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COVID-19: A PA’s Practice in Patience

COVID-19: A PA’s Practice in Patience

Sarah Patton, MSHS, PA-CCOVID-19 has been a practice in patience for me. I live in Washington state, where one of the first cases was reported in late January.1 After repeated denials from the federal and state government, researcher Dr Helen Y. Chu and her colleagues at the University of Washington began performing coronavirus tests without government approval on February 25. Without this testing, the spread would have continued unchecked as it had for months. “It must have been here this entire time,” Dr Chu recalled thinking with dread. “It’s just everywhere already.”2

Friends who worked in emergency and primary care relayed their inability to test patients who were suspected to have COVID-19 due to the very narrow guidelines on testing and the lack of testing supplies. My concerns echoed Dr Chu’s dread; COVID-19 already had wide community spread in Washington. 

In March, local health care organizations and hospitals were planning for the worst-case scenario in terms of hospital surges. If you were to capture my online phone and computer data during this period, it would reveal that I was maniacally texting and emailing my friends while constantly refreshing websites, such as New York Times, Worldometers, Centers for Disease Control and Prevention, and Washington Department of Health, looking for any new information. Frankly, I felt like screaming “shut it all down!” with the hope things would rapidly improve. A friend of mine who works in public health gently educated me that public health messaging is very nuanced and you cannot just shut schools down or people would revolt. Patience.

After a week of feeling like I was watching a train wreck in slow motion, I started having the kids walk to and from school or I drove them. I calculated fewer exposures if they did not ride the bus. Microsoft, and then Amazon, sent its workers home. As a medical provider, I became concerned about my proximity to patients and coworkers. I practice in the community where the first big nursing home outbreak of COVID-19 occurred. Using my dermatoscope to examine my patients’ skin does not allow for social distancing; further, we did not have N95 masks.

Not only was I worried about my exposure, I was worried about my patients. Since I work in a Mohs clinic, the majority of my patients are those who are at highest risk for complications from COVID-19: immunosuppressed, with comorbidities, and aged 60 years or older. What if I was asymptomatic and gave my patients the virus?  

At the same time, I was precepting a second year physician assistant (PA) student. To help minimize exposures to staff and patients, we had to tell her that she could not come in. I felt badly as I knew this could affect her graduation timing if we canceled her rotation. Fortunately, the same day, the university made the decision to pull all PA, medical, and nursing students from their rotations. My practice in patience became even more challenging as I was soon at home, prepping to transition to online teaching of PA students, all while homeschooling my elementary-aged kids and listening to my husband in Zoom meetings 10 hours a day. I volunteered to temporarily leave my clinical practice as the schedule was getting lighter and it was clear that we would need to close for the protection of patients and staff as well as the preservation of medical supplies. The clinic where I work followed the American College of Mohs Surgery guidelines, which call for only the surgeons and a downsized staff to come in once a week for removal of invasive melanomas and squamous cell cancers.  

I was fortunate that I could step down temporarily from my part-time clinical position as I still had challenging work and an income from my other position as faculty in a PA program. I also had a partner who was working full-time. I worried about my coworkers who would be without work. In some ways, I felt like I was not doing enough as a well-trained (though at this point, specialized) medical provider and a new faculty member, but I also felt really fortunate that I could be at home in a safe place with my family. My patience failed daily in home-schooling. 

I was keeping close tabs on the COVID-19 news stories: Sweden’s approach,3 the mask wars, lack of testing, friends from PA school and beyond who were telling me their experiences in the trenches. Even early on, it became clear people of color experience worse outcomes from COVID-19.4 As Dr Anthony Fauci said in April, “Health disparities have always existed for the African American community. But here again, with the crisis…shining a bright light on how unacceptable that is.”2

Then came George Floyd. This was shortly after hearing about Breonna Taylor, an emergency medical technician who was shot in her own home. Prior to that, the video of Ahmaud Arbery running had been released. I watched from home the protests in my city and around the world and felt helpless. 

Next came word that there was a protest being organized for Seattle health care workers to march for Black lives (social distancing, white coats or scrubs, and masks encouraged). I packed my bag for the protest with an extra mask, hand sanitizer, water, and snacks. The turnout was extraordinary. Ryan Buchan, a PA friend of mine, worded it well on his Facebook post: “Despite a global pandemic, 7,000 Seattle area healthcare workers donned our masks and took to the streets yesterday to protest institutional racism. We didn’t choose the time, the time chose us.” Racism is as much a public health crisis as is COVID-19. 

I went back to work several weeks ago. It was somewhat surreal returning (in personal protective equipment, of course) to see my lovely coworkers and grateful, kind patients. This is the longest time I have not worked clinically since I graduated PA school in August 2004, even longer than my maternity leaves. The time away has been something I have reflected upon repeatedly. COVID-19 has changed just about everything for everyone in our country and, really, world. I hope this change leads to meaningful improvements in how we choose to live and how we deliver equitable health care.


Ms Patton graduated from George Washington University’s PA program and has worked in dermatology for 15 years. In addition to her clinical practice, she teaches PA students at the University of Washington’s MEDEX program. She is a member of Society of Dermatology Physician Assistants, American Academy of Physician Assistants, and Washington Academy of Physician Assistants. She loves to write and lecture on the topic of skin cancer.  

Disclosure: The author reports no relevant financial relationships.


References
1. Holshue ML, DeBolt C, Lindquist S, et al. First case of 2019 novel coronavirusin the United States. New Engl J Med. 2020;382(10):929-936. doi:10.1056/NEJMoa2001191

2. Fink S, Baker M. ‘It’s just everywhere already’: how delays in testing set back the u.s. coronavirus response. New York Times. March 10, 2020. Accessed July 23, 2020. https://www.nytimes.com/2020/03/10/us/coronavirus-testing-delays.html

3. Goodman PS. Sweden has become the world’s cautionary tale. New York Times. July 7, 2020. Accessed July 23, 2020. https://www.nytimes.com/2020/07/07/business/sweden-economy-coronavirus.html

4. COVID-19 in racial and ethnic minority groups. Centers for Disease Control and Prevention. June 25, 2020. Accessed July 23, 2020. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html

5. Brady JS. Remarks by President Trump, Vice President Pence, and members of the coronavirus task force in press briefing | April 7, 2020. April 7, 2020. Accessed July 23, 2020. https://www.whitehouse.gov/briefings-statements/remarks-president-trump-vice-president-pence-members-coronavirus-task-force-press-briefing-april-7-2020/

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