EM Mindset: COVID-19 Edition – Quiet… Yes, I said it!

Author: Madonna Fernandez-Frackelton, MD, FACEP (@MadonnaFernand2, Vice Chair of Education and Program Director, Harbor-UCLA Medical Center, Torrance, CA) // Reviewed by: Alex Koyfman, MD (@EMHighAK), Manny Singh, MD (@MPrizzleER), and Brit Long, MD (@long_brit)

Welcome back to the EM Mindset series. Today we host thoughts from Dr. Madonna Fernandez-Frackelton. If you would like to contribute to the EM Mindset series, please feel free to reach out to us.

It was so quiet in the ED that even the most superstitious of us lost all fear of speaking the “Q” word aloud. A few days ago, we were sending residents home early. There was no one in the waiting room. The quiet was peppered with the intermittent COVID patient, and the extremely high speed MVA caused by an irresistible urge to go over 100 miles per hour on the never before empty freeways of Los Angeles. Most patients with the nerve to show up were quite ill.

We knew from New York that our time would come, and the anticipatory anxiety was palpable. As I write this, it has just begun for us in Los Angeles. Thankfully, we have had time to prepare and have learned from the collective wisdom and experience of our colleagues in Washington, New York, New Jersey, Italy… Strange things are happening… even stranger than the inexplicable and persistent run on toilet paper, not the least of which is that consultants are SUPER nice to us on the phone!

There has been much discussion, preparation, and education to address this pandemic. The daily Zoom and Skype meetings, and barrage of e-mails from the CDC, ACEP, SAEM, CORD and every FOAMed source available suggest that COVID is the only disease on the planet. And we all now know that the patient with appendicitis probably also has COVID.

My husband’s business has been deemed essential. He is in steel fabrication and plating. They manufacture store fixtures and supply grocery stores. Turns out the bottom shelves in the toilet paper aisles don’t stand up well to shoppers climbing to the top to get the last package. He imports a lot of product from China and has a plant there. In January, his colleagues in China sent him pictures of municipalities creating landslides to block the roads in and out. Word was this virus was much worse than we were hearing.

Once the dust and droplets have settled, what will we have learned… the good and the bad?


The Bad:

  • We all know more about big cats in captivity that we ever wanted to, and we can’t get those 8 hours of our lives back.
  • We also know that the social distancing will decrease the spread of disease and save people who would otherwise have died from COVID, but we cannot ignore the collateral damage. Many people with real illness… other than COVID… are staying away, not seeking the care they need, and eventually presenting critically ill, or maybe dying at home.
  • Millions of people have already lost their jobs, and many businesses will not survive this shut down. We thought we had a problem with homelessness in January. I fear it will pale in comparison to what we will see in June, and we as emergency clinicians need to also be prepared for that. Those whose jobs have been deemed essential are truly fortunate, like the WWE? Really, Florida? And the pot shops? Really, most states?
  • The people least likely to be harmed by this virus have arguably sacrificed the most because these are experiences that cannot be replaced when the economy eventually recovers. No graduation, no prom, no school, no accepted students’ day for colleges to help them decide where to go, no sports, no opportunity to get that scholarship, no Olympics.
  • Social distancing means social isolation to some. Compounded by the financial hardships of job loss, most experts predict a significant rise in suicide rates. And “safer at home” is not true for all. Our first responders have all noted a significant bump in domestic violence calls.
  • The most recent order placed with my husband’s company was by police for 2,500 riot batons. I hope they are wrong.


The Good:

  • This has brought everyone together in ways I never imagined. With the total ED volume down and elective rotations pretty much cancelled, we have the resources. Emergency Medicine, Family Medicine, and Anesthesia all contributed to add two more MICU teams. Surgery started a “line team,” and orthopedics created the proning team. Everyone is looking for ways to help.
  • People are showing real concern for our techs and facilities management crew, and appreciating them in a way that I feel will continue beyond this crisis.
  • Communication is better than ever, and it feels like everyone’s concerns are actually being heard and addressed.
  • This online conference thing is really amazing! Attendance is the best I have seen it in 24 years and people actually participate more in the conversations while on line. We are definitely going to incorporate it into conferences in the future.


Overall, the bad is winning right now. We will get through this “C” thing, and we will be changed, eventually for the better. It’s no longer “Q” in the ED.

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