When the coronavirus first hit the St. Louis area, doctors such as Neil Ettinger were taking cues from their counterparts in Seattle and New York, as well as in countries such as Italy that had many more cases of the virus and more experience treating patients suffering from COVID-19, the disease caused by the virus.
“We had a clear perception on their parts that when patients started to get worse, they needed to be on a ventilator,” said Ettinger, 62, director of pulmonary medicine at St. Luke’s Hospital in Chesterfield. “We quickly discovered that was a disaster because these patients take a long time to come off the vent. We learned that ventilating these patients isn’t always the best idea.
“So we created a floor to take care of COVID patients who had worsening respiratory failure. When they got up to 4 liters of oxygen or more, we moved them to this floor and started interventions such as prone positioning, higher concentrations of oxygen through different devices, the use of steroids and other drugs that are used to decrease inflammatory markers.”
Ettinger, who is Jewish and has two adult children, points out that while a ventilator can save a life, it also can injure a patient’s lungs and create serious health risks. He says the biggest surprise in treating COVID patients is that the “lung manifestations are different than in any lung injury or lung disorder we have encountered. We had to adapt very quickly to it.”
“You think you’re winning your battle,” he said. “Oxygen levels are improving. The patient’s almost off oxygen. Then something happens, and they’re up to 15 liters of oxygen, and you’re back to where you started.”
At first, Ettinger saw younger people in the hospital; now, waves of patients are coming from nursing homes.
“So we are dealing not only with COVID but advanced lung disease caused by Parkinson’s or dementia, which would limit their future lifespan,” he said. “Now they have COVID and are facing a battle for their life a few years prior to when they would.”
Ettinger was on the faculty at Washington University School of Medicine at Barnes Hospital in the 1980s when HIV hit, so he is familiar with epidemics. He said that if you made a mistake in treating an HIV patient and became infected through a needle prick, you might die years later. Death from COVID, on the other hand, can come weeks to months after onset of the infection.
“There is a more focused work ethic,” he said. “You have to avoid getting infected yourself. I had to do an emergency bronchoscopy (on a COVID patient) where I look down into the lungs, and that creates a lot of aerosols. I stepped into what you might consider to be a moon suit and did the procedure. I noticed droplets from his lungs on my moon suit, which highlights the risk to anyone doing procedures. All of us have to be mindful not just of the patient’s well-being but also our own health and safety and that of the team.”
What has been most impressive, Ettinger said, is the coming together not only as a hospital staff at St. Luke’s but as a medical community in St. Louis and beyond.
“We share information with each other,” he said. “When we couldn’t do rapid testing, BJC and SSM allowed us to use their labs and facilities for some of our patients at a time when they were strapped. I am seeing wonderful professionals and professionalism in our nurses and respiratory therapists who instead of running away from this situation are running toward it. They want to help and be part of this. It’s really a put-me-in-coach type of atmosphere.”
That willingness to get involved, along with how quickly the science on COVID is evolving, gives Ettinger hope.
“Pulmonary physicians, for example, are communicating with each other by blogs, by email, by webcasts,” he said. “We are all trying to learn as quickly as we can and share what we know with everyone.
“What gives me real hope is when we sit in these multidisciplinary meetings, everyone is energized. Everyone wants to pitch in. Everyone is willing to step up and review a topic and educate ourselves as quickly as we can about different aspects of this infection.”