Fighting on the front lines of COVID-19

Alumnus Jon Mark Hirshon, an emergency physician, faces isolation and personal risk while providing emergency care at a busy Baltimore hospital

jm-hirshon350.jpg
Emergency physician Jon Mark Hirshon (Porter ’84, biology and French literature).

Emergency physician Jon Mark Hirshon (Porter ’84, biology and French literature) does not dare to hug his wife and daughters. He is seeing patients sick with COVID-19 at a busy Baltimore hospital, and doesn’t want to bring the virus back to his house.

“I am exposed,” he said. “I know I am exposed. I wear my equipment to minimize being infected but I see people with this disease and don’t want to share that with my family. You hear stories of physicians who literally strip outside (their homes) so they can come in and go right into the shower.”

Dr. Hirshon’s wife and two of his three daughters live with him. Hirshon simply avoids them as much as he can, taking his meals and showers downstairs in a basement studio.

“I stay away. Most of the time, I stay in the basement, with a separate entrance that I go in and out from. I don’t have a kitchen, but I have a shower, a sink, a bathroom, a bed, a coffee maker, and a microwave," said Hirshon. "I have enough down there to keep myself reasonably comfortable, except for the important personal connections.” 

This living arrangement is isolating, but if he wants to provide front-line care without endangering loved ones, there is no other choice.

Sometimes, Hirshon drives through nearly deserted Baltimore streets in the dead of night to take the graveyard shift at his hospital, where he cares for frightened and very sick patients while wearing a mask, a face shield and a gown, or perhaps a full helmet with a battery powered air blower known as a PAPR.

Such is the life of an emergency doctor fighting COVID-19 in a large metropolitan area that is just starting to feel the brunt of coronavirus.

So far, 18 people in Maryland have died of COVID-19, a highly contagious viral infection that attacks the respiratory system. There are now more than 1,600 reported cases statewide.  One nursing home has 66 COVID-19 cases, with 11 hospitalizations. The National Guard and FEMA have teamed up to turn the Baltimore Convention Center into a sprawling field hospital with 250 beds. This makeshift center is set to open April 24.

 As cases surge in Maryland, Hirshon and his colleagues must risk their lives to give patients the best possible care, in spite of severely limited access to coronavirus testing.

“Every day on the job is a battle,” said Hirshon, a professor of emergency care and epidemiology at the University of Maryland School of Medicine. He was appointed a month ago as the interim chief of Emergency Services at Baltimore Veteran’s Administration. He is also the chair of the Board of Directors for the American College of Emergency Physicians (ACEP), helping to guide his colleagues during these difficult times.

“With this pandemic, things are changing on an almost daily basis,” Hirshon said. “If you are going into battle, do you think about winning the war? Does that comfort you? Or are you looking at the battle in front of you? We will get through this, no question, but the battles ahead require 110 percent determination, effort, and attention.”

Last week, the federal government declared Maryland a major disaster area. Maryland’s governor, Larry Hogan, announced his intention to add 6,000 hospital beds across the state. On March 30th,  he announced a total lock down of all but essential businesses.

The COVID-19 crisis has exposed the high cost, weakness, inequity, and fragmentation of healthcare in the United States. Already stressed hospitals are now struggling, in large part because of decades of under-resourcing and lean budgets, Hirshon said. With tight margins and lack of support, over the years hospitals have cut staff and trimmed resources, while at the same time insurance companies are now making record profits.

Because of this lack of preparedness, and an inadequate national initial response to the pandemic, it is essential that all Americans support doctors, nurses, paramedics, and others in the medical field, so that they all receive the protective equipment and support they need, Hirshon said.

Hirshon is on call 24 hours a day, 7 days a week, during the crisis. Each week, he has been working between 24 and 32 clinical hours giving emergency care, while putting in another 30 or 40 hours of administrative time. This past week, he pulled an 11 p.m. to 7 a.m. graveyard shift. The patients he sees are severely ill, with great difficulty breathing, and often with high fevers. Many are understandably fearful.

“We need to address the pandemic of fear along with the coronavirus pandemic,” Hirshon said. “We live in a society where we feel we have some control. Now many feel they have lost the control.”

Coronavirus brings out our fear of losing control because of its cruel inconsistency, leaving one patient asymptomatic and others fighting for their lives.

Hospitals across the nation have been grappling with severe and systemic shortages of equipment. So far, Hirshon’s hospital has the masks and materials it needs, but the future is uncertain.

“The preparedness at my hospital, and throughout the University of Maryland Medical System, is great. However, we are right at the inflection point,” he said. “If you ask me the same question a week from now, my answers may be different."

Meanwhile, the testing capacity for COVID-19 is severely limited. 

“We’ve had tests for people who were sick, who were being admitted to the ICU, but not for outpatients who were not particularly ill,” Hirshon said. In this respect, Baltimore is right in line with the rest of the country. 

His patient visits are similar to what happens in any emergency department situation, but in this case, there is a much higher degree of vigilance and care regarding exposure. Everyone who enters the room must wear a mask and gown. Sometimes Hirshon wears a full-on protective suit with a hood and a mask with a specially designed ventilation system to prevent him from breathing in aerosolized droplets. Still, his job puts him and his colleagues at serious risk.

“If you are over 60, as I am, you are not required to do this work,” Hirshon said. “I’ve had colleagues who feel so uncomfortable, they’ve stepped away from it, and someone else who has significant anxiety. But I’m comfortable with risk taking. As the Senior Vice Chair of our Institutional Review Board, I analyze research protocols with a specific focus on the risks/benefits of the research. I think of them all the time. Is my wife happy with me? No. But I went into medicine 30 years ago to take care of patients.”

He takes a long view about the risk factor, looking back at the history of medicine.

“A hundred years ago, when doctors put themselves at risk, they did not have access to antibiotics," he said. "Now there is risk again, but my job is to provide the best care I can.”

Many Americans who are sheltering at home want to know what they can do to help people like Hirshon, and give assistance to the countless nurses, paramedics, and support staff that are putting themselves in harm’s way as the coronavirus spreads.

In response, Hirshon said: “Wash your hands. Stay home. A lot of people want to help. Some are sewing (safety masks), though I don’t know how good the quality will be. It’s important to reach out to local hospitals and see if they have needs. Reach out to the California chapter of the American College of Emergency Physicians and ask what is needed.”

To celebrate the work of his colleagues on the front lines, Hirshon has been emailing friends and acquaintances a cartoon showing Superman and a pantheon of grim-faced superheroes addressing a befuddled-looking doctor wearing a white hospital gown and a stethoscope. “Welcome to the club,” Superman says. 

Beneath this lighthearted drawing lies a darker reality. Superman is all but invincible, but front-line providers are in serious danger. Already, several emergency doctors across the nation have tested positive for the coronavirus.

“There are emergency physicians integrated at hospitals where people are sick and in ICUs and intubated—and some of them may be my friends. I have people I work with who have tested positive. I have colleagues in New York and New Jersey and Washington state, which have all experienced devastating COVID-19 surges," he said.

“I am honored to be able to help patients and their families every day that I work in the emergency department, and to help my colleagues and our society through the work I do through my professional society, ACEP,” he said. 

But he and his colleagues recognize the danger that doctors face around the world when helping patients with COVID-19.

“It is not something we talk about, but I have to acknowledge that some of my friends may die in this, and that is a very real risk.”