Interviewer(s): Henry
Interviewee(s): Levi

Henry: Okay. So I guess I'll start out. How old are you?

Levi: 31.

Henry: And where are you located?

Levi: I am located in Philadelphia.

Henry: And what was your job? Oh, where do you work?

Levi: I’m an emergency medicine, doctor?

Henry: And what was your job in January 2020.

Levi: I was a resident in emergency medicine, completing my residency here.

Henry: So when did you first hear about COVID?

Levi: Probably January of 2020 Probably. And maybe December. Hard to remember. Either December or January.

Henry: Do you remember where?

Levi: No.

Henry: So what were your initial thoughts?

Levi: Honestly, my initial thoughts were it was just not a global issue. It just was not really anything I had to think about at that moment.

Henry: But do you remember, why?

Levi: It was very remote. It wasn't the first time there was a viral illness that was highly contagious that wasn't in this region. I just I never expected it to become a pandemic. I always thought it was just going to be an epidemic. So it wasn't really on my radar.

Henry: Were you working during Ebola?

Levi: No, I was not. I was still in medical school.

Henry: So who did you who did you discuss it with at the time that it would be.

Levi: Family, coworkers, mostly family and coworkers.

Henry: Did they agree with you?

Levi: I wasn't really opinionated. It wasn't really a big conversation. I thought it just I truly just it wasn't really a big topic because it wasn't really affecting me.

Henry: OK, so. OK, so this would have been around January-February, yes?

Levi: Yes, probably. Yeah, probably January. It had been discussed, but it wasn't really- didn't really impact me.

Henry: But can you describe how you were feeling about that time?

Levi: You know, certainly curious about what was happening. I was, but I did not know. I did not know much about the details or how deadly it was or any specifics of the illness course. I remember just being a little bit curious, but also a little just, I guess, thankful that I didn't have to think about that. Or deal with it.

Henry: So did this did your position or did your perception of this change at all before the first wave?

Levi: Yes, probably… I don’t remember exactly when it changed in terms of a timeline. But I think once it was more rampant in Italy, that's when it. That's when I realized that it was going to spread. And that's when I realized it was going to be a big strain on the health system. That's that's when my whole perception changed. I think there was an article that came out about how dire things were in Italy.

Henry: Do you remember what newspaper?

Levi: No, something online. Yeah, there was something online. I really don't know what the source.

Henry: But did you have like a eureka moment when you realized how bad it was going to be?

Levi: Yeah, I think so. Again, I don't remember exactly when it was, but I remember becoming very anxious about the situation I remember feeling that I, I was anxious about the thought of having to decide who would qualify for a ventilator versus who wouldn't. That was my kind of panic moment when I thought I would have to make those decisions based on predicted supply shortages, ventilator shortages, things like that.

That's that's. That was that was hard for me. […]Fortunately, never came to that. And it never, ever came to that. Yeah.

Henry: Because you didn't have ventilator shortages?

Levi: We had we never had a shortage in terms of ‘we need to intubate somebody and we don't have a ventilator’. We were not abundant in ventilators. But we never had a moment where I cannot provide life sustaining treatment to this patient because we don't have the supply, that was not an impact, that didn’t impact me.

Henry: That was a problem in Italy, wasn't it?

Levi: I believe it was. Or at least they were saying it was going to be. Again, I don't I don't work in Italy. But I believe they were saying that that was the issue. Either they were saying that the current issue, they or they were saying it's going to be the issue based on predicted trends.

Henry: Okay, so once you saw this article and you realized what was going to happen, did you do anything to prepare?

Levi: Yeah. Oh, yeah. Our whole department did. We… And it wasn't based on that. Article that our department prepared. I think I think just as as concern grew among, I think, the United States in general- And I think there was kind of a couple of weeks where concern started to mount among everyone. And once that happened, we started to prepare in terms of we bought as many masks as we could.

We bought PAPRs which are, you know, the PAPRs?

Henry: I've never heard it said like that. But yeah, P.A.P.R.

