NELA Chapter Update: Effect of COVID-19 on the Daily Practice of Medicine

I knew that Saturday when my pager went off with a “high priority” message, COVID-19 was here. In less than 24 hours, our regional chair restructured all that we do; four days hospital rounds, four days telemedicine, no outreach, work at one campus, days off requiring checking messages for updates of protocols, daily dashboard and system-wide town hall meetings. We were placed into teams to minimize exposure ultimately “to avoid all of us getting the virus at once.”

That Monday I had a full Lipid Clinic, within 24 hours our schedulers converted all appointments to telemedicine medical visits. Telemedicine is new to my personal practice. I start every encounter by educating patients on COVID-19 and providing our hotline phone number. For new patients, I walk them through the NLA website to obtain the appropriate diet. All needed reassurance that our laboratory services would minimize their time at the lab with an appointment and all patients will be screened at the door. For my FH patients, I am reviewing COVID19 precautions and placing a note in their medical record of higher risk for cardiac event with FH and COVID-19. Of course many have pre-existing CAD, stressing the need for uninterrupted medical therapy. Many are stressed worrying about delays in PCSK9 inhibitor delivery. Informing patients with elevated Lipoprotein(a), that the COVID-19 can trigger an intense systemic inflammation, with interleukin 6 and can increase Lp(a) increasing risk of myocardial infarction. Yet all the while, stressing that many patients who have COVID-19 do recover. Routine labs are of course postponed. For most, it is difficult to maintain therapeutic lifestyle changes during the Pandemic. So much we have yet to know about COVID-19 especially for patients with inherited lipid disorders.

I live in a lake community in the Poconos. Usually quiet this time of year, many traveled to their secondary home for refuge from the Philadelphia and New York City area. Our dashboard quickly changed, and now Northeast Pennsylvania is a “hotbed.” Each hospital rotation has anticipatory anxiety and when I arrive at the hospital, I am ready for the challenge. I have learned a great deal, yet there is so much more to learn about COVID-19 and cardiovascular complications. I do the best I can to protect myself, as I am a cancer survivor with not the optimal recovery of my white cell count post-chemo. 

I remain concerned that there are many patients with cardiac symptoms, angina, arrhythmia, and heart failure, fearful to come for treatment. They are fearful of contracting COVID-19. I suspect we will be very busy in the months to come. 

The healthcare financial impact is surmounting with so much uncertainty. Routine operations and admissions have been cancelled. Two weeks ago, our system administration asked for monetary and PTO donation for employees who will be furloughed. Last week administration announced for physicians, nurse practitioners, and physician assistants, in lieu of a pay cut, we must use a PTO day once a week. Another health system in this area has reduced pay by 35% and is no longer contributing into pensions.

As I last entered the hospital, my head was held down low, feeling physically and mentally depleted. I looked down at the sidewalk of the employee entrance into the hospital, in chalk on the side walk, “Heroes Enter Here.” A neighborhood child had done this. I smiled, shed a happy tear, and held my head up, ready to care for cardiac patients with and without COVID-19.

Be safe and be well.