Erik Anderson, MD, is an emergency and addiction medicine physician at Highland Hospital, the county hospital in Oakland, California, where he works in the addiction medicine clinic weekly. Additionally, he works at San Leandro Hospital, a community hospital in Alameda County.
Explore This IssueACEP Now: Vol 40 – No 06 – June 2021
BT: We are now a year into the pandemic. Tell me about the moment when the pandemic became real for you.
EA: I remember seeing the news reports about the coronavirus in China and how it was spreading to nearby countries. I thought it would be like SARS-CoV-1 and we would see what happens. I thought there’s no way that this would become a pandemic. I don’t think it was even on my radar that this would change our lives as we know it. It felt real to me when I started seeing the news in Italy of emergency docs giving reports of how overwhelming it was, the devastation, and how unbelievably out-of-a-movie things were there. I thought to myself, “Well, this is happening now. People need to get ready.” It felt like, from that point on, it was full steam ahead.
BT: Do you remember the first patient you saw with COVID-19?
EA: There were two patients that I remember when we first started testing people. It was midnight on an overnight shift when a woman came in with mild upper respiratory symptoms. She said, “There was a COVID-19 outbreak at my school.” Now, this was well before there were actually COVID outbreaks or clusters in our area. I thought to myself, “Oh my gosh. How did I not know about this? This is crazy.” I remember donning all the gear for the first time and looking at an instruction sheet on how to enter her room. In the end, we couldn’t even order a COVID test for her because at the time, we needed the Public Health Department’s approval. They weren’t convinced that there was a true outbreak there. So I had to go back in there and tell this poor, scared woman, “Sorry, the Public Health Department is not letting me order this test.” I remember that patient so clearly—just as clearly as the next patient I saw with coronavirus, who was a low-acuity, young, healthy patient with flu-like symptoms that ultimately went home and did fine. I remember, at the time, there was this whole thing with contact tracing when you see a COVID patient, and the hospital would track you down to tell you about a patient that you saw weeks ago who tested positive for COVID.
BT: Besides testing, were there any other obstacles you faced early in the pandemic when caring for COVID-19 patients?
EA: There was always so much discussion about who had enough testing and PPE for the weeks ahead. Working at a safety-net hospital always begged the question, Do we have enough of the resources that other places had? Early on, it was clear that big academic medical centers had more access to testing, and we had to figure out how to partner with these centers to help with our testing. So much of it felt unfair. We were caring for a very vulnerable patient population, and it didn’t feel like we had the same level of support as some of the places that had more resources. Things have not been equitable throughout the entire pandemic, and it has disproportionately impacted different health systems, communities, and patient populations. Whether it be testing or access to monoclonal antibodies, one of the biggest takeaways for me is how inequitably COVID hit various communities and health systems along the way.
BT: What’s been the impact of COVID-19 on the community and patient population at your hospital system?
EA: If we were to step back from the very beginning, at my health care system and across Northern California, we were seeing a lot of essential workers, particularly in the Latin(x) community, who were disproportionately impacted by COVID-19. Figuring out how to tailor interventions and education for that community was something that was going on early and still persists today. There is a significant indigenous Mayan community in Alameda County that has been tremendously affected by COVID, and there was essentially no COVID health information in the spring and summer of 2020 in any Mayan languages. There are these pockets of disparity among our patient populations that we do our best to navigate through.
I do addiction medicine as well, and there has been a lot written about increasing overdose deaths during the pandemic. We were really worried early on when our patients stopped showing up to the emergency department and clinic. The fear was that people were using more drugs and using them alone in a period of isolation. You never want that. A lot of my work has been focused on addressing this and keeping people safe.
BT: How has COVID affected the way you approach patients?
EA: My spouse and I worked on the Navajo Nation before we moved back to California. One thing that was really important there was, when you walked into a room, you’d shake the hand of the patient. You’d also shake everybody’s hand who was in the room with the patient, often family members. It was an important thing that you greeted everybody by shaking their hand. Coming back to California, that was something that I continued to do. Now, there is this unseen barrier of germs and viruses and the physical barriers of masks and gloves that change a lot about the patient encounter. Pre-vaccine, there was this fear that anyone could have COVID-19, so I always need to have my guard up. Maybe that means you are standing farther away from the patient when normally you would be close to their bedside. I think that changes the dynamic of what patient and providers see and feel in a negative way.
BT: How has the pandemic affected your personal life?
EA: It’s been hard, like it has been for everybody else. My wife is a primary care physician in addiction medicine as well. That transition between pre-COVID and COVID seemed like it happened very fast. We were working the whole time, and that stress of keeping your family safe and finding ways to do that with childcare was difficult. Trying not to be sick was just something that we never thought about. Getting sick with a virus was just not that big a deal before. Just recently, we agreed that we should write a will. Having to go through that was so emotionally difficult with small kids at home. But things are getting better. As much of the night and day from pre-COVID to COVID, it’s getting pretty darn close in terms of the post-COVID vaccine era. While still stressful to be at work and wear an N95 all the time, the emotional burden of going to work is so much less after the vaccine. I can’t believe we did that for a whole year. Coming home, taking your clothes off outside, and taking a shower immediately, hoping you didn’t bring something home, was a totally bizarre and difficult thing for our profession.
BT: Where do you see us a year from now?
EA: A year from now, I think COVID will still be out there globally. I think we will be getting ready for our booster shots. There will be more ability to see people and socialize, but we will still be living with COVID in a manageable way.
BT: How do you see emergency medicine changing when COVID is over?
EA: It’s hard to imagine not wearing masks at work, at least for patient encounters. It’s almost hard to remember intubating somebody without a mask on, let alone without an N95. I can’t imagine intubating someone without eye protection and an N95 for a very long time. We weren’t doing that regularly before COVID.
I’m interested in the public health interface of emergency medicine, and I think now we are going to be more aware of our role in population health. Before COVID, I was working a lot on HIV and hep-C screening in the emergency department, and that I think will become more easily understandable as a role of emergency medicine. On top of resuscitating patients, we have a part in public health and improving disparities in our communities. That’s what our specialty is.
BT: Any final thoughts?
EA: Even though our world has gotten smaller with COVID in terms of social distancing, it has been nice to feel closer with smaller groups of people. Our relationships with some people have grown this past year, given this shared experience. I hope that continues.