Coronavirus – A Tale of Two Cities: A Cautionary Tale for Shasta County

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My name is Nick Germano and I am currently the Chief Resident at my Internal Medicine Residency program and hospital in Mason City, Iowa. In July, I will be going on to complete Fellowship training in Pulmonary and Critical Care medicine at Creighton University in Omaha, Nebraska.

Dr. Nick Germano

I should mention that I grew up in Shasta County, and left to go to UC Davis as an undergrad at 18, attended graduate school in New York, and eventually found myself in medical school in Arizona. Despite that last decade and a half of school and training, I retain a strong bond to Shasta County, where my parents and grandparents reside, and for me, it will always remain home. This is why I plan to permanently return one day to practice and live.

Like most of you, and certainly those working in healthcare, the COVID-19 pandemic has been front and center for much of 2020. Like Shasta County, my County Public Health Department in Iowa took all the precautions necessary, including the “stay at home” provisions, very early on, which has so far greatly limited the impact on our communities, both in Iowa and here at home in Shasta County.

That said, physicians and other healthcare and public health leaders are not unaware that the “stay at home” orders have caused some real hardship on people and businesses. However, the current results of a relatively small number of cases, both here in Shasta County, and in Mason City, Iowa, should be celebrated as a success of decisive action, and not criticized as over reach and a vast conspiracy. This is said knowing that there is a very real possibility that a second wave is out there, and that our communities cannot let our guard down even though many want to feel that the threat is either over or worst yet, not real.

One aspect of this that can be difficult, for it is simply human nature, is that should we not see something with our own eyes, it can be difficult to contemplate the scale of what is happening. To that end, and to draw a stark comparison, let me share an experience. Very recently I volunteered to join my ICU Director here in Mason City to travel to one of the largest outbreak zones in the Midwest, in Sioux City, Iowa, to provide respite to the ICU physicians. These intensivists had been working weeks in a row, 12-14 hours a day, in full protective gear, in an area that could only be crudely described as a COVID-19 war zone.

As you may know, Sioux City, Iowa, has the unenviable distinction of being the number one Coronavirus growth city in America recently. With over 2,400 confirmed positive cases of the virus (knowing that the real number, because of the lack of community testing, is far higher) in a community the size of Redding (about 80,000 residents). Each of the two local hospitals had 70-80 coronavirus patients admitted on a regular basis, many of whom reside in expanded ICU rooms. In my time at the outbreak zone, I saw first-hand what a widespread pandemic looks like.

The mortality figures of those who end up in Intensive Care, from New York and around the world, are not exaggerated. Specifically, those who end up on ventilators exceed an 85% chance of dying. Those with disease progression past basic hospitalization will likely die from horrific multi-system organ failure.

We saw patients who remained intubated for weeks at a time, essentially decomposing on the ventilators through various wounds and bleeding, with no hope to remove them from the vents, but unable to stop treatment due to family wishes. Despite blood thinners, many patients form blood clots that travel to their lungs and cause them to go into cardiac or respiratory arrest from the strain. Should these patients survive, there is a high chance they move onto a bleeding phase that causes massive hemorrhage from nearly every orifice on their body. Those patients who were not intubated and sedated live in constant fear, knowing that should they end up on the ventilators they are essentially being condemned to die. The amazing nurses here, and other staff, try their best to comfort them, but there is no hiding the seriousness of the environment all around them. We lost several patients because of the virus each day, only to be replaced by new patients from the hospital floors or the Emergency Room. Staff were incredibly hard working, but outwardly and inwardly exhausted.

All of us wore personal protective equipment (PPE) from head to toe for our 12-hour shifts, not daring to take it off for fear of exposing ourselves and/or our loved ones at home. Patients’ family members were essentially barred from visiting (for safety reasons), but were allowed very short visits, to one or two people, in the case of end of life. Often, however, this wasn’t feasible, and in many cases they had to say their goodbyes over Facetime. The anxiety in the community was high, for when a family member gets sick from this virus and requires a trip to the hospital, families understood it may be the last time they will see them in person.

I have to say that my time spent helping were among the most difficult and exhausting days of my career so far. As I start my further Critical Care training at Creighton University Medical Center, I am thankful for this experience as I suspect I will unfortunately be seeing more of the worst this virus has to offer. While I am glad I could help and do my part, and see with my own eyes the tragic toll the virus can take, I sincerely hope that most of America, particularly my home town of Redding, never has to experience this.

The lesson to share is what you have all been hearing: socially distance, please wear a mask in public, regularly wash your hands and avoid touching your face, respect your public health officials and physicians, and take their advice seriously. Most of all, be thankful that the worst of this has not happened. If the community takes these steps seriously, you will greatly lessen the chance of seeing the worst of this disease. Since my parents and grandparents and extended family live in the North State, this is my sincere wish for them and for all those who live there.

Sincerely,

Dr. Nicholas Germano
Mason City, Iowa

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