Originally published in the July/August issue of the Tarrant County Physician.
by Kenton K. Murthy, DO, MS, MPH Deputy Local Health Authority & Assistant Medical Director, Tarrant County Public Health
It has been three months since Texas had its first reported COVID-19 case, and since then, the number of cases has risen dramatically. As of June 25, there are more than 125,000 cases and 2,249 deaths in Texas.1 In Tarrant County, the total number of cases to date is 10,363 with 218 confirmed deaths.2
Shortly after reopening, there were signs that COVID-19 had plateaued and perhaps decreased, but our latest numbers seem to unfortunately indicate the opposite.2
Texas, overall, has seen hospitalizations increase dramatically.3 While Tarrant County hospitalization rates are also increasing, we have not seen our hospitals become overwhelmed as other counties are experiencing.3 However, we are not that far off.
Currently, almost 70 percent of our hospital beds in Tarrant County are occupied, of which eight percent are occupied from confirmed COVID-19 patients.2 However, given the increase in the total number of new cases (especially those in the younger population), and increasing cases in long-term care facilities, it may be just a matter of time before we start seeing a surge of hospitalizations as seen in Dallas, Travis, Harris, and Bexar counties.3
Long-term care centers, and correctional facilities continue to be hot spots, while child care facilities are now starting to have outbreaks as well.4,5 Long-term care centers and correctional facilities are our most vulnerable groups and may see the highest mortality rates, so it is vital that we continue to test, track, and isolate these individuals. The continued use of PPE in caring for patients in these settings is also important.
While we are currently in Phase 3 of Texas Reopening, with amusement parks, media events and fine arts permitted to open and operate up to 50 percent capacity, and restaurants allowed to operate up to 75 percent capacity, the governor has since paused reopening of Texas due to the sudden surge of new cases.6,7
Locally, starting June 26th, Tarrant County will require face masks at all businesses and all outdoor gatherings larger than 100 people. The order does not include churches, although it is strongly encouraged that church goers and other members of the public wear a mask when inside or when social distancing is not possible.8
In addition to face coverings and masks, businesses must also continue to encourage their employees to hand wash frequently with soap and water for 20 seconds, use hand sanitizer with at least 60 percent ethyl or grain alcohol (ethanol) or 70 percent isopropyl or rubbing alcohol, maintain social distancing, and regularly clean and disinfect frequently touched areas. Businesses should also screen employees for increased temperatures and COVID-19 symptoms before they start work and immediately send staff and employees with symptoms home to self-isolate.9
“We must remain vigilant during this pandemic and not let our guard down.“
As our physician colleagues reopen their practices, they must also continue to keep patients and staff safe. With that in mind, the Texas Medical Association has posted a step-by-step guide called Road to Practice Recovery: A Guide for Reopening Your Practice Post-COVID-19. This guide covers everything from financial operations to clinical operations.10 Some of the same practices that other businesses employ should also be used for physicians’ offices.
Upon any examination or procedure with a patient, it’s especially important for clinical staff to use full PPE, including N95 masks, goggles or face shield, gloves, and a gown.10 While currently Tarrant County does not have a ban on elective surgeries, doctors, nonetheless, should prioritize procedures and hold off non-urgent surgeries or other medical intervention to decrease the risk of COVID-19 transmission as well as to preserve bed space for coronavirus patients. Telemedicine and telehealth practices should be used as much as possible to continue to serve patients without putting themselves or ourselves at risk.10
At Tarrant County Public Health, our HIV clinic has changed almost entirely to a telehealth model with a few exceptions. We’re also now screening everyone entering our building for COVID-19 symptoms and doing touchless thermometer temperature checks. We’ve installed plastic and Plexiglass barriers in our waiting rooms and have patients wait in their cars rather than in small waiting rooms prior to their appointments.
While it is vital we reopen our Texas economy, it is just as important to do this as safely as possible. We must remain vigilant during this pandemic and not let our guard down. Physicians have a strong voice in our community, so let’s reemphasize to our patients that they must continue to socially distance whenever possible, practice good hand hygiene, and wear an appropriately protective facemask.
We’re all in this together, so let’s continue to keep each other safe.
From the July/August issue of the Tarrant County Physician.
I have never been asked to deliver a commencement address, but since most institutions of higher education are not going to be having commencement exercises this spring, I decided I would write one just in case a need arises. -Greg Phillips, MD
“Klaatu barada nikto” (Helen to Gort in order to prevent the destruction of Earth.)
“The Day the Earth Stood Still”—1951 (Michael Rennie as Klaatu; Patricia Neal, Helen; Sam Jaffe, Professor Barnhardt) NOT 2008 (Keanu Reeves, Klaatu; Jennifer Connelly, Helen).
The world had survived World War II and was in the middle of the Korean War. A spaceship lands on a baseball diamond in Washington, D.C. A lone alien, Klaatu, in the form of a human being, and his robot, Gort, exit the ship and Klaatu asks to talk with the leaders of planet Earth. Not surprisingly, the Washington politicians refuse his request and Klaatu embarks on a mission to circumvent them. He ends up taking a room in a boarding house where Helen and her son, Bobby, reside and befriends them. Since politicians will not listen to him, Klaatu visits the world-famous Dr. Barnhardt (an Albert Einstein look-alike) to get his support. Despite Dr. Barnhart’s entreaties, Klaatu still is unable to persuade the world to take him seriously, so he demonstrates his resolve. He stops all machine-related activities on the planet at the exact same time on the exact same day (sparing, of course, airplanes in the air and hospitals).
