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Hospitals still 'jam packed’ despite COVID-19 cases declining in some cities: Physician

ICU physician at Boston Medical Center Dr. Lakshman Swamy joins Zack Guzman to break down the ways hospitals are handling coronavirus cases and how reopening states could impact the spread of the virus.

Video Transcript

ZACK GUZMAN: Meantime, as Brian was noting, a lot of the uncertainties do stem and focus on the idea of a potential second wave. We've heard those fears raised on the front lines in hospitals across the country, mainly as people watch a rise in cases in states like Alabama as people return to work and raise concerns about people not wearing masks as well.

For more on what we're seeing play out on the front lines, I want to bring on a front line physician. Dr. Lakshman Swamy joins us, an ICU physician at Boston Medical Center. And Dr. Swamy, when we look at this, I mean, how has it been. Maybe more time to prepare was really the thinking here in flattening the curve and making sure that if we did see a rise in cases, whether it be, you know, in March, April, or maybe down the line when we get to the fall, that the hospitals will be prepared. Have you seen an improvement on that front?

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LAKSHMAN SWAMY: So thanks for having me. I think what we've definitely seen is that hospitals are-- have learned a lot, in some cases the hard way like in New York. But we've all learned from that. So on the one hand, I think we know much better how to reconfigure our operations, how to manage a huge number of patients coming in that are critically ill that need ICU beds and ventilators.

I think we have a plan for that, right? In Boston, we certainly have a plan for that. We've been executing it. And fortunately, we're scaling it back. What I'm seeing in Alabama of course terrifies me, as it does so many people.

We're all suffering from lockdown. It's a huge hit to, you know, of course the economy, to individual people, to health, to everything. But it pales in comparison to the costs that the virus takes when it runs free.

Obviously, we're hoping we can get something done with all the lockdown time. I think we all were hoping we'd have a lot more testing and contact tracing and all of that in place, that public health infrastructure that allows us to open kind of carefully and allows us to manage it so that we can stop those big surges before they hit that critical-- that critical surge sense where we can't handle it. We came really close to that in Boston. And it was terrifying.

ZACK GUZMAN: Yeah, and it wasn't just Boston. I mean, we've heard-- we've heard stories from a lot of doctors on the show. And a lot of places in this country did come very close to the brink in terms of what capacity they have in their hospitals and even really, honestly, pushing beyond it and doctors stepping up.

But when we look at, you know, the burnout effect here too-- and that's something that I know that you have talked about and you have seen firsthand, because you do have all these doctors and everyone throwing force in there to handle all these cases that's well above what they're equipped to handle. You deal with issues on PPE and all of that as well. When you do get this lull here, you're not taking a day off. You still have other things to deal with in the ICU as well, maybe not as many coronavirus cases. But what does that do to the actual efficacy of the team-- team morale, doctors in this situation before we potentially prepare for a second wave?

LAKSHMAN SWAMY: Yeah, it's-- it's a great question. You know, we-- we study burnout at my organization. We've written a bunch of papers on it. Burnout was a problem that we were really focused on before the pandemic. And that was a setup for really getting hit even harder. I think we all had a surge of kind of motivation and existential calling that this is what we're here for. This is what we've trained for so long for. But that works for a sprint.

And you know, it's interesting because for example, you look at Boston. And what are people seeing across the country in our numbers? They're seeing coronavirus cases go down. That's fantastic. What you're not seeing is that the hospital is still jam packed with people that were deferring care, which-- who were staying at home, scared of coming in. So the hospital is still really busy. No one's getting a break here, you know?

And it's terrifying to think that now on top of this, you know, as we start to reopen, we could lose control of the virus again. So I think people are suffering. And the toll of that is going to come out in a lot of ways. I think certainly you have PTSD at the extreme end. You have people, unfortunately, we've already seen, taking their own lives. You also have a lot of people, I'm worried, leave the profession. And this is the time when we can't have that. The pipelines aren't flowing enough to really-- to give us all the clinicians we need, not just doctors but nurses, everyone.

ZACK GUZMAN: Yeah, no, definitely, very important, no, and definitely wanted to talk about it with you. But we're also, as you mentioned, testing and the issues there. You can look at case counts. Some people like shifting to look at the positive percentage of tests. There's a lot of different ways of looking at what could be signs of a second wave.

Also interesting to note that-- that, specifically in Massachusetts, when you look at the serology reports and looking into who actually has contracted the virus based on testing versus whether or not you see antibodies-- we've seen that here in New York. Curious to get your take on what that actually looks like and maybe how many people may have been infected with COVID-19 that actually haven't gotten tested or maybe just don't know they've had it before. But what does that-- what does that necessarily tell you about where we're headed from here?

LAKSHMAN SWAMY: Sure. So you know, we know that there's a huge amount of people who-- who we know about that we-- you know, my patients that I would call and say, sounds like you've got it. The best thing for you to do is to stay at home and quarantine-- truly quarantine, right? So we know that the numbers are not that clearly reflected in our data.

What we can hope for is that a lot more people got it. But I think the reality is and what we're seeing from the serology testing, flawed is it may be, in the most optimistic sense, I can still say with pretty much certainty that we don't have herd immunity, herd immunity being enough people having had the coronavirus and not being able to get it and transmit it again. There's a lot of science that's unknown there. But I think what we know is that we can't rely on the virus not being able to hop around and catch like wildfire, even in Boston.

ZACK GUZMAN: Yeah, in Boston, or again, anywhere else. But when you look at it--

LAKSHMAN SWAMY: Anywhere else, anywhere else.

ZACK GUZMAN: --there are a lot of concerns about everywhere else. I, mean in New York and Boston, we've talked about the ways that maybe people will be wearing masks when they go back out and reopen. But in some other states out there, we haven't necessarily seen that per se in some more crowded venues. And when we talk about masks, what does that mean to you as a doctor when you see people out there maybe not wearing one or maybe some of the confusion out there around why it's so important to wear these masks, maybe not even an N95 masks but even just a bandana?

LAKSHMAN SWAMY: Yeah, so first of all, it's a great point you make. I'm speaking about Boston because this is a place where we've been hit. And the community has learned and felt it. And then you look across the country where people haven't been hit as hard, thank god. But you see that people don't get it. It's a really abstract concept. It's hard to believe in that, right? It takes a lot of trust to believe what you're seeing and hearing.

The masks are sort of a symbol of it. The bigger thing is the social distancing, right? I mean, crowds together in open spaces or especially in enclosed spaces, it's terrifying. And it takes weeks to see the effects of that. So people will feel like, oh, look, we did that. It's no problem. Hey, look, they did it over there. We can do it here too. And it's heartbreaking because what we see over and over again is two to three weeks later, the cases start hitting. And you see a surge. And you see spikes.

I hope that doesn't happen anywhere else. But the virus is here. It's everywhere. So it's-- it's heartbreaking. I hope we can get to people before the virus does.

ZACK GUZMAN: Yeah, I share the same hopes and appreciate you doing much more than I am here, to be honest, and on the frontlines. Always appreciate you and other doctors that take time out of their busy days to come on and give us these updates. But Dr. Swamy, appreciate it. And good luck out there.

LAKSHMAN SWAMY: Thanks so much. Really appreciate it.