Fighting On The Front Lines Of Covid-19

Monday, March 30th 2020

Doctors and nurses across the state are finding themselves on the front lines in the fight against the spread of Covid-19, and that fight comes with some peril. Medical personnel often risk their own health in trying to help others.

So how are those in the medical field holding up? Do they have the supplies they need? And what can regular citizens do to help them? Decibel's Judy Maggio talked with Dr. David Fleeger, president of the Texas Medical Association, about the impact of Covid-19 on the doctors, nurses, hospitals and medical clinics across the state.

Judy Maggio: So let's first talk about preparation. I know there's a Covid-19 task force that's representative of your 53,000 members. What kinds of things have the task force members been doing?

Dr. David Fleeger: Well, we started with some of the simple questions that doctors had from the very beginning when we, two weeks ago, were dealing about, well how do I test, where do I test, what's needed? We started talking about what level of personal protective equipment is needed in different scenarios, and we put out essentially white papers or announcements to the membership on almost a daily basis on those kinds of issues to try to help them to prepare and know what they were looking at.

One of the problems we have is there are just multiple, multiple sources of information. Many are good, many aren't, and we try to consolidate and the task force is filled up with experts of infectious disease, epidemiology, public health. They can look through these and make sure our members are getting the right information.

JM: And I know it's probably changing on a regular basis, too.

DF: Exactly, we literally have to put a date on everything so they know when the last time it was updated because I can tell you something today, and a week from now, I might be wrong. So it's changing.

JM: One of the big concerns as we understand it among the medical community is this lack of protective gear, the masks, the gowns, gloves, things you really need so that you don't contract Covid-19. What is the latest on that situation?

DF: Well, we're still in dire need. This is something of proportions that no one could really prepare for, and so what we call personal protective equipment, or we'll call it PPE is something that we need to protect ourselves as you said, but much of what is needed, it's not something the doctor would have in their office, normally. I mean unless you were coming in contact with infectious patients on a regular basis, you wouldn't necessarily have this, nor would the hospitals have it in the degree that they're going to need it. So we're making efforts to try and collect that.

A couple things have happened. The first is that the governor has reached out to industry, have them donate theirs and bring that in. They've also got a task force that's helping to acquire PPE from around the country and around the world. I heard as of the last three days, they've put out $80 million worth of bids for PPE for the state of Texas. So big things are happening there.

In the meantime, our county medical societies, which of course are spread over the huge geography of Texas are collecting PPE in the local communities from think about it, construction sites use the M95, these high filter masks that we use, clean rooms for high tech industry, dentistry, veterinary medicine. We're collecting it from any and everywhere we can get because we know that in some time in the near future, we're gonna have a huge demand.

JM: So we hear so much about social distancing, and now we have a shelter-in-place order here. It never hurts to talk about why this is important because those of us who are not doctors or in the medical field sometimes don't understand why this is critical to keeping Covid-19 at bay.

DF: The importance is, you've probably heard this term, flattening the curve. It really is important because this is a disease that if we didn't do anything could spike and sort of go through the community in a month or two, but in doing that, it would far exceed the capacity of our hospitals, and more importantly, our intensive care units, and the numbers of respirators that we have.

So we literally would have patients coming to the hospital with no room for us to put them anywhere, no ability for us to put them on ventilators. By flattening the curve, by isolating ourselves, by slowing the degree of infection and spread, we are keeping underneath the capacity of the healthcare system, allowing us to take care of those patients. The good news is fewer people will die. The bad news is that that means that this prolongation of the curve will occur. We're talking about spreading it from weeks to months.

JM: Yeah, and that impacts our lives in so many different ways, but as you said it, it's so important that we do flatten the curve. I'm thinking about the rural hospitals, Dr. Fleeger, because they are already facing such issues. How are your rural doctors faring in all of this? Some of those hospitals have been closing. There's some people that don't have medical facilities for hundreds of miles in rural Texas.

DF: No doubt, no doubt. As you know, it's a major problem in the state of Texas to begin with. If you'd asked me before this came up, one of the things I'd often tell people is we've had nine hospitals in our rural areas close in the last five years, and that's a trend that seems to be accelerating. So they have problems with financial viability in and of themselves, but oftentimes, these hospitals are a major part of the infrastructure of their towns, and they're going to be taxed to the max as far as being able to deal with this. We have a lot of concerns. We're going to need to have special attention and help them to supply them with personnel, and I see really a lot of people needing to be transported from these small towns into our bigger, urban areas with their larger hospitals.

JM: As it stands right now, do you feel like we have the capacity to handle the Covid-19 cases that will be, obviously, building in the next month or so?

DF: Well, of course that's a question that I don't know if anyone can answer.

JM: Yeah. A lot of different modelings that go on. I think that if we don't flatten the curve, then we are really in trouble. We will, by everyone's estimate, exceed our capacity. So we flatten the curve, hopefully we'll be able to stay in an area that we can continue to provide ventilatory support to patients. Continue to provide hospital beds to patients. I think we can do it. As Texans, Texans are proud, and they're tough. I think we can do it, but it's gonna be a battle.

JM: Indeed it is. Final question, Dr. Fleeger. What do you think are some of the big misconceptions among people about this virus that you would like to perhaps clear up as a medical doctor?

DF: Well I think probably the first thing I'd say is this is real, okay. This is not something created by anyone with a political agenda or by Facebook or other social media. This is war. We need to have a mentality to approach war. So in this war, 80 percent of the people who get this disease won't ever have to set foot in the hospital, but 20 percent will, and that 20 percent are at high risk for severe illness, and even death. So the 80 percent are trying to protect the 20 percent.

The 80 percent are making it so we do this right. Your children can play with their grandparents. If we do try, your friend who has breast cancer and needs chemotherapy will still be here, have a family in the months to come. If we do this right, Bob who has a bad heart can continue to tell his corny jokes around the water cooler, and those people will still be with us, but if we don't do this right, then basically those people will be gone, and they will leave society.

What can the people of Texas do to help them? They can wash their hands. They can cover their cough. They can clean and sanitize. They can stay home, and that does sound like much to do as far as the battle's concerned, but I have friends that are nurses and doctors, and they're willing to help those people in the hospitals, and some of them will lose their lives by doing that, so it's important that everyone pitch in and help, and that would be my message.

*This interview has been edited and condensed for clarity.

For a broader look at healthcare in Texas, you can check out our roundtable with Dr. Fleeger and other medical experts. (*

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