Levi: Okay. Yeah. Yeah. So we bought additional PAPRs. We started doing additional kind of training in the emergency department of Refreshers on, you know, simple things like intubation. But we also started practicing how to intubate in a PAPR. How to communicate in PAPRs, because they were very loud. You couldn't really speak. So we started practicing hand signals in terms of what it would be like.

We started preparing... how do you know what would be the process for donning and doffing PPE, what the team would be like? And we started organizing intubation teams because that was mostly in the nursing side. We would just respond if we had to, but we started having like a floating nurse who would be just responsible for responding to when we need to intubate a patient.

So we could do a decent amount of prep. We started preparing, We started preparing kits that were going to have everything you needed them for when you had to intubated patient because the door would be closed and we didn't want to be opening and closing the door for supplies. So we started pre preparing all these kits with everything that you could potentially need.

Sure There's other things we did to prepare, but you know, off the top of my head, that's some of the stuff that stands out.

Henry: Do you remember when you started making those preparations or those trainings?

Levi: Yeah, probably the first or second week, ehh, probably second week of March, first or second week of March. I don't know. Early March. Yeah.

Henry: But you personally like in your personal life, though, did you make any behavioral changes?

Levi: Sure, yeah. I mean, I stopped seeing my family, stopped seeing my friends, I didn't see my family for months. Which was very unusual for me. Prior to that, I had a tradition going where I would see my dad at least once a month for, you know, just to catch up. We've done that for years and years and years. Stopped doing that.

I didn’t see my nephew...

Yeah.

Henry: That was after those after March that you started doing this, did you stop doing anything in January or February?

Levi: In the last I mean, I don't see my I didn't see my family that frequently. So I probably the last time I had seen them was early February anyway. But no, nothing in the first half of February, probably even the latter, probably the latter half of probably March. I don't think I made any real changes in early February, but then again, it just wasn't endemic to the region.

So there was no need to.

Henry: And one more thing, you were you were a resident. Right. You were?

Levi: Yep. I was a third year residenct, a senior resident.

Henry: So where does that fall in the hierarchy? In the E.R..

Levi: In terms of.

Henry: Who do you answer to? Who’s your immediate supervisor?

Levi: At the time? At the time, my attending physician yeah. The attending.

Henry: OK, so who was organizing the trainings?

Levi: That was our program leadership, our residency program leadership, who are also attendings, but they were the ones organizing those trainings.

Henry: OK. Was there any kind of meetings or group discussions happening?

Levi: Yeah, there were other meetings about how we would need to modify our curriculum going forward, how we would need to you know, we had once a week we would meet for didactics, for lectures, and we had to modify how we did that to modify we had to set up, obviously WebEx sessions, virtual sessions to continue with the curriculum.

We started creating a surge schedule for should residents or should anybody become sick? And we need people to work. So we started creating backup schedules. Backups for backups on… our critical care team needed additional staffing, so we started pulling our residents off of other rotations that they had been doing, to allow, to provide extra people to help on the critical care service.

So those were all meetings that were happening behind the scenes that I was a part of. I was I was a chief resident at the time, so I was pretty involved in all those decisions.

Henry: Was anyone pushing for more, more action early?

Levi: Like was somebody trying to blow a whistle and nobody was listening? Not that I can recall. I don't think that was the case.

Henry: Um, so anything you wish that the hospital or that the organization had done differently?

Levi: I felt very, very fortunate to be part of my organization while this was happening. I thought that they prepared as best as they could have for it. I thought that they were extremely transparent with their communication. We had daily meetings with the hospital CEO. It was virtual, but we had daily meetings and I think it was a phone call where there was just updates everyday given about what was happening and I for me, really masks never became a huge supply issue.

I never really ran into that issue where I didn't have an N95. So I always felt like I was taken care of in terms of my health and protection. I can't really say enough about how well my hospital handled the entire pandemic. Yeah. I feel very, very I feel very fortunate to have worked there and to continue to work there.

Henry: Good.

Levi: Yeah.

Henry: You're lucky.

