As state and federal leaders say that protective equipment and funding are on the way, physicians in Southern California have been telling us they fear for what's to come in the days and weeks ahead, as supplies run short and coronavirus case numbers rise.
"The PPE (personal protective equipment) has become a major concern already, and we haven't even seen the onslaught of patients, so that's a pretty frightening aspect," said Dr. Mark Futernick, an emergency room doctor in downtown Los Angeles, and board member of the California American College of Emergency Physicians.
One hospital worker in the South Bay area told us they recently bought an ultraviolet device to be able to sanitize N95 masks as hospitals have begun to ration supplies.
"It's a real threat and a lot of doctors are scared, myself included," said the hospital worker, who spoke on the condition of anonymity for fear of retribution.
Dr. Somil Viradia, a physician in the Los Angeles area, said that he's been asked to use one N-95 mask to see five patients before throwing it out. Under normal circumstances, he'd throw the masks out after each use.
He said news about doctors in critical care in other states for COVID-19 have sent chills in the medical community:
"In all my years of medicine, I've never seen such unanimous kind of agreement over one issue amongst medical workers as I've seen with this -- and that's just the outright fear of getting sick, possibly critically ill, or possibly dying."
An ER doctor with nearly 30 years of experience at several major L.A.-area hospitals, who asked to remain anonymous, told us, "This is the scariest thing that i have ever been through. We're not prepared. I'm scared and so are my colleagues. A tech I know was just told that an N95 mask is not necessary -- she's not allowed to use a mask."
CDC ADVISES 'BANDANAS'
Guidance from federal officials haven't allayed fears, either. Last week, the Centers for Disease Control and Prevention issued new guidelines saying healthcare workers can use homemade masks, like bandanas and scarves, as a last resort.
"That's obviously extremely concerning," said Dr. Ritu Viswanath, a hospitalist in the Los Angeles area.
The L.A.-area ER doctor with three decades of experience expressed disappointment in the CDC for its changing guidelines. "For 30 years I looked to the CDC for guidance." Now, he said, "I have zero trust in them."
He went on to express concerns in the medical community about the risks of exposure to coronavirus during the intubation process, when patients often spew saliva and mucus into the air. He said the procedure requires not just an N95 mask, but also a device called a PAPR. "It's basically a gas mask that goes over the whole head, like you see in Italy and China. The whole intubation team should have them. But many facilities have none."
Another surgeon in the Los Angeles area, who also didn't want to be identified for fear of retribution from her employer, told us: "No one is trusting them (the CDC) in the doctor community because it's like an insult to people's intelligence -- wear a bandana?"
"I'm not a hero. I'm not going to die because I don't have a mask," the surgeon said.
"We're going to drop like flies. some of my colleagues aren't going to make it. I hope I make it."
TESTING REMAINS LIMITED, EVEN FOR DOCTORS
As testing remains limited, it's hard for even doctors to know whether they've been exposed to the illness. Many ER doctors have been isolating themselves from loved ones, Futernick, the ER physician, told us.
"They just don't want to take any chances at all," he said. "They're renting motels, they're living in the garage. They're too afraid to see their families at all."
Doctors worry that as physicians and other healthcare frontline workers get the illness, they will be spreading it more to their patients without knowing it.
"The larger medical community worries that if we become asymptomatic vectors, are we even exposing our potential patients to the disease?" Visnewath, the LA area hospitalist, said.
'THROWING OUT THE OLD PLAYBOOK'
Dr. Larry Stock, an emergency physician at Antelope Valley Hospital, said they've tried to extend the use of protective equipment as long as possible.
"There's no region of the country that's adequately resourced," he said.
Stock, who volunteered in Liberia during the Ebola crisis in 2015 and during the country's civil war in 2003, said that because of this, doctors are going to have to think of doing things in new ways.
"You've got to kind of throw out the old playbook of how things are done, in terms of PPE, in terms of how we approach how long people stay in the hospital," he said. That may mean that standards of care will drop from "excellent" to "adequate," he said.
Stock, who's been appointed as deputy mayor in Lancaster for the coronavirus crisis, said the city has now created a field hospital at the Antelope Valley Fairgrounds with about 500 beds to prepare for the surge.
"We very much want to make sure we can do the most good for the most people," Stock said. "It's a real unprecedented time in emergency medicine, for sure. It's a major challenge."
SOME STRAIGHT TALK ABOUT COVID-19
We're all living through this extraordinary and frightening pandemic. The vast majority of our newsroom has been working from home (here's some advice on that) since March 11 to bring you calm, helpful reporting. We are answering your questions and taking more.
We're here to help. And if you can help support that effort financially, we'd be grateful.