Vicki Zhou spent New Year’s Eve in an emergency room—not as a patient, but as part of her first year as a doctor. The 27-year-old Zhou was wrapping up another eight-hour shift on the ER staff at the Hospital of the University of Pennsylvania in Philadelphia, and had to rush to a friend’s rooftop for the midnight fireworks.
“I made it in the nick of time,” Zhou says. “You could see all the skyscrapers, and we have fireworks on each side of the two rivers that border Philly.” But as she was enjoying the celebration, a contagion was rapidly multiplying inside the lungs of people in Wuhan, China. The year of coronavirus disease had begun.
Even without a global plague, it’s a huge jump from being a medical student to doing a residency, the professional apprenticeship that follows medical or nursing school.
“The first six months are a big challenge, because as an intern, you’re sort of the workhorse of the hospital,” Zhou says. “You’re the one who gets there the earliest, who writes all the notes, who is put on the spot to present to more senior doctors.”
Zhou says she was just getting used to the experience as the novel coronavirus began to rise in China. She was reading the news like everyone else, and hearing on-the-ground accounts from her grandparents, who live in Shanghai. “But it was so far away. I wasn’t seeing effects in our hospitals, definitely not in January,” she says.
Now, newly minted medical professionals such as Zhou and her colleagues have been thrust into a once-in-a-century pandemic.
Coronavirus crash course
Unrelated to the coronavirus, Penn Presbyterian Medical Center began the new decade by preparing for disaster. During the first two months of 2020, the medical center had started conducting a hospital-wide emergency drill, which recruited staff from various departments—trauma service, inpatient services, the intensive care unit—to practice what the response might be during a situation with mass casualties.
“We were thinking about dirty bombs. We were thinking about the Las Vegas mass shooter. We had thought about Ebola,” says Jonathan Bar, 29, a third-year medical resident in the emergency department who helped run the exercise. “We had medical students acting as both first responders and patients for the drill. The FBI even came to visit and watched.”
As part of the drill, the hospital staff set up a decontamination tent, which ended up being temporarily repurposed for COVID-19 patients as the U.S. outbreak began to grow. A senior resident, Bar is now part of the tent crew, which serves as the hospital’s first layer of defense. The team screens incoming patients for signs of the respiratory disease. Suspected cases receive a mask and color-coded tag, so they can be sorted away from uninfected patients inside the emergency room.
“We don't want the people who are potentially infected mixing with the guy who came here just ‘cause he broke his ankle,” Bar says.
One of the hardest transitions has been telling people that they can’t be with their critically ill loved ones, says Zhou. After Pennsylvania recorded its first coronavirus cases on March 6, the hospital switched to crisis protocols, and only essential personnel are allowed into rooms housing patients with respiratory complaints. It’s a precaution that takes an emotional toll on families and medical staff alike.
“You should not be in hospital if you don’t have to be,” Zhou says. “But it’s a hard pill to swallow. It’s hard for me, as somebody taking care of a patient, to tell them, I’m sorry. I can’t let your loved one be here with you.”
During their limited downtime, the emergency team conducts practice exercises for basic activities, from clearing a patient’s airways to donning personal protective equipment (PPE). This roleplay may sound rudimentary, but it is essential to managing cases during a crisis. For example, air-purifying helmets, called pappers, can be cumbersome to wear and difficult to talk through at first. Practice made it easier to communicate when worried patients started arriving with COVID-19 symptoms.
Emma Rogers, 28 and a first-year resident, says the early days of the crisis were especially difficult due to the absence of COVID-19 tests. “We were having to make a lot of decisions not having a ton of data to go off of,” she says. “It's not really something that they can always teach you in med school.”
Everyone at the hospital—both seasoned and starting out—is coping with this crash course. They’re learning new lessons as they go, such as how to spot patients who arrive with run-of-the-mill respiratory complaints but actually have a raging pneumonia brewing inside.
Surge of emotion
For the medical residents, the COVID-19 experience comes with mixed emotions. They’ve spent years training for the opportunity to turn calamities into victories.
“Even though it’s still early in my career, an experience like this may never happen again,” Zhou says. “Maybe 40 years from now I can say, Back when I was in my first year of residency, you wouldn’t believe what I saw.”
On the flipside, the scale of the crisis is daunting, especially due to equipment shortages. And all of the epidemiology models say the worst days are ahead; Philadelphia is already leading the state in COVID-19 cases, and as of writing, more than half of the city’s ventilators are already in use.
So far, hospital staff have been working eight-hour rotations, but that is due to change as a “surge schedule” is implemented for the coming weeks and months. “Right now, it's sort of an ‘all hands on deck’ situation, where we can't be too far from the hospital at any time,” Rogers says.
Through the COVID cloud, moments of brightness do appear. Members of the Philadelphia community have had food delivered to the hospital. Zhou says family friends from China have been sending large packages of surgical masks to donate to the hospital, returning the favor after her U.S.-based parents shipped supplies to China earlier this year. Rogers’s neighbors have posted letters of encouragement on her door and offered to walk her dog while she works her shifts.
“It’s been really nice seeing how everyone has come together,” Rogers says, “because we definitely can’t do this in health care just on our own.”