MGH doc Jarone Lee: We’re seeing patients of all ages

'We are at the beginning of an exponential growth phase’

Dr. Jarone Lee, a critical care physician at Massachusetts General Hospital, appeared on the Health and Consequences CommonWealth Codcast six days ago, providing a report from the front lines in the battle against COVID-19. On Thursday, he provided an update to Paul Hattis of Tufts University Medical School

PAUL HATTIS: How would you describe the overall environment right now at MGH?

JARONE LEE:  As expected, overall COVID-19 illness volume is steadily increasing, including on the inpatient side. We have patients both in regular beds as well as in the intensive care unit and the numbers in both places are greater each day. I can tell you that two months or so of preparation for what is happening now helps, as does the fact that we are one of the designated centers in the US to learn how to care for special patients with highly infectious diseases such as Ebola. It helps with readiness. But it is fair to say that in terms of getting operational kinks out of the system at all levels of care—you learn with each new patient on how to improve our systems to treat patients with the COVID-19 illness.

HATTIS: Last week when we spoke, it was only a trickle of patients. Today’s reports indicate there are over 70 patients in beds suspected of having COVID-19 and five in the ICU a day or so ago. What is happening now?

LEE: The numbers continue to change and increase daily. It appears we are at the beginning of an exponential growth phase. Sitting here at noon on March 19, the numbers are already higher than what was reported earlier this morning. We are handling the patient volume well with the resources we have currently. My personal expectation is that this will only get worse in the weeks ahead as the number of cases rise dramatically.

HATTIS: For the critically ill, are your patients similar to what has been reported to date, with seniors and people with underlying medical conditions at greatest risk of getting more seriously ill?

LEE:  In the ICU we are seeing everyone. What I mean by that is that even though, as you would expect, older people with underlying chronic conditions are clearly the modal sort of patients that are now in the ICU, we are seeing people under age 60 as well. It looks like we are seeing statistics similar to those reported this morning from the Centers for Disease Control. We have some patients that are younger adults, with no apparent underlying medical condition that would put them at greater risk for requiring hospitalization and ICU-level care. It shows the importance of doing everything we can to reduce spread of the virus, especially amongst our young and healthy; that’s why they need to take social distancing seriously.

HATTIS: Are the serious medical issues you are dealing with similar to what has been reported?

LEE: Yes, most of the patients are having pulmonary problems leading to something called ARDS (acute respiratory distress syndrome). These medical conditions in COVID-19 illness patients have been present ever since the disease first appeared in China. It also seems to be the case that both young and old who get seriously ill and need ICU level of care, this tends to happen not right away when they start to feel sick, but instead 9-10 days after symptoms first appear.

HATTIS: Can you say anything about whether there any health care workers or first responders who are critically ill and likely became infected through their work?

LEE:  All frontline staff are at high-risk of getting infected from work. We have focused a lot on our doctors and nurses— thank you – but our pandemic response is a massive effort that includes many other front-line staff, including respiratory therapists, janitors, people that restock ICU rooms with supplies, maintenance staff. They are all at potential risk of exposure. They are all given personal protective equipment (PPE) and are trained on how to use the protective gear given to them. First responders are also clearly at risk given their jobs out in the community. Health care workers in a variety of  job roles and first responders will become infected through their work. As hard as we try, it is unavoidable. We try to keep the numbers as low as possible of course, and when someone becomes infected, it takes them out of the workforce—for possibly 14 days, if not more.

HATTIS: You mentioned personal protective equipment, or PPEs. Do you have enough so far?

LEE:  Yes, so far we do. We are worried and trying to conserve by limiting the number of people who go into a known infected person’s room. Our medical and other students are no longer part of the care team, for example. Across the country, everyone is worried about PPE sufficiency and here we think a lot about N95 respirators, surgical masks, face shields, as well as gowns. The bottom line is that our health care system needs access to more PPEs fast.

HATTIS: Can you tell us what the current situation is with testing for COVID-19 right now at the hospital?

LEE: At MGH, we are now doing our own in-house virus testing and that has led to a quicker turnaround time. Hopefully, additional commercial testing will help even more, and hopefully be available soon.

HATTIS: With the governor’s plan to close child care centers by Monday and reopen emergency centers for health care workers and other first responders, are you hearing anything from staff about their ability to get to work because of child care issues?

LEE: I did hear the governor wants to open new centers to help serve the needs of health care workers and first responders. This is a huge issue for all of us taking care of these patients. I also appreciate that MGH is trying to work out options for its essential staff. One thing I have heard is that some medical students around the city, since they can’t be in class or in a clinical setting right now, on their own accord are trying to see if they can be helpful as child care providers so that needed people can do their jobs. It’s amazing the engagement and commitment from everyone. Similarly, I have heard from friends asking if they can help in any way. In many ways, this unfortunate event is bringing us closer together, despite the distancing.

Meet the Author

Paul A. Hattis

Associate professor, Tufts University Medical School
HATTIS: How are you and your family doing right now?

LEE: I am OK.  Working 70-hour clinical weeks, plus answering some administrative related calls when I am off, is tiring. But my wife, who is at home 24/7 with a 5-year-old who can’t really go out on play dates, also has a challenging time. Social distancing doesn’t exist for our 5-year-old. Similar to many of my colleagues, we worry about bringing the virus home. We will get through this, but we know the most difficult days for all are likely ahead. We are grateful for what we do have overall and are heartsick by what people and families who have now lost jobs and already have been living paycheck to paycheck before this happened are going through.