Nov. 13, 2020 -- With nearly 30,000 active COVID-19 cases and a test positivity rate of 20% according to the city's dashboard, El Paso, TX, is averaging about 1,000 new cases a day.
To get a sense of how that is playing out for doctors on the ground, Medscape spoke with Ogechika Alozie, MD, an infectious disease doctor and chief medical officer at Del Sol Medical Center, about the city's current surge. Alozie is also a member of the Texas Medical Association's COVID-19 Task Force and co-chair of El Paso's COVID-19 Task Force. The interview has been edited for length and clarity.
Medscape: Can you give us a general sense of how things are in El Paso right now with COVID-19? What is a forest-level view of the situation and how it's trending?
Alozie: Until you've been in a city or a health care system that has suddenly had 300%, 400%, 500% increase in COVID patients over what they had just 2 to 3 weeks ago, you can't really convey it to anybody.
The feeling of having 30 patients sitting in your emergency room, having a full intensive care unit, and having to initiate your surge plan into other areas in the hospital. Until you're really living with it and dealing with the operations of it — the nursing shortages and the position shortages — you can never really get it.
I'm co-chair of the COVID-19 task force for the city and even for that group, the sudden spike that we had in numbers and then in hospitalizations and now unfortunately in tragic deaths, the lag indicator, has been disheartening and challenging.
We have resources. I'm blessed as chief medical officer here at Del Sol Medical Center. We have the backing of HCA healthcare behind me and our supply chain and all those things, but even with that, it's a lot. You just get tired. There's this sense of exhaustion. The analogy I use is if this was a workout, it would be high-intensity intervals training (HIT). We had a first level in July and August and now we're having another one. You're in the middle of this HIT, and you're like, 'Damn, when does this plateau? When do I get my break?'
It's just constant, day after day and hour after hour, and we're hopefully not going to get to month after month. But it's where we are, and we're trying to get through it.
Medscape: Concerning the number of infections in El Paso, is this something the health care community in El Paso was prepared for?
Alozie: From a hospital, health care, and city standpoint, we were doing table-top planning back in March and April, setting up operations. So it isn't something that caught us by surprise at all. But until you live it, it's not the same.
Doing a table-top exercise is very different than having the patients come in, then having a stretch on your vent and BiPAP and high-flow resources, and having a host of personnel either out sick because they themselves got COVID from community spread or are just exhausted and need days off, because people can't work 7 days a week, 24 hours a day.
Medcape: What is the current average daily case count in El Paso?
Alozie: Today, [Nov. 7] we have 1,020 cases, yesterday it was 1,920, the day before it was 3,100. The last 2-3 weeks, we've averaged a 1,000 cases a day. This week, unfortunately, we've had 40 deaths in the last 2 days. The medical examiner's office says they have over 250 unaccounted for deaths that they're processing; they just brought in the fourth van for the morgue. (Editor's note: The city is reportedly now using 10 refrigerated trucks for temporary morgue space.)
The medical examiner staff is the staff you can't surge. FEMA can send in nurses and doctors; the Department of Defense and Disaster Medical Assistance Team can send in nurses and doctors. Nobody ever really surges into the medical examiner's office. I'm in close contact with them, and they're really overwhelmed.
People will talk about, 'Are these really COVID deaths? Did they really die of diabetes?' That's a false narrative. The long and short of it is that we have excess deaths above and beyond what we typically have in our community.
Medscape: How can we best convey the deaths to the public without being gruesome or garish but helping them understand the real risk?
Alozie: I don't know. I think that we, the global 'we,' have been very clear around the threat of COVID; we'll say only 5% get hospitalized, less than 1% die, and I always tell people: it's best for that not to be you or your family.
If you look at New York, people really got the message when the percentage of people who knew someone who died or was hospitalized went up. The unfortunate thing about this is that those numbers don't go up until you have this kind of crazy, chaotic community spread.
