“Shortness of breath.”
Those are just a few of the descriptions members of Boston EMS are given when responding to a call for someone struggling with the effects of the coronavirus. But with the range in damage COVID-19 can inflict on the body, EMTs often don’t have a clear picture of the patient’s situation until they arrive at the scene.
LaToya Lewis-Guy, an EMT with Boston EMS, recalled responding to a call in recent weeks for a woman, a mother, who had recently tested positive for the coronavirus and was reported to be having difficulty breathing.
“It almost seemed as if she was trying to figure out, ‘Should I cough or should I breathe?’” Lewis-Guy told Boston.com.
The woman’s family was gathered around her, clearly affected as they watched her struggle with the virus’s devastating impacts.
“The reality was, we’re taking her to the hospital — families can’t come to the hospitals with the patients, they can’t even see the patients in the hospital, so is this our goodbye? And I think it’s in that instant that those people realize, ‘This is real,’” Lewis-Guy said of responding to calls during the coronavirus pandemic.
Lewis-Guy has worked as an EMT in Boston for almost five years, and she said she normally wouldn’t describe herself as an emotional person. But scenes like that are affecting, she said.
“Sometimes we don’t have an idea of the gravity until we physically see it,” she said of working on the front lines of the coronavirus. “So each call is honestly different.”
Boston EMS began preparing for the possibility of COVID-19 spreading in the city in January, when reports of the outbreak in China began, Chief Jim Hooley told Boston.com. The work done was largely to refresh and go over plans the department had established back in 2014 to prepare for Ebola, should it arrive in Boston.
As it became clear COVID-19 was spreading beyond China, more preparations were made.
“We did some more training on viral infections and some more training on PPE use for droplet precautions, what does that mean and the potential for pandemics,” Hooley said of monitoring the outbreak in China.
When the first case of coronavirus was identified in a Boston resident in early February, Boston EMS was able to do some screening for a while, he said. When calls came in to the 911 call center reporting respiratory symptoms like those associated with the virus, it could be asked if the individual had any recent travel to a city or region known to have community spread.
But as the outbreak expanded beyond China, it became clear that travel history alone could not screen out the potential for the virus.
The focus became looking for symptoms and whether any known close contacts had been exposed.
“We started gearing up for that,” Hooley said of the ramping up of droplet precautions for his crews.
The number of calls where coronavirus was either confirmed or suspected, which requires responding crew members to don full personal protective equipment for protection against droplets, only continued to rise exponentially.
“We went from a couple a week to over a hundred a day,” Hooley said.
On May 4 alone, Boston EMS had 334 total incidents they responded to, 176 of which were situations where the patient ended up being transported to a Boston hospital.
Of that number, 133 were suspected or confirmed coronavirus patients where the crew took full precautions for droplets — masks on patients and masks, face shields, and gowns on crews — and notified the hospital that the patient would need to be put into isolation upon arrival.
— Boston EMS (@BOSTON_EMS) May 1, 2020
As of May 7, Boston EMS had responded in full COVID-19 equipment on 5,721 responses where the disease was either confirmed or suspected.
And while the overall calls for emergency medical services has been down during the pandemic, Boston EMS says the widespread infection in the city has made the work on every call more taxing for paramedics and EMTs.
‘It’s this invisible entity that we’re trying to hold off’
Boston EMS has built up a “significant infectious disease office” within the department, Hooley said, staffed by nurses and physicians who serve as “officers” for infection control.
“We’re trying to be very aggressive for running down any potential exposures and don’t hesitate if we have to put people out on quarantine or wait until we get a test back,” he said. “If you’re not feeling good, maybe it’s going to be seasonal allergies, maybe it’s your asthma kicking up. But no harm, no foul. We’re going to ask you to stay out until we get a test back and can be sure that that’s the case.”
Hooley and his crew members said the responsibility of being cautious — on the job and off — to the community and their colleagues is well understood.
“You really are dependent on each other a lot here now,” the chief said of his department. “It’s this invisible entity that we’re trying to hold off.”
Protecting against the virus is a team effort, the EMTs agreed. They have to look out for one another more, and there is an awareness that good infection control protects the whole crew, as well as the public.
With the changes to the day-to-day routine brought by COVID-19, no call is simple. There’s a degree of difficulty for each, just because of the nature of the virus and the pandemic.
“We more or less walk into every call and it’s treated as COVID until proven otherwise,” Lewis-Guy said.
Crew members wear PPE even when just with each other or checking equipment in the trucks to protect against infection. Face masks and shield helmets are worn when responding to any call and, if symptoms of coronavirus are reported, gowns and boots are required.
“People have accepted that there’s no real downtime now,” Hooley said.
All the necessary protective equipment can become uncomfortable on calls, Lewis-Guy and her colleague, Marianne Muniz, said.
“Third floor on a hot day with an N95 and a face shield is not fun,” Muniz said.
The face masks and helmets can fog up, and they make it harder to hear and communicate with patients.
It’s a physical adjustment they’ve all had to get used to while continuing to provide care to patients, they agreed.
“In terms of our patient care, our assessment has essentially changed, and it can be uncomfortable,” Lewis-Guy said. “And I think for some people, it was a hard adjustment to treat everything as COVID. You have to ask certain questions immediately regardless of what their initial symptoms are. So that was kind of stressful. And as the virus progressed, and we were actually encountering patients who had this virus and seeing the type of distress that they were in, I think it became more real for a lot of us.”
