Carol A. Cunningham, MD, FAAEM, FAEMS

In my role as State Medical Director for the Ohio Department of Public Safety, Division of EMS, I cannot recall a busier time of networking amongst governmental, public, and private sectors at the federal, national, state, regional, and local levels. 

This is also a unique time in history for me to be able to personally witness the events and interact with the healthcare providers from the patient’s side of the fence. 

I underwent a scheduled surgical procedure on March 2 and was transferred to Aurora Manor, a rehabilitation facility, for physical therapy on March 5 with an anticipated stay of one week prior to discharge home. However, less than 48 hours after my arrival, the facility went on lockdown with no visitation permitted and the governor’s “stay at home” orders temporarily closed home health agencies including those that provide physical therapy services. So, I became “trapped” in the COVID-19 orders from the State that I serve as EMS Medical Director for 41 days (from March 2 to April 11). Go figure!

During my extended stay there, my room served as my command center, and I was able to teleconference, issue multiple guidance documents for Ohio EMS, coordinate the creation of a COVID-19 public safety announcement video, and serve as a panelist on two national webinars from my bed. 

Carol A. Cunningham’s Aunt Phillis and “Pandemic Patrick,” Carol’s trusted companion throughout her COVID-19 “entrapment.” (Photo provided by the author.)

Thankfully, a dear friend gave me a stuffed dog when he was visiting me in February, and “Patrick,” who has a constant smile on his face, has been my constant companion during my post-surgical journey. In fact, following a webinar where he was visible, he became known as “Pandemic Patrick.”

There are many observations and lessons that I learned that would not have been identified if I was working remotely from home or stationed in the state emergency operations center. 

While there was clearly fear of the unknown in the eyes of some members of the staff, everyone at the facility took extraordinary measures to ensure that everyone (staff and patients) remained safe and healthy.

There is definitely the fear of the virility of COVID-19 virus, the lack of COVID-19 vaccine or a definitively effective treatment for the infection, and the, yet to be discovered, facets of this novel virus. 

The staff has fear of the transmission of the virus from asymptomatic carriers, those who refuse to comply with social distancing recommendations, and the potential for lack of the appropriate personal protective equipment (PPE) while at work as well as at home.

Fear is often paired with anger and frustration, emotions that I shared with the staff. Medical care involves a team of healthcare workers, working in synchrony and with collaboration, where all sectors within the team are essential to the best patient outcome. 

While none of us have experienced a pandemic such as this in our lifetimes, lessons have been learned from previous events that have posed a threat to public health. 

Like the chain of survival, every link needs to be strong, supported, and valued in an equivalent manner as other links. EMS is a critical link in this chain. During the H1N1 influenza campaign, EMS providers administered nearly 50% of the immunizations to the general public in Ohio during the mass vaccination campaign. Yet at the onset of the Ebola pandemic in 2014, there was a delay in the issuance of PPE and transport recommendations for EMS and first responders. 

On September 29, 2010, the American Board of Medical Specialties formally approved EMS medicine as a practice of medicine. While those of us within the EMS community have always known and respected our value, this historic landmark slammed the door on false notions that EMS is an ancillary service and non-essential. 

Despite this fact, there are still documents and measures that some systems have generated where EMS personnel, first responders, and healthcare workers within extended care facilities are either cited as a secondary afterthought or not formally included within the cadre of “healthcare workers.”

If there is ever a time for this archaic attitude to stop, it is now.

Once the administrative and operational protocols have been written, we must also remember that maintenance of the healthcare workforce also hinges on addressing the human needs of those engaged in the pandemic response. 

Knowledge that one’s family is supported and protected from the COVID-19 virus is imperative for every responder. Many systems are providing off-duty housing for healthcare workers who are fearful of infecting their loved ones at home. Some have evacuated family members from one of their homes so it can serve as a “safe house” for fellow co-workers when a housing resource as not been provided to them. 

Single parents, couples who are both tasked as responders, caretakers of elderly loved ones, and single responders who reside alone have additional challenges. The provision of child and elder care in an environment of safety can mean the world to them. 

An allotment of meals and a small supply of sundries (e.g. diapers, toilet paper, disinfectants) for the family should also be considered. This amenity can be an essential bridge to the next workday for those whose grocery stores or delivery or drive-up services are closed following a long shift at work particularly in rural communities.

Lastly, and one of my greatest concerns, is not the economic aftermath of this pandemic, but its psychological impact. All of us have had a tragic day at work or have lost sleep over the demise of a patient despite our best efforts to save them. 

When I think of my private conversations with my friends who are operating in the COVID-19 hot zones in our nation, I cannot imagine reporting to work for days on end knowing that multiple patients will die regardless of the care delivered and that the volume of those seeking care will continue to climb. 

They are frontline warriors on a battlefield despite being trained in a civilian setting. Without aggressive intervention, our healthcare force will erode beyond the resolution of this pandemic due to voluntary departure from or change in their profession, inability to return due to post-traumatic stress or depression, or, in the worst scenario, suicide.

The COVID-19 pandemic has impacted every corner of society in our nation and the entire planet. Tragically, there are already a mounting number of casualties within our ranks. I predict that all of us will be personally touched by a loved one who has endured illness or lost their life to this virus. 

My beloved friend who gave me Pandemic Patrick is a drummer in New York City, and one of the most generous and warm-hearted people I have ever met. In addition to being abruptly unemployed due to the closure of the Broadway theaters, he is now valiantly fighting for his life after contracting COVID-19. 

The first COVID-19 death in the county where I reside was Darnell “Anthony” Davis, one of my paramedics for whom I was honored to serve as his medical director for 15 years and to embrace as a treasured colleague. Tony could sing like a bird. 

As I openly wept with the news of each of these disturbing events, my nurses and physical therapists, despite the PPE and social distancing, offered the genuine comfort to my human side that my broken heart so direly needed. 

Music has always been my fuel. Music takes the broken soul and makes it whole. As I entered my sixth week with no direct contact with family or friends, I looked forward to sharing a big bear hug with my friend who gave me my sole companion during the period of isolation and being reunited with live music. 

My dear, lost paramedic Tony loved his community and will always be a treasured healthcare provider in the hearts and minds of those of us who knew him so well. I am confident that today, on Easter Sunday, he is leading his new choir and filling every corner of Heaven with his magnificent voice.

I was discharged home the day before Easter and two days before my birthday. As I drove in the sunshine listening to Raul Midón and Snarky Puppy in my car for the first time since February, my faith that our world will see brighter days was renewed.

While I have been fully engaged in the COVID-19 pandemic response from my room at Aurora Manor where I have been “encamped” since March 2, I am ecstatic to be able to continue my work from my home while maintaining social distancing (although Maynard, my favorite teddy bear, and Patrick are welcome to sit on my lap at any time).

Maynard is the author’s favorite teddy bear. (Provided photo)

Experiencing the pandemic response from the patient’s side of the fence has been both unique and enlightening. Although we have nursing home and skilled nursing facilities that are challenged by COVID-19 outbreaks, I can honestly say that the staff and practices implemented at Aurora Manor are a shining example of how to prevent the spread of disease and protect the patients and staff during a dynamically changing public health crisis. And their physical therapists are phenomenal!