Sonoma County doctors detail life on the front lines during coronavirus crisis

Dr. Mark Shapiro has a routine.

When he leaves work at Santa Rosa Memorial Hospital, he drives approximately one mile to his home. He parks in the garage and proceeds to wipe down the inside of his car with disinfectant wipes. He hits the steering wheel, gear shift, knobs. He hits his coffee mug. Before he gets to the door leading inside the home he shares with his wife and 3-year-old son, he stands in a basin with a towel submerged in an inch or so of bleach.

He takes off any clothes that have been in the hospital, including the shoes he just soaked in bleach, chugs some water, resanitizes his hands and walks in the door.

“I tell everyone hello and go straight to the shower,” he said.

All in a day’s work.

Shapiro, an internal medicine physician with St. Joseph Medical Group of Sonoma County, is by nature an optimist but he’s also pragmatic. His job demands that he be around and in contact with potential coronavirus patients. He is a leader in the hospital’s preparedness plan. Still, he takes every prudent step he can think of to keep his work from coming home with him.

“I’m locked down,” he said. “I go to work, I come home and that’s it.”

With 34 confirmed coronavirus cases in Sonoma County and all residents under shelter in place orders in an attempt to quell the spread of the highly contagious virus, health care workers are bracing for what is expected to be a surge in cases locally. It is being described as a wave that is building, but few are willing to guess when it will hit or how many patients will be part of the crescendo.

“It’s deciding where are we going to take care of patients who are awaiting a test result, where are we going to take care of patients who have it, where are we going to take care of patients who have it and are critically ill,” Shapiro said. “All of these things are critically important.”

And discussions are constant.

“There is still a lot to do,” he said. “The guiding principle is ‘Don’t let perfection be the enemy of progress.’?”

Everyone is working toward readiness, but foremost is building capacity.

“If we see an exponential rise in this thing because we didn’t get a hold on it early, we will definitely not have the beds and ventilators and oxygen to handle it,” said Dr. Ty Affleck, medical director of Santa Rosa Sports and Family Medicine and a private family medical doctor. “That is why we are mobilizing resources.”

For when?

“Nobody knows that answer, it’s all guessing,” he said.

And the number of confirmed cases locally is a misleading figure because it does not take into account unconfirmed cases - both those that haven’t been identified because of insufficient testing and those who show little or no symptoms.

“They are misleading, there are people with the disease treating at home because they don’t need supplemental oxygen or an ICU bed,” Affleck said. “I know those people are out there treating at home because of it.”

In a global pandemic, there are guideposts. First China, then South Korea, and Italy and Spain, and now New York - communities grappling with a massive influx of cases and patients needing urgent care. Heartbreaking stories emerged from Italy of doctors faced with life and death decisions when surges of positive cases emerged and there were suddenly far more patients than ventilators. Medical professionals told harrowing tales of deciding which patients would be saved and which removed from life-giving oxygen.

The notion of rationing care is unfathomable to those in the health care community and yet in the face of coronavirus, those conversations are happening both nationally and, to a degree, locally.

“Rationing care - we do not want to be in that situation, we do not,” Shapiro said. “We know that around the world that has become a practical unreality. We don’t want to be there, but we also have to be pragmatic. That is why we talk about it.”

“We have not gotten that far in the conversation here in this region, but as a profession, we are starting that conversation,” he said.

The key, health care officials said, is keeping so many patients from being stricken at once and overwhelming local health care capacity. That so-called surge is the worst case scenario.

“Everyone has that anxiety: Are we New York yet?” Affleck said. “Nobody knows the answer because we have put in to place restrictions to try and prevent that from happening and it’s too early to tell if we have done it at all.”

But those restrictions have taken their toll as well. Schools and businesses are closed, restaurants are shuttered and now parks are off limits. Sonoma County residents are being told to only go out for essential trips and even then to keep six feet away from other people.

“When I talk to my colleagues, the biggest thing is taking care of our kids and our family, ‘What if my kids are out of school and the daycares are closed, what am I doing now?’” said Valerie Martin, a vascular access specialist nurse with Sutter Santa Rosa. “A lot of my colleagues have their parents watching their children and is that a good idea? But what choice do we have?”

For years, Martin has worked around highly contagious patients. She doesn’t worry about contracting coronavirus herself, but the way this one is spreading and who it is affecting does make it feel different.

“Maybe I could get my family sick, which is huge stress,” she said. “It’s kind of hard to reconcile.”

Another nurse, who works at Memorial Hospital and asked not to be identified, said she’s been monitoring her 6-year-old daughter who has run a fever for eight days. Her family’s health, the constant onslaught of ever- changing information and the regular rigors of the job have her on edge.

“My anxiety level is so high, I’m not sleeping at night,” she said. “Every night between 4 a.m. and 6 a.m. I am just wide awake.”

Taking the edge off has gotten more difficult with each passing day. The closure of city, county and state parks, which followed the closure of gyms, libraries and local coffeehouses is an additional burden. Options for places to decompress are increasingly limited.

Still, Shapiro said he’s buoyed by what he sees as proactive steps to take what can be learned from other communities dealing with coronavirus and implementing strategies here.

“I’m seeing consummate professionalism at the highest level you could imagine,” he said. “Acknowledging those fears and acknowledging those anxieties and showing up every day and delivering. It’s remarkable.”

And the wider health care community, he said, is sharing everything - on social media, especially Twitter, and in medical journals.

It’s helping, he said.

“We need to take advantage of every minute we have,” he said.

“I’m really trying not to worry,” he said. “Worrying doesn’t help. I want to act. When I’m stewing I’m not effective. When I worry I’m not effective.”

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