While there have been events that presented logistical and physical challenges to responding to calls — such as the series of snowstorms in 2015 — or stressful events like the week of the Boston Marathon bombing — it’s an apples to oranges comparison to what Boston EMS has faced since February.
The coronavirus pandemic is an unquestionably unprecedented situation for his crews, Hooley said.
“You are potentially being exposed on every single call you go to now,” Hooley said of the change in reality for his crews. “And only by being very good about using their PPE, being very good about cleaning and infection control, and everything else is the only thing that separates you from being one of those patients. So it’s got to be very stressful on our personnel to maintain that up tempo pace, which is really, now, like nine weeks for us.”
‘Just hope that you don’t bring it home’
The biggest worry for everyone on the team is the fear of bringing the coronavirus home to their families and loved ones.
As of Wednesday, 13 members of Boston EMS had tested positive for COVID-19. Hooley said some members of the team have taken advantage of the offer to use dormitories at Northeastern, which opened up rooms to first responders concerned about infecting family members at high risk for severe complications from the coronavirus.
At least one team member opted to stay in a hotel as he continued to work, concerned about his parents at home.
If you think you have symptoms and want to visit a #COVID19 testing site, please note:
* Testing is free regardless of insurance or immigration status
* Hours vary for each location
* You must call ahead for pre-screening and to schedule an appointment https://t.co/HJLcj80Ckw pic.twitter.com/ATzkqMGAP2
— City of Boston (@CityOfBoston) May 8, 2020
Muniz, who has worked with Boston EMS for almost four years, said not seeing her family has been the most difficult adjustment to working on the front lines of the pandemic. As the oldest sibling in her family, she used to be the one always checking in on her family members.
“I went from taking care of my grandmother a few days a week to then rotating with other family members,” she said. “That was the main thing that I would do after work. Just checking in on everybody.”
She now limits check-ins with family members to phone and video calls, since she self-quarantines in her home when she’s not at work.
“They’re super worried,” she said of her family’s concerns for her. “But I just reassure them that I’m taking all the proper precautions — I always make sure that I tell them that I’m good, making sure that I have no symptoms and I’m super careful.”
She has reassured her grandmother that as soon as she gets home from work, her uniform comes off and she takes a shower to decontaminate from her shift.
As a single parent, Lewis-Guy isn’t able to self-isolate when she’s not working. But she also is careful to decontaminate when she gets back to the home that she shares with her mother. She also hasn’t visited her own grandmother out of concern for unwittingly infecting her.
“It has made it a bit difficult,” she said of the impact of the virus on her personal life. “Because you can’t see the ones you love the way you normally would. I think between work and home it has made things a little more stressful. I’m just trying to pray and meditate and make it through every day and every shift and just hope that you don’t bring it home.”
Both EMTs said they try to take a break from news about the virus when they’re home and are taking care of their mental health through therapy to help with the added stress of working on the front lines of the pandemic.
Muniz said she tries to keep herself distracted when not at work to help with the stress, cleaning and rearranging her house, cooking, and working out.
“Whatever you can do to get your mind going, get your mind away from work life for a little bit,” she said. “I’d say that’s probably helped me the most.”
‘This virus is real’
The city and state have succeeded in slowing the spread of the coronavirus, the first responders said, but the level of infection and calls for potential coronavirus patients still remains high.
In Boston, 11,168 residents have tested positive for the coronavirus, and it has killed 533 people. Statewide, more than 5,000 people have succumbed to the virus.
Lewis-Guy credited city and department leadership for making sure she and her colleagues had everything they needed to respond safely to the pandemic.
“The hospitals, the housekeepers, the doctors, everyone in Boston has done an amazing job,” she said. “This probably could have been a lot worse if we as a city weren’t prepared and we weren’t studying other places. I think the preparation that we’ve had in Boston has definitely helped us.”
Even with the steps taken to prevent the hospital systems from being overwhelmed, Boston continues to see big numbers, Hooley emphasized. The city is still seeing more than 400 people in intensive care on ventilators, the chief said.
“The impact is there,” he said of the COVID-19 deaths in the state. “I don’t know if folks who get a little bit inconvenienced by some things realize how much worse that could be if the health care system hadn’t geared up.”
The emergency rooms at our hospitals in Boston are safe. If you need to go, you should. Don’t let fear of getting #COVID19 prevent you from getting life-saving care. If you’re having a life-threatening emergency, like chest pains or shortness of breath, call 9-1-1. @BOSTON_EMS
— Boston Public Health (@HealthyBoston) May 9, 2020
The chief and his colleagues said they are glad more people haven’t been directly affected. But, pointing to the crowded demonstration outside the State House this month demanding the state reopen, they said they are concerned that there are still people who might not understand the gravity of the situation.
“We know a lot of people who have,” Hooley said. “We’ve been in their homes, and we were maybe the people that brought them to the hospital. So we certainly know that the surge is real and that we were impacted here.”
Lewis-Guy pointed to the call with the mother who was struggling to breathe as an example of the serious impacts of the virus.
“A lot of nurses and doctors on social media have emphasized we go to work so that you can be healthy. Stay home for us,” she said. “We want to stay healthy as well so that we can go home to our families. So heed the CDC’s guidelines, heed the city’s guidelines. This virus is real, and it’s really affecting people.”
She and Muniz urged the public to take the virus seriously and continue to practice measures like social distancing and wearing masks to prevent its spread.
“Just because it hasn’t hit you specifically or people you know closely doesn’t mean it’s not real,” Muniz said. “It’s very, very real.”