Brandon Bikowski is board-certified in internal medicine. He works as a hospitalist in Phoenix, Arizona. Below, in his own words, Bikowski reflects on his experiences at his job and shares his opinions on the surging COVID-19 crisis.
I am a hospitalist in Arizona, which is one of the most infected states in the nation. COVID-19 cases are surging here. I watch, horrified, as the number of cases and deaths increases.
Every day I hear "Code Blue" called overhead for someone in one of the many COVID units. I listen as colleagues notify family members that their loved one is unlikely to survive. We talk of people more than a decade younger than I am who have died. I read the plans for how we are to score and triage patients so that we only utilize our already scarce resources on those with the highest chance of five-year survival.
I find myself wondering if the general public has become so desensitized to death, that it has simply become a number. Part of me understands the people who don't believe that this is real because they haven't seen it. Those of us working in hospitals, on the other hand, are watching it spin out of control in real time.
That's why I recently wrote a Facebook post detailing what my experience has been like working as a COVID doctor in the hospital. To my surprise, it has been shared over 138,000 times. While my social media posts are rare or related to major life events, I have begun using social media during the pandemic as an outlet to share information with the general public.
In an addendum to my initial post, I wrote, "To be clear, COVID-19 is caused by a virus. This is a PUBLIC HEALTH CRISIS. It is not, never has been, and never will be a political issue. Politics have played a huge role in getting us into this mess, and it's time to cut them out. COVID doesn't discriminate, and it definitely doesn't care who you're going to vote for. When you see/hear/read anything related to COVID-19, pay attention to who is posting the information. If it is not coming from a medical professional, question your source."
Though I try to focus on the supportive comments, it's hard to escape that there are just as many comments that have questioned my credentials and attacked my character for telling people to social distance and wear a mask. Regardless of the feedback, I am a doctor and part of my job is to educate. I will continue to do so, but sometimes I am so frustrated by the misinformation and malice in the comments that it is difficult to form a calm and reasoned response. A lot of times, I just want to scream. Often, I feel as though I've somehow failed.
The chief medical officers of all the major health organizations in Arizona recently developed a triage plan for the state. Business competitors have been forced to come together and collaborate to share plans, resources, ideas, because of the severity of the situation and the leadership vacuum regarding this pandemic. And the plan? Essentially, when resources become scarce, patients (both COVID and non-COVID) will be reduced to a number generated by a set of criteria. Those numbers will be used to determine who is able to receive those precious resources.
I'm relatively young and relatively healthy, so if I get COVID-19, I'm less likely to die from it. I still maintain an appropriate level of fear, because it prevents me from being careless. What I fear most is being broken by the weight of the responsibility that will inevitably be placed on me and my colleagues in the coming weeks. My motives in my original Facebook post that went viral were pure and therapeutic, but I now write with determined and selfish intent.
My message is unchanged. I am pleading with the people of Arizona to stay home, and if you have to go out, socially distance and wear a mask. However, this time I am sharing my message with the hope of preventing myself from having to tell a patient that, because their calculated score was higher than someone else's, the best I can offer them is comfort care. I hope to avoid a scenario where I have to withhold treatment while a patient struggles to breathe and begs me for potentially life-saving interventions when there simply aren't enough to go around.
I'm a resilient human, but I think that could break me. It won't break me immediately, because there will still be other patients to treat and other tough conversations to have, but eventually my resiliency will be depleted. Eventually it will break my colleagues. Some are already broken. Some have quit and many more will follow.
When I last checked, ICU beds in Arizona were at 91% utilization despite avoiding placing patients on a ventilator until it is an absolute last option. If you ask state leadership, you will be told that we have an adequate number of ventilators. That's not a lie. What we don't have are beds in which to put patients attached to those ventilators, or trained staff to take care of them. The general public is not being shown that multiple patients are being crowded into rooms because we're running out of space. Physicians are seeing more patients in a day than they can handle. Nurses are trying to care for more patients than is generally considered safe. Labs are overwhelmed by testing and results are delayed.
Allow me to be perfectly clear:
- Having a ventilator available does not make it a usable resource.
- Trained staff are a limited resource and cannot provide the usual standard of care.
- There are not enough tests or enough facilities to handle the processing of tests.
- If we cannot mount a sustained antibody response, we cannot develop herd immunity.
- It is too late for contact tracing.
Arizona is at a point where, even if all of the right things were done by leadership right this second, it comes too late. Unnecessary deaths will occur because the medical system will become more overwhelmed and we will not have the resources available. The goal now is to try to limit the amount of time the system is overwhelmed and thereby mitigate the impending damage done. To do this, we need to make drastic changes immediately.
First and foremost, I would encourage people to think about their sources of information. The health care professionals, epidemiologists and public health experts have a unified goal to minimize the spread of the virus to save lives. There is no agenda or malicious intent. The goal is to save lives. Epidemiologists don't pretend to be experts on politics, commerce or governance. It would be helpful if commentators, legislators and economists stopped pretending to be experts about medicine and public health.
Second, Arizona has to shut down again. We cannot contain the virus at the current rates of infection. When it is safe to open, we must follow appropriate and safe guidelines for doing so.
Third, everyone must socially distance and those of age must wear a mask. Trust me, I hate this as much as you. You can ask the scab on the bridge of my nose from where my N95 has rubbed my skin raw. If I can put up with that, you can wear a surgical or cloth mask to go to Costco.
Finally, we need to care about each other and about the lives of our fellow man. I don't know how to tell you to care about other people.
If your house were on fire, you would call a firefighter, not a politician.
Arizona is our home and it is engulfed in flames.
Please stop throwing fuel on the fire.
The views and opinions expressed in this article belong solely to the author and do not necessarily represent the views of ABC News.