Medical Doctor Answers Questions about COVID-19

There’s no shortage of opinions and advice coming from politicians and pundits who are only qualified to comment on the color tie they’re wearing and probably not much else. We reached out to a local medical doctor, Kerim Razack, with more than 20 years of experience in critical care medicine and pulmonary (lung-related) disease treatment to answer common questions Fort Worthians have concerning COVID-19, the rapidly spreading disease that has afflicted more than80,000 Americans to date. Dr. Razack is a partner with Texas Pulmonary & Critical Care Consultants at Texas Health Southwest.

Is this just a new strain of cold or flu?

No. This is a new strain of SARS [Severe Acute Respiratory Syndrome]. The family of coronaviruses is not new. The novel coronavirus [that we are seeing] is a virus that is similar to a virus that can cause the common cold.

What are the manifestations of COVID-19 in the lungs?

The most common symptoms arecoughing, fever, and shortness of breath. We are realizing that there are a lot of [gastrointestinal] symptoms now. Nausea, vomiting, diarrhea, abdominal pain, and loss of appetite have been reported in 30 to 50 percent of some cases.

Most people will get something that seems like the flu with cough, fever, and shortness of breath. It can go on to become extremely severe and cause acute respiratory distress syndrome. That’s when the capillaries in the lungs start to leak, and then you end up with fluids in air spaces. That is generally what people die from. 

Why is sheltering in place important right now?

Two reasons. If you have it, you don’t want to be spreading it around. If you are asymptomatic and you show symptoms 14 days later, you were spreading it to everyone. However, there have been reports of some incubation periods as long as 25 days or longer. If you stay in place 14 days without symptoms, then it is unlikely that you have it. The other purpose is so you don’t get it from someone else. 

What makes COVID-19 worrisome for medical professionals?

It has to do with the transmissibility of the virus. The misconception was that this was a bad flu. The thing with the flu is, you can see it coming. The flu transmissibility is about one-to-one. However, with COVID-19, what ends up happening is that you get it, you are contagious, and you spread it because you might not manifest symptoms for 14 days. 

What has been the biggest misconception about this pandemic?

The misconception is that it’s no big deal. All the people who are bored right now don’t realize what is happening in hospitals. The hospitals are being inundated. Wearedoing our best to not get it ourselves. All the resources are being used up. 

We’re starting to see the beginning of [the outbreak] in Fort Worth. [Without taking steps to slow the spread], hundreds of people may end up in respiratory failure and needing a ventilator. When we run out of ventilators, we will be deciding who lives and who dies. Meanwhile, everyone is sitting at home being bored and not seeing any of this. That’s the misconception. No one gets to witness what is happening in hospitals.

How has the pandemic affected your medical team?

We are stressed out. We know what’s coming. Some [staff] are getting pre-traumatic stress disorder, which includes anxiety and depression. 

I’m taking care of a patient with COVID-19. You have to go in with a gown, double gloves, surgical hat, N-95 mask, and a face shield. We’re not quite using a hazmat suit. Every time you enter that room, you’re wondering if you put your suit on right. What it’s done, you’re wondering if you took it off right. “Did I touch something after I took this stuff off and touch my face?” You’re constantly worried that you did something wrong and that you are going to get sick.

How are patients being tested?

I treated one known positive patient. That’s not because we don’t have other positive patients. The testing is taking seven to 10 days to come back. In an ideal world, you would have a test that comes back in an hour. Anyone who has symptoms is being put in isolation, so we treat them in full garb. That’s why we’re burning through all the personal protective equipment.

What steps should someone take if someone begins to feel sick?

They need to self-quarantine. That means away from the rest of the family. They need to monitor their body temperature twice a day. The CDC [Centers for Disease Control and Prevention] defines a fever as 100 degrees and above. If you have a fever of 100 degrees or above, cough, or shortness of breath, you need to self-quarantine. 

At what point should someone seek medical care?

When theyget in some sort of respiratory distress. If you can’t breathe, you need to seek medical attention. If it’s severe, you need to call an ambulance. If it’s mild, you can go to an emergency room or an urgent care center. You don’t want to go to the emergency room for everything because they are already overtasked. Urgent care centers are equipped to see these patients. They can see you and check your oxygen level. Most primary care offices are not equipped to handle a potential COVID case. It depends on the office, but most are not equipped with the proper protective gear.

What steps has your hospital taken to prepare for a possible surge of cases?

For the entire Texas Health Resource system, they are having COVID meetings every morning at the local level and system level [for the entire network]. At the local level, we are repurposing staff. There are no more elective procedures. Colonoscopies, radiographic procedures, ultrasounds — all canceled.

The staff has been repurposed to do other things. They are becoming COVID monitors in many cases. COVID monitors watch you put on the personal protective equipment. They watch you take it off and make sure that you leave the room and wash your hands. 

We are trying to procure all the right equipment like ventilators and medications. We are trying to segregate patients into areas. One section is for COVID patients. Protocols are coming from the CDC then to administration and worker–bee level. Things are changing on a daily basis.

Have there been planning lapses at the national level?

After the H1N1 epidemic in 2009, there was a huge push for having a pandemic response team. All the hospitals came up with plans for this. Even the federal government had a pandemic response team. Everything fell to the wayside because that was 11 years ago. [President Donald Trump] dismantled the pandemic response team in 2018. His reasoning was that we could reassemble it on the fly. The problem is that COVID-19 moves so quickly, trying to reassemble that team (taking months or longer) has been unhelpful.

What are the most practical sanitation steps we can take?

This is relatively simple. Number one, wash your hands. Soap and water is the best thing you can do for this. Wash your hands for 20 seconds. If you touch anything that is suspect, wash your hands. The virus has an airborne component. If you are coughing, you want to cough into your arm and not your hand. Use hand sanitizer if you don’t have access to washing your hands. Finally, shelter in place. Don’t go out. 

What’s Fort Worth’s best-case scenario?

The best-case scenario is something called “full Wuhan,” a complete lockdown until new cases get to zero. That’s the best-case scenario. We can’t do that nor are we willing to do that. In Italy, people are dying by the truckloads. New York City is in a bad state right now. DFW, hopefully, won’t be as bad as New York because the population density is lower here and we put shelter in place when we did. But it’s far from over.