A PA’s Perceptions While Practicing During a Pandemic (COVID-19)

Part One: Written March 23, 2020

The Overseas Origin of an Outbreak

Towards the end of 2019, a highly contagious novel coronavirus was first identified in Wuhan, China. The current theory is that the virus was somehow transmitted from bats to humans, perhaps through an animal market called the Huanan Seafood Market. Most affected people have had mild cold-like or flu-like symptoms. However, in a relatively small percentage of the patients who contract the virus, the virus causes severe complications, including some deaths. Most of these patients have been elderly, immunocompromised, or had diabetes, heart disease, asthma, chronic lung issues, or cancer. Some of the complications include pneumonia, ARDS, cardiac injury, among others.

The Virus Hits Home

Due to the fact that the virus is so contagious, it has espread quickly to other countries, along with panic. In January 2020, the virus first entered the United States, and in early March 2020, the virus first entered my state in the Midwest. Our governor has issued various executive orders to try to help decrease and slow down the spread of the virus. Some examples of these orders have included the following: closing schools, limiting restaurants and coffeeshops to only serve takeout food and beverages, as well as shutting down other “gathering places” such as bars, museums, gyms, hair and nail salons, movie theaters, casinos and other places of entertainment. Throughout our state and country, schools and colleges have been ordered to close, sports events have been canceled, weddings and birthday parties have been canceled, and basically everyone has been told to stay home as much as possible to practice social distancing to try to assist in “flattening the curve”. The concept of flattening the curve includes attempting to slow the spread of the virus, so that the amount of people being sick at one time is hopefully lower. Doing so would assist in decreasing the amount of sick people having to be hospitalized all at once, thus not overwhelming our medical resources. 

Facing a Few Frustrations

I am writing this article in the midst of the pandemic; however, I do not feel as though the virus as quite “hit” our state yet. Sure, we have had confirmed COVID-19 cases, and even a death so far. However, unfortunately, outpatient testing is not currently available. The common symptoms include fever, cough and shortness of breath with some patients having myalgias, headaches, sore throats, and few with diarrhea. Sounds very similar to influenza, no? However, testing for influenza also currently is not available as outpatient. So, many patients may have COVID-19 (or influenza), though we do not really know. This has been a very frustrating issue, as we as providers are unable to give patients a diagnosis besides an “unspecified viral respiratory infection”. Sure, for most patients, the symptomatic treatment is the same or similar no matter which viral infection they have. But not having outpatient tests available has made advising and treating our patients difficult nonetheless. We are having to assume many of these patients have COVID-19, and advise them on self-isolation / quarantining. Additionally, the treatment can only be symptomatic at this point, as there are no approved or recommended outpatient treatments available. The reported number of cases are also flawed as the testing is so limited. There have been some frustrations encountered by us healthcare workers as well as our patients during this pandemic.

Attempts to Protect Patients and Healthcare Workers

Our clinic / healthcare system has implemented several policies / guidelines that change often many times within one day, including the following: recommending well / healthy patients come to clinic early in the morning if they must even come to the clinic, starting to use phone visits for patients in addition to starting telemedicine visits, canceling non-emergent surgeries / procedures, and cutting back on the hours of specialists’ offices. In general, there has been much stress associated with working in family medicine during this pandemic. However, I am trying to practice an “attitude of gratitude” by being very thankful that I currently have a job during all of this, as many other people have been told to stay home, and have had to file for unemployment. This has even included other family medicine providers with other healthcare systems, as well as speciality providers. I am also incredibly thankful for those in healthcare who have been working in ERs and hospitals as they have been taking care of the truly ill patients. Unfortunately, there is a shortage of PPE as well, especially in the places where the virus is more prevalent at this time. Measures have been put in place to try to preserve the PPE, and hopefully our clinic and health system will be able to do so.

The Panic Associated with the Pandemic and Combating Stress

There has been so much blatant public panic with this pandemic. So. Much. Panic. The panic has seemed to be almost as viral as the virus itself. Some of it has been founded, but some of it has seemed to be perpetuated by the media. Shocker, right? Regardless, during this crisis, I have been reminded that so much of our job as PAs is trying to calm and reassure patients when they are anxious and scared. This can be very difficult when we are stressed as providers. It is important to do our best to be patient with our coworkers, our patients, and ourselves. It is important to practice self-care (while also practicing social distancing, of course). Everyone’s definition of self-care is different, but some ideas include the following: spending time with family, listening to music or podcasts, reading, praying, cooking healthy meals, going for walks, yoga, etc. 

PAs Prepared for the Pandemic

In summary, we physician assistants must do our best to care for our patients during this health crisis, as many of us are serving on the frontlines of healthcare. Many of us are the PCPs of our patients, the psychiatry providers managing the severe anxiety of our patients, the ER providers evaluating shortness of breath of our patients, or the providers intubating the patients in the hospital. We must continue to adapt, which is innate to the PA profession, thanks to our well-rounded training in general medicine. Our patients are counting on us, and we need to continue to provide the excellent quality care that we always have, even if we are in the midst of a pandemic. 

