Abu Dhabi: Because COVID-19 is brought about by a novel coronavirus, the evolving nature of its treatment is challenging for even the most seasoned medical professionals.
Dr Ken Dittrich has completed nearly 40 years of work in emergency medicine, yet he is unequivocal when he says that he has seen nothing like the COVID-19 outbreak.
“I like to be on frontlines, making first contact with the patient, problem-solving and investigating their symptoms in a manner that is critical and can often be lifesaving. This novel coronavirus is exceptionally challenging. It isn’t just a respiratory illness [anymore]; we’re even seeing developing symptoms like blood clotting, clots to lungs, dual diagnoses and cytokine storms,” the consultant emergency physician at Sheikh Khalifa Medical City (SKMC), told Gulf News.
Still, like hundreds of healthcare professionals, Dr Dittrich dons his Personal Protective Equipment (PPE) every day and heads out to battle the microscopic enemy that has altered the shape and form of entire health systems around the world. The Canadian-born doctor has been heading up the emergency medicine department at SKMC for the past 17 years, and says healthcare workers are having to learn on the job every day as they fight the coronavirus.
“As a medical professional, I find this disease trying because of the continual education its treatment entails, the volume of cases cropping up and even the amount of ventilation [healthcare facilities] need to provide,” Dr Dittrich said.
Increasing patient numbers
His testimony reinforces just how fast and greatly the outbreak, and its related treatment protocols, have changed since the coronavirus came to light just five months ago. From taking in every patient who tested positive, hospitals are now only able to admit those who need medical attention due to the severity of their symptoms.
“We recognised that the coronavirus would come to the UAE because of its position as a travel hub, and the first two patients we saw had travel history to China and Italy. At that time, we were admitting all patients who tested positive. But then, the volumes kept increasing very rapidly,” Dr Dittrich said.
To intubate or not to intubate?
Another illustration of this is the protocol on invasive ventilation.
“The early trend [and protocol] was to put patients on ventilation early. But as more and more cases emerged in [Europe and the United States], the recommendation changed to put off intubation for as long as possible. [Doctors were finding that] the device can put high pressure in the lungs, thereby causing further injury,” Dr Dittrich said.
Now, physicians try all other interventions before proceeding to invasive ventilation, including respiratory exercises, nasal canulas to provide oxygen, and non-invasive ventilation through face masks with attached oxygen reservoirs.
The doctor explained that normal oxygen saturation is 94 per cent or higher. In patients with minor cases of COVID-19 in the UAE, the saturation level ranges from 88 per cent to 94 per cent. When this level drops to 60 or 70 per cent, patients may be alert, but they struggle to breathe and talk.
“Fortunately, 80 per cent of cases are mild or asymptomatic. Only 20 per cent require hospitalisation for oxygen therapy, and only five per cent are potential life-threatening cases, such as those experiencing a cytokine storm,” Dr Dittrich said.
And again, not all of the people with severe cases of coronavirus need to be intubated immediately.
But they do require intensive care, with medical professionals working around the clock to stabilise patients.
“One of the most difficult cases I have seen recently is that of a 50-year-old patient who came in last week. He had come to the hospital during the previous physician’s shift, and had presented with COVID-19 pneumonia. He then experienced several cardiac arrest episodes, as well as massive blood clots to the lungs, and was never stable enough to even be moved to the Intensive Care Unit,” Dr Dittrich said.
He and his team worked all night long to tend to the patient.
“Thankfully, he is still with us, and I hope he will recover,” the doctor said.
A trying and often-lengthy illness
Due to the nature of his job, Dr Dittrich is not often able to follow up on the patients he sees. But he knows that many of them, including the ones who were hospitalised in early March, are still under treatment, with some even receiving convalescent plasma therapy.
The lengthy treatment course means that entire hospitals around the world have been transformed into facilities dedicated to the treatment of COVID-19. According to Dr Dittrich, all of SKMC’s 600 beds are being made available for patients with coronavirus, including for those who require hospitalisation for other medical conditions but are also testing positive for COVID-19.
And he was unambiguous that a COVID-19 case can be trying.
“We see dire cases in the ER, including motor vehicle trauma, cardiac arrest, sepsis and cancer complications. Then there are patients with major burns, which I find the grimmest to deal with because I can empathise with the lifelong struggle the patient will have to face. But with COVID-19, every part of the care is important,” Dr Dittrich said.
Every spoke in the wheel
To that end, the doctor gave a shout-out to “every spoke of the [healthcare] wheel”, including the nurses who toil in healthcare facilities and the vast array of support personnel who have risen to the occasion.
“As emergency physicians, we do a lot. But you cannot discount the hospital administration that supports our work and provides the PPE, the cleaning staff who disinfect contaminated rooms, or the security personnel, the respiratory technicians and the kitchen staff. It really is a team effort,” Dr Dittrich said.
“Then there are the protective mechanisms put in place by the government. The economic and mental health impacts of this outbreak cannot be discounted, and [it is reassuring] that the government is looking after us so well,” he added.
Doing his part
For his part, the 62-year-old doctor is continuing to train at home with his wife, and eating healthy.
“[I’m in] an at-risk group, I know, but my wife and I do our best to stay fit. And then they test us at the hospital every week,” he said.
He is also clearly staying positive: when asked if he would have reconsidered his profession if he had known he would face a pandemic, Dr Dittrich didn’t miss a beat.
“I am glad to be able to contribute to this crisis. I see only the critical cases, but I know the entire community is making huge sacrifices. So as they say, we are going to get through this together,” he said.