The Last Day of Normal

By:  Sarah Cole, DO, FAAFP

On Saturday March 7th I flew from St. Louis to Chicago with friends.  I had spent the week preparing contingency plans for when SARS-CoV-2 trickled into my corner of the Midwest and was ready for a fun weekend.  My friends had casually wondered in the days preceding if we should still go, as there were rumors that the East and West coasts may start to restrict travel, and they asked my opinion as the physician in the group.  I was fairly certain we had a few more weeks before Missouri was significantly affected and enthusiastically said, “Let’s go!”  It was a lovely day.  We shopped the Magnificent Mile, stopped for appetizers at the top of the Hancock Building and attended a show at the Chicago Theatre.  It was also the last day of normal.

As we sat in the theatre, surrounded by nearly 4,000 people, waiting for the show to start, my phone dinged.  St. Louis had just detected it’s first case of COVID19.  In less than a week, “social distancing” was a household term, travel restrictions were tightening, gatherings of more than 50, then 20, then 10 people were banned and everything I had done on that last day of normal was now taboo.

I flew home on the 8th, naively proud that I had already crafted a plan to protect both the 28 physicians/APPs on my team and their patients by “silo”ing our doctors into just hospital care or just clinic care to prevent cross-contamination between providers.  It wasn’t enough.

By the 12th I had revised contingency plans, including further “cohort”ing my team into subgroups that alternated days of care to ensure if one group was exposed and forced to quarantine, the other group could still provide care.  It wasn’t enough.

By the 18th all clinic staff wore masks all the time.  By the 19st my institution invoked its crisis response plan.  By the 23rd our clinic team canceled visits for all but the highest priority patients (infants and pregnant women) and converted other appointments to video or telephone visits.  By the 24th our hospital team was seeing patients on a formal COVID19 unit.

Every day, sometimes every hour it seems, brings a new update or change in protocol as now we wait to see, “is it enough?”  At the time I write this (April 4, 2020), the Institute for Health Metrics and Evaluation (IMHE) at the University of Washington projected Missouri still has 44 days until its peak in death rate of 22 COVID-19 deaths on May 18, 2020 and 47 days until its peak resource need on May 21, 2020. Since then, Governor Parsons has issued a state-wide “stay-at-home” order.  As you know, data is changing on a daily basis and IHME has updated its projection for Missouri (as of April 6, 2020) to peak resource use on April 19, 2020 with a peak in deaths per day of 12 deaths on April 18, 2020.

Across Missouri family physicians are mobilizing to combat SARS-CoV-2.  The most broadly trained of any specialty, we work emergency and respiratory tents, separate our well and sick in clinics, scramble to provide virtual technology, maintain protective supplies and acquire knowledge regarding evaluation and management of a disease we had never heard of four months ago.  Your actions are heroic and I salute you.

No less heroic are the efforts of MAFP’s staff as they, too, mobilize, getting information and emergency supplies to MAFP’s members in rapid fashion during this time of need.  Check https://www.mo-afp.org/advocacy/covid-19-resources/ for real-time updates.  Contact office@mo-afp.org if your clinic is in need of medical supplies.  Register for the Show Me Family Medicine Conference, rescheduled to August 14-15, as conference information becomes available at https://www.mo-afp.org/cme-events/annual-scientific-assembly/.

Never have I been prouder to be a MAFP member.  Send me your stories and let me know how I or the MAFP can support you and the patients you serve at sarah.cole@mercy.net.  We will greet each other on the other end of this and until then, blessings to you all!