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Pediatric resident fears for at-risk, providers who care for them during outbreak

Urges collaboration to ensure that efforts are coordinated, safe, evidence-based

At age 22, I was diagnosed with Hodgkin lymphoma. It happened about a month after I graduated from college.

I had started my first job out of college three weeks prior, and my entire life changed that month. I received chemotherapy every other week, and in the following week, my blood counts would drop so low that I was vulnerable to numerous infections. I attended my appointments wearing a face mask into the hospital, with hand sanitizer in my pocket. I heard people around me coughing and sneezing, and I lived in fear that my fragile immune system wouldn't be able to keep me safe. I followed a special diet for immunosuppressed patients that meant I couldn't eat many fresh foods, for fear that even small amounts of bacteria could make me dangerously ill.

I went to work as often as I could, trying to be a good employee — despite having cancer. I was afraid of losing my income and my health insurance, and what might happen in the future if my treatment didn't work.

After six months, I was due to receive my last round of chemotherapy. My cancer had responded well to my treatment, but my body was exhausted. Despite my best efforts, I had been hospitalized twice for fever and infections.

Seven years later, and I am a resident physician in my second year of pediatrics training at Doernbecher Children's Hospital, at Oregon Health & Science University. As health care providers, we take care of the most vulnerable patients and we do our best to heal them — and above all else, not to harm them.

On March 4, the U.S. House passed HR 6074, an $8.3 billion emergency response bill for novel coronavirus and the disease COVID-19, which includes $3 billion in funding for research and development of vaccines and diagnostics, $2.2 billion for the U.S. Centers for Disease Control and Prevention, $1 billion for state and local response efforts, and $1 billion for procurement of medicine and medical supplies.

OHSU has been working closely with local public health experts to ensure adequate response efforts and education for providers. As physicians, we rely on this information when deciding how to test and treat the patients who are in our emergency rooms and clinics.

Initially, testing was only offered to patients who were deemed the highest risk. On March 4, messages provided to the public indicated that any American could receive a test as long as they had a doctor's order. At the same time, state authorities raised alarms concerning how many testing kits were available and how many tests could be run.

Misleading statements can lead to inappropriate and unsafe use of health care facilities and resources. At this time, there are limited resources to test any American with symptoms consistent with COVID-19, despite a doctor's orders. The criteria for testing will likely change as more testing kits become available and laboratory capabilities expand.

During an outbreak, it becomes even more important for us to protect our communities and the providers that care for them. I can't imagine how scared I would've been seven years ago if the COVID-19 outbreak was happening. Now, I fear for our most vulnerable patients and families who rely on all of us to keep them safe. Vulnerable patients don't have the option of foregoing trips to the emergency room when they are ill. Health care providers themselves are at increased risk of being exposed and subsequently falling more ill.

This is why it is so important for the public and health providers to follow guidance from local health authorities on how to appropriately access diagnosis and treatment and ensure that personal protective equipment is available to those who need it most. We need the help of the federal government, our local public health officials, as well as the public, to ensure that our efforts are coordinated, safe and evidence-based.

If you or a loved one are ill with symptoms of COVID-19, please contact your local health authority or health care provider for guidance on how to seek treatment and testing.

Dr. Bridget O'Connell-Long is a second-year pediatric resident at OHSU Doernbecher Children's Hospital.

This viewpoint was originally published March 9, 2020 on the Portland Tribune website.


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