COVID-19 physicianA 35-year-old female emergency medicine physician presents for evaluation for severe myalgias, headache, fatigue, mild nasal congestion, profound anosmia, cough, and subjective fevers and chills. She has no measured temperature above 100.4°F, but has been taking anti-inflammatories around the clock. The day previously, she called occupational health and received testing for the novel coronavirus. The next day, her test returns positive. What happens next? We are here to share our personal experiences with COVID-19 and provide some resources to best support yourselves, your families, your learners, and your colleagues throughout this uncertain and ever-changing situation.

How did you feel when you found out?

I felt so sick (flu-like) that I really wasn’t surprised when the result came back positive. To be honest, I didn’t feel scared or sad or angry or anything related to how this result might affect me or my family. I was singularly frustrated about how much this would impact my colleagues, who’d inevitably have to cover my ED shifts. I also felt badly missing work when everyone was already working so hard to fight the pandemic.

How do you let your supervisor/department know?

The second I woke up feeling so sick, I let my chief know. Occupational Health initially told me I could not get tested due to limited availability of tests and to just quarantine myself for 14 days from my last contact with anyone at the conference, but my chief was able to get me tested in our emergency department. The Department of Public Health called me the next morning with the positive result, and I called my chief next, but she already knew, because the positive result was routed to her from the emergency department. In fact, several members of my department knew my test result before I did, which was quite a violation of privacy. Ideally, as the patient, I would be the first to know about the result and then have the opportunity to choose how to disclose the information to the rest of the team.

I emailed our chair and medical directors, my division, and our residency leadership team to inform them, and shared my illness with the residents during our Zoom weekly conference two days later.

How do you let non-medical family and friends know?

This was a bit harder, because I knew everyone would be incredibly worried, much more so than I was myself. I informed my close friends and family via text, focusing on the fact that I was safe and not severely ill, and that my partner was keeping a close eye on me. I also emphasized that I wasn’t worried and that I felt confident everything would be fine. My positivity helped assuage their fears.

What did your department do? Was that helpful? What could’ve been done better?

My department was incredibly supportive. The moment I felt sick, my chief told me that she would find coverage for my upcoming shifts. It was an immense relief to have that taken off my plate. My division very sweetly purchased me a meal delivery gift card, and several colleagues offered to drop off groceries or meals.

The one thing that colleagues could’ve done better was to understand that I was actually sick. My brain was totally foggy and I was too fatigued to focus on much, and yet, time-sensitive emails and tasks kept coming. I, of course, felt obligated to try and address these issues, then dug myself in further because my feeble replies were interpreted as engagement and readiness to continue working, so the cycle continued. I can’t even express the immense relief I felt when one colleague stepped in and replied to all, “You just focus on getting better. I will take care of this.”

My advice to readers is to not only be kind and compassionate to your sick coworkers, but also to yourself. No one expects you to work during an active illness, they just forget that you’re ill or aren’t aware. Give yourself a break and set up an automatic reply. Then don’t check your email until you actually feel well enough to act on it. If it’s truly urgent, people will find a way to contact you.

How did you isolate? Any recommendations?

This was an interesting one, because my partner, Jack,* and I live in a loft apartment– it’s literally all one room, so would be impossible to truly isolate. At the time of my diagnosis Jack was completely asymptomatic, and the Department of Public Health recommended that he stay on home quarantine for at least 14 days from the onset of my symptoms. At that time, there weren’t temporary housing options in place for infected healthcare professionals. We didn’t really want to be separated during such a stressful time and so we decided to stay home, together. We did our best with impeccable hand hygiene, vigilance about not touching our faces, not sharing towels, blankets, utensils, or food or drink, and using separate toilets. I actually didn’t worry much about infecting Jack– I assumed his ultimate infection was inevitable!

Any surprises on how the isolation affected you?

Well, it wasn’t a surprise, but I felt really guilty about being unable to do anything during the three days of intense illness, as well as not being able to work clinically for so long.

What was kind of surprising was that, rather than feeling isolated and lonely, I actually felt overstimulated and fatigued by all of the constant communication from loving, concerned colleagues, friends, and family. I’m a pretty intense introvert but I knew how worried everyone was, so I felt as if I couldn’t avoid any of the texts, calls, instant messages, or video hangs, and ultimately felt exhausted from the constant social bombardment. Definitely something for readers to keep in mind: when initiating check-ins, think about what the infected loved one would want. For infected introverts, consider designating one person in the family/friend group as the contact person to perform a check-in every 24-48 hours and relay information back out. Another option is to preface any loving check-ins with “No response expected.”

How was the return to work?

Return-to-work protocols have changed nearly daily throughout my illness and quarantine. Initially, my institution’s Occupational Health combined the WHO’s guideline at that time, 7 days since onset of symptoms and at least 72 hours afebrile and with improving symptoms, with a second Covid virus test on day 8. Despite mild congestion and a very rare cough, my second test was positive, so I was kept at home to complete a quarantine for 14 days since symptom onset. Initially, I was going to be tested again on day 14, but fortunately, that requirement went away.

I experienced immense frustration with the discordance between the Department of Public Health and my institution’s Occupational Health, superimposed upon constantly-changing protocols. At the same time, I fully understand and appreciate why everything was so dynamic, and don’t blame any individual or any one governmental institution. Our system was broken long before this pandemic, and now the general public can see the cluster we’ve all navigated for years.

How can I best support myself, my learners, and my colleagues through COVID-19 infection and quarantine?

  • For you
    • Allow yourself time and space to feel sick and to recover. All of the emotions you are feeling are OK– it’s OK to feel sad, guilty, scared, angry, uncertain, anything.
    • Set up your automatic reply on your email letting your colleagues know you are out on medical leave.
    • Some institutions will pay for you to stay at a hotel or airbnb if you have COVID-19. ACEP has partnered with Hilton Hotels to provide discounted rates for EM physicians. Use code 9233354 when booking with the hotel, or by selecting “Special Rates” and enter the code into the Corporate Account field when booking online.
    • Take advantage of your institution’s counseling center. You can also get three free, confidential counseling session through ACEP as a member.
  • For others
    • Empty your colleague’s plate for them, at least for the first 3-5 days. Explicitly tell them and the team that you will be taking over time-sensitive stuff for Projects X, Y, and Z, and that other things can wait until full recovery.
    • Keep the sick individual out of the discussion about how their shifts will be covered.
    • Increase backup call schedule for EM physicians as the pandemic continues to make sure it’s not a last minute scramble to find coverage.
    • If your loved one is a fitness enthusiast, consider purchasing them subscriptions or equipment for home workouts.
    • Organizing a signup list for food delivery so that your coworker does not have to cook meals, or grocery runs since they can’t leave the house.
    • In California, if you have COVID-19 or a family member has to stay home to take care of you, you can apply for FMLA (family leave similar to pregnancy) in California.

* name has been changed

Dina Wallin, MD

Dina Wallin, MD

ALiEM Series Editor, The Leader's Library
Assistant Medical Director of Pediatric Emergency Medicine
Zuckerberg San Francisco General Hospital;
Assistant Clinical Professor of Emergency Medicine and Pediatrics
University of California San Francisco

Moon O. Lee, MD MPH

Associate Professor
Department of Emergency Medicine
Stanford University School of Medicine

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