Levi: Now. Yeah. I mean, a lot of my friends were not as fortunate. Personally... A lot of friends in New York City but it was it just wasn't the case for me. We saw a lot, took care of a lot of sick patients, but I never felt like I had to do so at the jeopardy of my own health.

Henry: Did you guys get hit pretty hard?

Levi: Yeah. I mean, not again, not as hard as I think New York City, but we definitely we definitely were feeling the impact, but also the first wave was in conjunction with other patient volumes being down. So just the only people coming to the emergency department or essentially being intubated with covid. That's what it felt like. It was….

Henry: OK, so is there anything that you would have done differently as an individual?

Levi: I never really thought about it. I can’t really- I just never really considered that, not off the top of my head.

Henry: Yeah, it's a hard question.

Levi: Yeah. I mean, I still haven't gotten I still haven't gotten Covid, so I feel like I'm doing OK.

Henry: Yeah, same here. I feel like I'm one of the only ones.

Levi: I mean, not that I could think of.

Henry: I mean, I I just I tried to get it. My parents got it in the first wave and I went back from I was in Thailand at the time and went back to, you know, make sure, like, care for them. And, yeah, I wasn't wearing a mask or anything. I was like, give it to me now. I'm healthy.

I have plenty spices in my body.

Levi: Yeah. Yeah. I mean, I feel glad I didn't get it, but, you know, maybe if I could do one thing different, maybe I would've started masking earlier. Probably was a lot of confusion on if you should be wearing a mask. If you shouldn't, it's can cause you to touch your face more. But I feel like I was just gone based off the best recommendations from the CDC that I could have at that time.

Well, if I could go back and change one thing that probably would have mask earlier, I actually remember seeing a guy on the plane, the guy on a plane at the end of February. I was on a plane and he was running gloves and a mask, and I was kind of stuck that's pretty extra, but I think he had it right.

Henry: I remember I remember flying back in through Boston and there's, you know, in the line, you know, all of us were crowded in this terminal for customs. Nobody's wearing a mask. They're customs officers not wearing a mask. And there's this these two black girls who are wearing the like the eye coverings from the plane over their over their mouth because they saw everyone wearing a mask and they didn’t have anything.

Levi: So they’re smart.

Henry: Improv. So you generally like went by what the CDC was saying?

Levi: Yeah. I mean, there was really no other advice we could go off of.

Henry: Were there any, in in your hospital, were there any like older doctors that everyone looked up to?

Levi: Yeah. I mean, our infection prevention team was in charge of a lot of the recommendations for our organization. And that was part of those daily meetings at 5:00 I remember. We would get updates on them and updates on they were doing meetings daily, basically briefings. And the idea was you would call into the meeting. It was not mandatory but it was available to you if you would like.

And it was hospital wide. You can join whether you were a physician, a nurse, a tech, an environmental service cafeteria worker, you know, it was open for everyone to participate in kind of what are the updates and what are the recommendations. And a lot of that was a lot of the policies were crafted by our infection prevention team. So I think what I think they were taking the CDC's recommendations and then combining that with, I don't know, they're just going by their recommendations.

Henry: Do you remember when those meetings started?

Levi: Sometime in March? I remember one sometime in March, probably. Probably middle to middle to second half of March. Would make the most sense, I’m trying to recall.

Henry: And was your wave concurrent with the one in New York?

Levi: It was usually, it lagged. Usually one to two weeks, I think, because it took time for a kind of trickle down [state] and then to the area so it certainly lagged a little bit, but not not far after.

Henry: So I was speaking with someone at [organization] in New York and they were they said that in the E.R. they had a real, real trouble separating the COVID patients from the COVID patients. Or separating the suspected COVID patients.

Levi: Mm hmm.

Henry: What did you what did you guys do to to keep the separate COVID patients isolated?

Levi: Yeah. Honestly, for the first time that I had ever worked at that hospital, we had we had enough- usually we’re just overrun with patients, like right now, too many patients. So at that time, that was not the case. People weren't coming to the hospital. We were able to put them in rooms. So that help isolate them. These people who were suspected Covid positive, we were able to get them into a room. we only had two negative pressure rooms, I think.

