A report from the frontlines at MGH

Dr. Jarone Lee, a physician at Massachusetts General Hospital working on the frontlines of the COVID-19 pandemic, is very worried as predictions of infection rates run as high as 60 percent worldwide.

“I am a critical care doctor so I do see the sickest folks. We are very worried on the ICU side,” he said on the Codcast with Paul Hattis of Tufts University Medical School and John McDonough of Harvard’s TH Chan School of Public Health. (The interview was taped Friday afternoon.)

“At this point, we’re worried about the worst-case scenario, hoping for the best.,” Lee said.  “On the ICU side, if it gets to the point of Italy or some other places we’ve heard about in the world, we do not have the capacity to take care of that many patients. I believe that’s true probably for the US health system in general. We don’t have enough ventilators or ICU beds.”

Lee said government officials are urging the public to practice good personal hygiene and social distancing measures to slow the spread of the disease and reduce the number of cases per day so the health care system doesn’t get overwhelmed. Lee, however, cautions that the situation will get worse before it gets better.

“We are all worried that the cases are already there, and patients are going to get sicker,” Lee said. “The incubation is so long, somewhere between two to 14 days before some folks even show symptoms. We also know from some of the data out of other places that the sicker ones usually present later, somewhere between 8 to 9 to 10 days after having symptoms. So it’s sort of a late presentation. We’re at the upslope of the curve.”

Hattis cited one health analyst who says eastern Massachusetts has a total of 600 intensive care unit (ICU) beds, which are typically occupied 75 percent of the time. He said that doesn’t leave a lot of margin for a huge influx of COVID-19 patients.

Lee said hospitals are also establishing standards of care for times when staff and equipment are in short supply. In Italy, he said, there’s been a lot of “moral distress” by frontline staff having to choose who will receive care and who won’t. “This moral stress in many ways is not fully preventable, but we can definitely curtail it a lot with the correct system so we don’t have a bedside clinician making  impossible decisions,” he said.

McDonough said testing for the virus appears to be the big fail so far, with not enough tests being conducted. (Testing was lagging as of Friday, but appears to be picking up.)

Lee agreed.  “I’m not an expert on the testing, but I feel like it is a big problem. We don’t have enough tests to test everyone that we probably should and want,” he said. “If we had access to more tests, we would be testing more folks, including our own staff if they’re potentially exposed and everything else. If there’s anything we can do to increase the number of tests that would be ideal.”

Lee said Massachusetts General is working on its own test, which should be available soon. Several private testing companies have also won approval to do their own COVID-19 tests. Once more testing is done, officials in Massachusetts may get a better picture of the size of the problem.

“It’s in some ways good and bad news. The bad news is we’re probably not testing enough so there’s probably a lot of folks who are positive that we do not know about,” Lee said. “But at the same time we also know a lot of folks are probably asymptomatic or mildly symptomatic and it doesn’t really cause them any issues. And because we don’t have the true number of folks who are really infected, I think a lot of these reports of mortality and everything else are probably higher than they really are.”

One problem with COVID-19 is that the symptoms take so long to develop that people can be spreading the disease without really knowing it.

“That is what is so unique about this one. It is the common cold virus, the coronavirus, so most folks might not even know they have it or just have the sniffles or low grade fever. It’s not them that we’re concerned about. It’s the folks who are at high risk for complications – mostly the elderly with comorbidities, with other diseases. … These are the folks who really get devastated by the flu and corona.”

Lee said Massachusetts General is planning for a surge of patients, trying to figure out how to expand its ICU space, leverage resources across the hospital, and protect hospital staff from being infected. He said roughly 20 percent of health care workers ended up being infected in China, a percentage that dropped to 10 percent in Italy.

“That shows us that health care workers, first responders, are very high risk,” he said. “What we do have now is we have the time. We’re actively planning and working on teaching everyone the proper way of using their ppe, their personal protective equipment, and different ways of taking it off and putting it on.”

Lee said the workforce bench at Massachusetts General is deep right now but everyone is worried. He said infection isn’t the only concern in keeping staffing levels up. “One thing we are encountering, and this is personal, too, is that my son’s school just closed. So child care is a big issue. We have a lot of two physician families here. Everyone is trying to figure that out,” he said.

McDonough wanted to know how Lee, an Asian-American physician, feels about references to COVID-19 as the Wuhan or Chinese virus. Lee said his colleagues are all respectful, but he nevertheless tries to stifle coughs or sneezes (he has allergies) when he rides the subway to work because he fears people look at him differently.

“I haven’t quite noticed that personally, but I have heard multiple personal accounts of things that happened,” he said. “I do very much worry that folks are thinking that this is the Chinese virus, the Wuhan virus. I’ve heard other names for it, of course. We definitely do need to think of this and talk about it not as a Chinese virus in any way. This is a coronavirus that’s affecting the whole world and we’re all in it together. It did come from China from what we can tell, but they’re also big victims in this as well.”

