things that have worked on other diseases, but there’s no data indicating how effective they are against COVID-19. (Last week, Duke Health announced that it had joined a national study of remdesivir, a drug that’s has proven effective in combating MERS and SARS, diseases caused by other coronaviruses.) There’s a lot they don’t know.
“I don’t use the word ‘experimental,’” Wolfe says in a thick Australian accent. “Many of [the treatments] are well-studied, but not studied for this scenario or well-studied in a lab or on people who are healthy, not in an intensive-care situation. The reality is you are facing an illness that has no real treatment.”
For this patient, he prescribes an antiviral infusion.
Wolfe is not just a doctor. He’s also a scientist who’s spent his career studying infectious diseases, including HIV. Since early January, when the first reports of a fast-spreading respiratory illness surfaced in China, the hospital has been mobilizing for the public health crisis to come.
Wolfe says Duke has seen more than 100 positive cases, but most patients are well enough to recover from home. So far, it’s been a steady trickle. He’s not sure what will happen if and when it becomes a flood.
The University of Washington’s Institute for Health Metrics and Evaluation projects that North Carolina’s coronavirus crisis will peak on April 22. On that day, the IHME estimates, the state will be 862 hospital beds, 625 ICU beds, and 954 ventilators short of what it needs.
“Our biggest fear isn’t that we can’t handle the number of patients, but that we can’t handle them all in one week,” Wolfe says. Social-distancing measures to “flatten the curve” are designed to prevent just such an overload.
Wolfe leaves the ICU wing and methodically peels off his protective gear.
“As you repeat it over and over again, it becomes your safety blanket,” Wolfe says. He moves with precision to avoid cross-contamination: He removes his gown, then his gloves. He washes his hands. He puts on a new pair of gloves and removes the goggles or the visor shielding his eyes, then his surgical face mask, then a head hood called a powered air-purifying respirator, or PAPR.
He thinks very carefully about each step. He says he’s not too worried; after all, his team designed the safety protocol. If he gets sick, there’s a plan. He’d recover in isolation, as most patients do.
Back home, his two young children are probably bouncing around the house, “vastly oblivious,” as his wife, also a doctor, works remotely.
He takes his gloves off again and washes his hands, scrubbing vigorously. He snaps on a third pair of gloves, this one clean. He takes a short walk to clear his head. His office is in the hospital command center, a separate building about 10 minutes away from the patient ward. He starts to decompress, but questions flood his mind.
Normally, he’d be thinking about basketball. Now he can’t remember the last time he watched a game.
One question dogs him: How do we know we’re winning?
The statistics are grim. The government’s top infectious-disease experts have warned the U.S. death toll could reach 100,000 to 200,000 if we do everything right.
Does victory look like professionals showing resilience in the most stressful and dire situations? Does it look like patients receiving quality care even from overwhelmed doctors and nurses?
“How do I measure when I’ve been successful here or not?” he asks. “I don’t know how to do that. That’s hard. We’re all trying to learn.”
Contact Raleigh news editor Leigh Tauss at ltauss@indyweek.com.
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