Our United States government sees this as a threat rather than an indication of sincerity and issues an order to track Klaatu down. He is eventually shot and taken to a hospital, but Gort has instructions to destroy Earth if anything happens to Klaatu. The climax of the movie is Helen, racing to the baseball diamond as Gort is leaving the spaceship, saying the above phrase, “Klaatu barada nikto,” which aborts world-wide catastrophe. Gort then retrieves Klaatu from the hospital, takes him back to the ship and restores his health. Finally, politicians from all over the world gather in Washington to hear Klaatu’s message.
His proclamation is simple. Other advanced civilizations in the universe have been keeping an eye on planet Earth for some time and are alarmed by our behavior. They note that as we develop the capacity to travel off Earth, we will eventually begin to interact with them. However, since we can’t seem to get along on our own planet, they fear our coming to their worlds. Our hostilities toward one another cause other civilizations great concern. So much so that Klaatu warns the leaders that if we don’t straighten up and fly right (like the song by Nat King Cole originally but covered by many others including Lyle in 2003), the peoples of the rest of the universe will have no choice but to eliminate life on planet Earth.
If this were my commencement speech, so that I could fill up the allotted time, I would list and discuss the many examples of how dysfunctional our world remains:
¬ Ongoing wars and conflict between nations
¬ Global terrorism
¬ Global warming and environmental risks
¬ Religious intolerance
¬ Trade wars
¬ Global poverty and malnutrition
¬ Global disease and pandemics
¬ Political intolerance even within the same nation
One actually could give an entire commencement speech on each of these topics and still not cover them thoroughly. While there have been some attempts over the decades to address these issues and while we have a United Nations, little has been done to bring us together as a Whole Earth. The current/recent coronavirus pandemic clearly demonstrates that national and political priorities take precedence over the well-being of the citizens residing on our planet.
Fortunately, Klaatu did not give us a deadline and, for whatever reasons, we have not been eliminated from the universe by outsiders. In the past 70 years (and I have been around for all 70) the nations on planet Earth have not taken appropriate steps to reassure the rest of the universe that we care to get along. If anything, we seem to have gone in the opposite direction!
On the other hand, maybe the citizens of the rest of the universe have continued to watch us and decided not to waste any time or energy on us. It seems unlikely that any of us ever will be interacting with the peoples of the universe anyway and we’re well on the way to ending life on our planet by ourselves.
With the return of August heat and daily temperatures now approaching 100 degrees, Tarrant County Public Health reminds residents to avoid heat-related illness.
“The risk of heat injury or death is at its worst when high temperatures continue over multiple days,” said Public Health Director Vinny Taneja. “People suffer heat-related illness when their bodies can’t compensate and properly cool themselves. Natural cooling occurs when people sweat, but under some conditions, sweating is not enough, and a person’s body temperature rises rapidly.
“While the elderly, young children and people dealing with chronic ailments are usually the first to suffer from the heat, I urge everyone to take precautions,” Taneja said.
Among those precautions:
Never leave children or animals in parked vehicles. When outdoor temperatures are high, children and animals left inside parked cars can be overcome by heat within minutes.
Minimize exposure. Being outside in high temperatures for prolonged periods puts anyone at risk of heat injury, especially if active in outdoor athletic programs, youth organizations or schools.
Avoid dehydration. Water is the most critical beverage a person can drink to prevent heat injury. Develop the habit of drinking water every hour when it’s hot outside — even if you are not thirsty. Avoid drinking alcohol on hot days.
Maintain adequate ventilation/air conditioning. Some people turn off their air conditioning, do not run it long enough or may not have access to fans or other devices that circulate cool air. Unless people have a high tolerance for heat, this practice puts them at risk for heat injury.
The elderly are most at risk. Neighbors, friends and family should regularly check on the elderly when temperatures are high for multiple days.
Before the COVID-19 pandemic began, medical professionals, including surgeons, had already been utilizing social media for networking purposes. An example is the monthly Association of Women Surgeons Tweet Chat (@womensurgeons). Students can participate, and I personally have been able to meet resident and attending physicians at various residency programs through these chats. This interaction provides me and other applicants the opportunity to network before interview season begins. Without audition rotations, these interactions will become highly valuable. Having the ability to connect with program directors, residents, and attendings through these chats may be the difference in being offered an interview or not.
Fourth-year students are also concerned the virtual interview process will not provide us an accurate representation of residency programs. One emergency medicine (EM) resident physician echoed this concern and tweeted asking EM programs to share information about their program, including name, a unique aspect of that program, and information about the program’s city. Numerous residents have replied to his tweet, allowing rising fourth-year medical students to gain insight about EM programs from all around the country. Seeing the success of this tweet, I decided to ask for general surgery residents to share more about their programs. The responses have allowed me and other aspiring surgeons to learn about more than 25 different general surgery programs across the country.
Twitter is not only a means for residencies to share information about their program; it is also a way for them to learn about applicants. The biography section is an opportunity for us to provide more personal information, including our medical school, hobbies, and interests. I have been expressing myself through Twitter by re-tweeting surgery research, posting about cooking and baking, and sharing funny videos to show my sense of humor. Programs want to know more about applicants than our board scores, and thoughtful biographies and tweet content can show a residency program more about a student and what we can bring to a program.
For this year’s rising fourth-year medical students, it is more important than ever to be active on social media. This engagement is enabling us to network, learn about residency programs, and show programs who we are. With the help of Twitter and other technologies, residencies and medical students alike will be able to interact and form relations in spite of physical distance.