COVID Chronicles: Dr. Liz Goldberg, Lifespan Emergency Physician

This emergency department doctor and mom of three stands on the front lines of the coronavirus outbreak in Rhode Island.
Dr Goldberg

Photo courtesy of Dr. Liz Goldberg

Every day, Dr. Liz Goldberg wakes up hoping this is all just a bad dream.

Goldberg works as a physician in the emergency departments at Rhode Island Hospital and Miriam Hospital, and she provides care for Rhode Islanders infected with the novel coronavirus, COVID-19. She’s also assisting with protocols for field hospitals when local emergency departments no longer have the capacity to care for the critically ill. Recently, she lost her first patient.

“On an individual level, it’s very stressful. We’re all waiting for the surge to happen,” she says in a phone interview from her home in Providence, where she lives with her husband and three young children. In between shifts, Goldberg helps home school her kids. This week, they sewed face masks to wear on walks around the neighborhood.

“My husband and I are very compliant, but the children, not so much,” she says with a laugh.

Her children are eight, five and two and, while they’re a nice distraction, she admits it’s difficult to focus on being a mom when she’s pulled toward her work. Goldberg, who also has her master’s in epidemiology, spends several hours of her off-time researching COVID-19 best practices. (To date, it’s still supportive care.) Despite her preparation, Goldberg isn’t immune to concern. She worries about patients who can’t see their loved ones while fighting for their lives. She worries about bringing the illness home to her family. She worries about not having enough personal protective equipment (PPE); she and her colleagues are currently re-using N95 respirators, which filter at least 95 percent of airborne particles, including viruses.

“The biggest risk of you getting the virus is removing that infected PPE. The fact that we’re not just throwing it away, we have to reuse it, and put that potentially infectious PPE back on, is a little frightening,” she says. “But we’re making due with what we have.”

She feels her hospitals — which are part of the Lifespan health care system — are doing the best they can to protect health care providers, particularly older physicians, those who are immunocompromised and those who are pregnant. Extra backup is built into the schedule, and doctors are more flexible with their shifts. Goldberg also touts Lifespan’s infectious disease brain trust, which includes experts trained in disaster and emergency preparedness who worked to contain the Ebola outbreak. Every day, she says, she receives several emails about changes to the way she’ll care for patients. What hasn’t changed, though, is the way regular people stay healthy.

“Your best bet is prevention and that involves, really, staying at home,” she says. “When you cough, the viral material can travel even further than the six feet people believe.”

Goldberg 2

Notes of support from a group from Juanita Sanchez High School, via Twitter.

Goldberg says she’s bolstered by support from the community — a group from Providence’s Juanita Sanchez High School recently adorned doctors’ car windows with thank-you notes — and from Governor Gina Raimondo, too. She points to the state’s collaboration with CVS to double our testing capability at a remote site at Twin River Casino in Lincoln. When people are tested off-site, she says, health care workers at hospitals can use their limited supplies of PPE more judiciously.

Goldberg says the “jury is still out” on the sensitivity of the CVS tests, which rely on a machine called ID Now built by Abbott Laboratories. ID Now tests for virus antigens — substances on the surface of viruses that trigger an immune response (read: you should be showing symptoms before you get this test) — and results are ready in fewer than fifteen minutes, a remarkable turnaround given most diagnostic tools for COVID-19 take much longer.

The ID Now test was given emergency use authorization from the FDA last month based on data using the nasopharyngeal collection method, when a long swab is inserted halfway into a patient’s nose. This procedure is administered by a health care worker and is very uncomfortable. Alternatively, patients who visit the CVS testing site in Lincoln administer the swabs themselves in their nasal passages, less than one inch into the nose, and the procedure is not at all uncomfortable. (I know; I was tested.)

“If Abbott says you can get it in a less-deep swab, we need to feel like those scientists have some proof,” Goldberg says, adding that all tests — including the one administered by her hospitals — can result in false negatives and false positives. Ultimately, she says, the pro of testing thousands more Rhode Islanders outweighs the con of a potentially less-sensitive test. She says some studies show self-administered tests can get fairly accurate samples, and we’ll have a better idea of ID Now’s accuracy in a month or two.

“The diagnosis is tricky for this disease. This has added to health care provider stress and patient stress,” she says. She’s seen patients with classic COVID symptoms — cough, shortness of breath and fever — tested three times via nasopharyngeal swab before they received a positive result. “We tell everybody who leaves the hospital with negative results or a test pending that they should self-isolate until they’re symptom-free, haven’t had fever for seventy-two hours or seven days have passed.”

If you’re feeling ill, she says, the best course of action is to call your primary care doctor. He or she will be able to tell, even via video, how quickly you’re breathing. If it looks like you’re in respiratory distress, your doctor will want an oxygen level and you’ll be asked to go into the office or go to the emergency department. When you arrive, front line workers like Goldberg will take a swab or perform an X-ray to confirm infection.

“I’m scared about what we’re going to see and the suffering we’re going to see, but I and my emergency medicine colleagues are trained for this,” she says. “I actually feel tremendously useful and needed right now, and that’s a really wonderful feeling to have as a physician. We went into this profession because we wanted to be there for everyone at all times. That’s more important now than ever.”

 

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