So we tried to prioritize those patients for people who are going to be intubated requiring any sort of aerosolized procedure. But at the very least, we tried to get suspected covid positive patients in a room and not a hallway bed.

Henry: OK, so looking back at this, you know, this pre crisis period, so from from the time you learned about it to the time you really start getting hit. What would you like to tell me about the way you were feeling?

Levi: Again, I mean, probably towards the beginning of January, I wasn't really feeling anything. It wasn't it just was not an issue. Like, I think for most people, it wasn't an issue, it was something that was happening on the other side of the world. Nobody anticipated a global pandemic. It was I don’t think people were happy that there was this you know, I'll call it an epidemic at the time that was killing people, but it wasn't anything that was really on my day to day radar.

So I really wasn't feeling much. And I I really think the probably my turning point was, was when a lot of the stories started coming out of Italy and then I realized how this was spreading and it was going to spread and there was gonna be shortages. So. But prior to then, I, I don't know, I don’t know if you want to call it ignorance.

It just wasn't really an issue for me. So it just wasn't on my day, it wasn't on my mind.

I hope that helps.

Henry: Yeah, it definitely definitely. OK, so that's it for my main questions. I have two wrap up questions? But, lemme me just see if there's anything I wanna cross-checked with you. Um, do you remember if the if the, these infection prevention team meetings do you remember if they cited any of the prior epidemics like H1N1 or Ebola or the original source.

Levi: I don’t think so, I don't think so.

Henry: And how would you describe the mood of the other doctors in the E.R.

Levi: They vary very based on people's risk factors. Right. I think there are some people who were very frightened and I think there were a lot of people who took a lot of pride in their job at that time. I know a lot of people who felt that this was our specialty’s moment to kind of show what we do know.

And I think I shared that sentiment also. I wasn't really concerned for myself, so I didn't have that. You know, I don't have any comorbidities or underlying risk factors I got. It's not that I thought the virus was fake. I just felt that if there's anybody here that should do this, you know, I'll be OK should something happen, and I think a lot of people felt that way.

And I think a lot of people just felt pride in our specialty. At least from the physicians’ standpoint, you know, I don't know I don't know what the nurses were feeling at that time.

Henry: Are there any outliers?

Levi: I can't I, I can't even think, it was it was like a moment where people just rallied right? It was the initial phase. You know, you think of 9/11, right. Where people just rallied and they came together and they there was a huge found of community like this feeling of community. And at the time, patriotism, we'll call it.

I think people kind of rallied. People wanted to help out in any way they could, whether it was some of my colleagues who volunteered to work extra shifts or work extra, you know, potentially be on the surge schedule I was creating or the community members who just wanted to send bagels and pizza, you know?. Right. Like, I don't know.

People were just I think that was just the sense of across the country, people wanted to do something I think I felt similar.

Henry: What was there any sense of like shared panic at any points?

Levi: No, we never panicked. No, no, no. I I mean, this could sound hokey, but emergency doctors, we don't panic. It's not you know, we don't we just don't panic. Nobody panicked. I think we planned and then we acted accordingly. I think there was definitely some anxiety among some people, you know, including myself, like I mentioned earlier. But overall, the feeling was was, you know, we can do this or that we’ll do this.

Henry: OK, so is there any question that you think I should have asked you that I didn't?

Levi: Not that I could think of off the top my head. Honestly, I'd really never reflected that much on that time. So I don't think I have PTSD. But, you know, I just never, ever really thought back and reflected on that time that much.

Henry: I don't think about my time as an EMT much either.

Levi: Yeah.

Henry: And is there anything else that you'd like to tell me.

Levi: Not really.

Henry: If you could describe, you know, the period of January through January to March in a sentence or two.

Levi: And I feel like I kinda have. I don't know if there anything else I could characterize it as. Yeah.

Henry: Ok I’m gonna stop recording, OK?