It's unfortunate, but it feels as if, as a culture, we have decided that we are not going to engage in scientific discourse until it affects us. People say it's not that big a deal. I tell them, 'Come visit us in the ICU and we'll show you how big a deal it is.'
Medscape: What are the biggest challenges facing doctors and the health care workforce in managing COVID-19 patients?
Alozie: When you go into health care, you expect that you're going to see things happen. But the thing about emergency situations usually is that emergencies are short-lived — they last a day or 2 and then you do the cleanup. The problem with this is that it's prolonged. The duration is not a day or 2 but weeks to months; so people are stressed, people are challenged, people are burned out.
I hear the superhero cliché all the time — I actually kind of hate it. People in health care don't have capes. We're just human beings, and we have families, and we have hopes and fears, and get frustrated and burned out just like everybody else. But we also understand our jobs and roles and responsibilities, and I'm blessed to be in an organization and in a community that really cares about the people putting in this work.
I often tell people when FEMA shows up in your city, there's no cause for celebration; that's a problem. There's a tent outside our ER — that's not meant for camping; that's where we're putting people because they can't get into the hospital. A tent is not a cool thing.
Medscape: What can health care workers and public health officials tell El Paso residents in order to help reduce transmissions?
Alozie: It's important for people to realize that just because we had Election Day on Nov. 3 doesn't mean that the virus has gone away.
We're heading into some of the worst days of this pandemic for the United States. It's going to be worse as we go through the month; hopefully it will peter out some time in December, after Thanksgiving, but we need to stay focused. People need to understand that yes, this is difficult, but if we get through this next 2 to 3 months, on the back end there's this message of hope: We are every day getting better at treating this; hopefully there will be multiple vaccine candidates that will help mitigate — not eliminate but mitigate — this threat.
Medscape: How are health care workers themselves dealing with the toll in terms of mental health, sleep, etc.?
Alozie: It's hard. The biggest thing that we provided is the ability for people to vent and to get counseling and to engage with somebody that can help them work through a lot of these processes. That's a huge thing, but that's just a piece of it. The other part is finding resources, extra physicians, extra nurses, extra respiratory therapists, extra phlebotomists — those are all the things that we have been able to bring in.
When this surge started we had enough doctors, but what we were missing most was nurses. The doctors can only do so much. We have to cherish our nurses and protect them and give them all the resources that they deserve.
Medscape: What are the biggest needs of the health care community right now? Do they have enough PPE? Enough staff? Enough beds? Enough rooms?
Alozie: The last days for us have felt calm because 1,020 cases is much better than we had been doing at 1,300, 1,800, and 1,900 cases per day. From a hospital standpoint, it just feels like a calm — I don't know if it's the calm before the storm or the calm at the back end of the storm. I hope it's the latter, that we've peaked and come down, but none of the models that I've seen show that.
Truly, from a resource standpoint, I think we're ready: We can surge into space, we have nurses both local and FEMA, we have physicians, we're ready for the challenge of whatever comes as we go into this winter moments. We're not resource-challenged at the moment.
Medscape: Is there anything you want to add?
Alozie: We're facing challenges. Is this where we wanted to be? Absolutely not. After the July/August surge, I don't think any of us expected us to be here. But again, this is the postmortem for this, we'll look back and try to figure out what happened.
We're managing through it. It is a stressful time, [but] there's hope at the end of the tunnel and people just need to focus on that.
One thing people need to realize is that we are 'lucky' right now because we are a hot spot in a country that doesn't have a lot of hot spots flaring as badly as we are. The one concern I do have is if we continue to get worse and the rest of the country does too — 45 out of 50 states are trending up in terms of COVID cases — then where are those resources going to go? If Houston flashes? Phoenix, the Dakotas are already a mess.
That's the one thing that my local community needs to hear: We need to get this down now because in November and December, when other parts of the country start to surge, we may not have the resources that we have right now, federally and statewide.