Are you a PA-C practicing during the COVID-19 pandemic? What has it been like for you and your organization? Or are you a future PA student or a current PA-S? Has this affected your PA school interviews or your rotations? Tell us about your experience in the comments. 

Part Two: Written May 31, 2020

COVID-19 Continues

Here is an update since the initial post a couple of months ago, which includes some details of the COVID effects on my professional family medicine PA life, society as a whole, as well as my personal life. 

Over the past couple of months, there have been several more COVID-19 cases, hospitalizations, and deaths in my state. Health leaders continue to push out the suspected “peak date”, meaning they thought COVID cases were going to peak sometime in May, then they said sometime in June, and the latest has been sometime in July. These suspected dates are based on various models, but for now, we await the unknown (because, let’s be honest, humans do not truly know what the future beholds). 

Regardless, I am over COVID. There, I said it. I recognize that it may sound a bit selfish and unprofessional, especially considering that this sentiment is coming from a medical professional.     I think it would be mentally so much easier if we knew the actual upcoming peak date, and the date of when things can return to “normal”. This would allow me to be able to tell myself, “Well, it’s onlyanother 3 months (or 6 months, or 1 year, etc.)”. Because let me tell you, this COVID pandemic is just seeming to dra-a-a-g on. And it has only been 2.5 months since the beginning of the craziness!

Professional Effects of COVID

Since the initial post, my company (which has several clinics throughout the state) decided to close some clinics temporarily, as well as make some clinics split into seeing respiratory / sick patients that could potentially have COVID in one area of the clinic and the healthy patients in another area. Otherwise, some clinics were made into designated healthy clinics and others into designate respiratory / sick clinics. My clinic ended up being a healthy clinic; however, we also have had to rotate through a separate respiratory / sick clinic on some days. Next week, though, we are all just going to be working from our normal clinics again. I’m not sure the reasoning behind many of the decisions that have been made, but I guess it’s not my job to understand the reasoning. I have been trying to continue to show up with a positive attitude each day, but honestly, it has been hard. During some of the days at the sick clinic, I have been able to perform curbside COVID testing wearing a CAPR (trying saying that three times fast!). This has been a change of pace to the days, and has been somewhat enjoyable. 

My company has told us they have lost several millions each month since COVID started. Although my company has been furloughing clinical staff (such as some of the front desk staff, LPNs and CMAs, managers, etc.), providers have not yet been furloughed. However, for this month and at least next month, our pay has been cut to 75% of what our pay was on average for last year. (Most of us are compensated based on wRVU’s, though some are still on salary). I’m still thankful to have a job during all this; although, the couple of things that disheartened me more than the pay cut were the following: our 401k contributions will no longer get the employer match for the rest of the year, and our CME budget was completely taken away for the year (unless we had used it already). This blog is about financial independence, so not getting my employer’s match to my 401k bummed me out! 

Societal Effects of COVID

Although my compensation has taken a bit of a hit, I am truthfully way more concerned about some potential underlying, unseen effects of the COVID pandemic. The first of which is the delay in diagnosis and treatment of various cancers. Preventative health maintenance has taken a backseat, and many cancer surgeries were not considered “emergencies”, so they were delayed. Next, I’m concerned about an increase in alcohol abuse, as many people have been laid off, stressed, and likely drinking more. This correlates with mental health as well. Many of my patients have had worsening anxiety and depression symptoms with everything going on, including being furloughed, loss of jobs altogether, companies shutting down, trying to homeschool their children, and fear of the virus among others. Additionally, I’m concerned about the potential for more abuse to take place in the homes of the victims who are quarantined with their abuser. These are all troublesome, disturbing effects that the COVID pandemic may having on our society. 

Personal Effects of COVID

On a lighter note, I am thoroughly missing traveling! Travel brings me so much joy. This not only includes the obvious trip itself, but also the planning / organizing aspect of pulling a trip together. Researching the sites and cities where we will visit on upcoming trips, thinking about activities that would be fun to do, and finding delicious looking restaurants to try are some of my favorite things to do in my free time. I recently earned my Southwest Companion Pass, but travel has been pretty much shut down! I’m looking forward to experiences new places and cultures, hopefully in the somewhat near future. Fingers crossed. 

Finally, I think that what the COVID pandemic has taught me the most is to appreciate what had seemingly been the small things (but were rather the very big, important things in life). Simply meeting a friend up for coffee at a coffee shop or for a bite at a restaurant sounds so enjoyable right about now. Phone calls or video calls just don’t cut it for me. Another thing that was missed was the sense of community being able to gather and worship at my church provided. My pastor was somewhat forced into become a “YouTube pastor” due to the virus as churches had been told to shut down as well. He somewhat begrudgingly excelled at the changes and provided the sermons online. Thankfully, we recently have been able to open up a bit, while having fewer members attend split services to practice social distancing. During the past couple of months, I have been so thankful to be able to spend time with my amazing family, whom have been pretty much the only people I have socialized with besides coworkers. Although this post started off as a bit self-admittedly melancholy and even a bit complaintive, I am appreciative for so many things in my life including health, the ability to work and earn an income, and my wonderful friends and family.