BRUCE MOHL


CORONAVIRUS

Globally

David Leonhardt offers a chronology of President Trump’s comments offering false information and attempting to minimize the threat of coronavirus. (New York Times)

At many airports nationwide, travelers are greeted with chaotic scenes as they return to the US and undergo screening for COVID-19. Some say the crowding at airports is dangerous. (USA Today)

A coronavirus vaccine trial starts Monday. (AP) The Trump administration tried to woo a German firm working on a coronavirus vaccine to move to the the US, raising concerns in Germany that Trump wants any potential vaccine to be made available first in the US. (New York Times)

A nun gives tips on social distancing. (MassLive)

Locally

Gov. Charlie Baker launches a series of sweeping measures, including no gatherings of more than 25, no eating-in at restaurants, and school shutdowns statewide. Many of the announcements represent big shifts from stances taken hours and days before. (State House News) Restaurants scramble to stay afloat amid the dining-in ban. (MassLive)

Virus notes: At Logan International Airport, no chaos but uneven screening procedures. …Non-emergency evictions postponed. (CommonWealth)

Stop & Shop announces reduced hours and cuts pick-up service. (Patriot Ledger)

The city of Boston is working with area companies and philanthropies to launch a fund to aid people struggling financially as a result of the pandemic. (Boston Globe)

The MBTA says it is considering moving to a reduced schedule. (Boston Globe)

Cardinal Sean O’Malley has suspended all masses and relieved Catholics around Boston of their obligation to attend mass until further notice. (Gloucester Daily Times)

As Massachusetts schools close for three weeks, unanswered questions linger about what happens with standardized testing. (MassLive) Some schools are providing free meals to students during the shut-down. (The Salem News)

Worcester’s government — like many others — will operate virtually, while schools there will let students and staff collect their belongings on Monday and Tuesday. (Telegram & Gazette) North Shore officials worry about the impact on tourism. (Gloucester Daily Times) The Essex County Sheriff’s department suspends all jail visits. (The Salem News) Gamblers leave MGM Springfield as the casino shuts down. (MassLive) Food pantries are changing how they operate. (Gloucester Daily Times) An Abington restaurant offers kids free meals as schools shutter. (Patriot Ledger) New Bedford’s restaurants are doing the same. (Standard-Times)

A Boston University business professor explains why we’re all hoarding toilet paper. (The Salem News)

Cape Cod travel agencies are feeling the effects of coronavirus-related cancellations. (Cape Cod Times)

Small businesses across the Greater Boston area weigh in on their lack of foot traffic. (WGBH)

BEACON HILL

Berkshire lawmakers say the House’s transportation bill would be beneficial despite the hike in gas taxes. (Berkshire Eagle)

MUNICIPAL MATTERS

It’s hard to get public records from the Worcester police. (Telegram & Gazette)

WASHINGTON/NATIONAL/INTERNATIONAL

In the midst of the coronavirus crisis, President Trump indicated he is likely to pardon his former national security advisor, Michael Flynn. (New York Times)

Trump has remade the federal judiciary at a record-setting pace, appointing scores of rock-solid conservative justices who will shape the country for decades. (New York Times)

ELECTIONS

In what may be their only one-on-one debate, Joe Biden said he would pick a female running-mate if he’s the Democratic presidential nominee; Bernie Sanders said he probably would do so. (Washington Post) The Democratic contenders dealt at length with coronavirus. (AP)

BUSINESS/ECONOMY

Jason Kauppi of the Merit Construction Alliance says union favoritism is hindering housing production. (CommonWealth)

EDUCATION

ICYMI: The state education department announced on Friday that it is asserting new oversight of the Boston schools in the wake of a scathing review of the district’s shortcomings. (CommonWealth)

HEALTH/HEALTH CARE

Berkshire Health Systems shifts staff from its North Adams facility to its Pittsfield hospital, raising concerns about coverage. (Berkshire Eagle)

A Worcester man went into cardiac arrest and died on a flight from Dubai to Boston. (Telegram & Gazette)

The flu shot last year was not very effective, according to new CDC data. (Telegram & Gazette)

TRANSPORTATION

Rep. Sean Garballey of Arlington says the new MBTA rail cars are built on the backs of children in Madagascar. (CommonWealth)

ENERGY/ENVIRONMENT

Craig Altemose of the Better Future Project suggests the public should explore buying Columbia Gas instead of Eversource. (CommonWealth)

Tiverton’s town attorney has been asked to look into whether the town can impose regulations to prohibit trucks from using a town road to access a fuel company that wants to expand into the propane business. (Newport Daily News/Herald News)

CRIMINAL JUSTICE/COURTS

MassLive takes a deep look at the problems behind the walls at Souza-Baranowski prison.

Lack of storage space for untaxed and smuggled cigarettes means law enforcement are limiting their seizures of illegal tobacco products. (Gloucester Daily Times)

PASSINGS

Tim Brennan, the retired director of the Pioneer Valley Planning Commission, dies at 73. (MassLive)