State Rep. Jon Santiago is an ER doctor at BMC. Here’s what he wants you to know about the response to COVID-19.

“I want people to understand that if we don’t do what we need to do right now, that we could quickly become the next Italy.”

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A week ago, Massachusetts state Rep. Jon Santiago posted a video to his Twitter account in what would become the first in a series of videos to talk about the coronavirus outbreak. 

Serving both in the Legislature and as a doctor in Boston Medical Center’s Emergency Room, Santiago said he started sharing the videos as a way to both provide reassurance and raise awareness for constituents about the COVID-19 pandemic, as well as address misinformation about the virus. 

“People were starving for updates, for information to see what was going on — out of fear, out of concern for what their families were potentially going to experience in their communities,” he told in a recent interview. “So I wanted to be a source of information — I think people responded well to it, people have been thankful for it — and just to give people some insight into what’s going on.”


Below, the representative serving the state’s 9th Suffolk District shares more about what he’s seeing in the emergency room, the measures he still hopes take place in the state, and why it’s so important people practice social distancing. 

This interview has been lightly edited and condensed for length and clarity. How are things right now at the hospital? How are you and your colleagues holding up there?

Jon Santiago: Morale is still high. With these emergency medicine professionals — doctors, nurses, medical assistants, anyone who’s in that setting — we go through a lot. We see a lot on a daily basis, long before the coronavirus existed. So, no doubt that this is a challenging period for the medical community, but it’s one that I think we’ll get through. Based on what you’re seeing as a doctor and as an elected representative, what are your biggest concerns related to COVID-19 in Massachusetts right now? 

Jon Santiago: I think they’re two-fold. I think first and foremost there’s been an issue with testing nationally. It’s been well documented from the top on down how we’ve been very slow to scale up testing. Over the past week though I think we’ve made some major advances, and I look forward to seeing increasing numbers the next week or so. 


I think this week you’re going to have the state lab doubling the number of tests they have the capacity to do per day, which is a reassuring sign. In addition to all the private sector individuals that they’ve brought on as well — there have been multiple labs that have joined. So I’m feeling a lot better in that regard. 

Make no mistake, there’s a long way to go. But testing is such a crucial component to this, because without testing, we don’t know what’s out there. We can’t test healthcare workers to see if they’re then infecting other people, we can’t test people with symptoms to see where we’re at in terms of infectivity, and now the virus is spreading. 

With the testing, two things have been allowed that to happen. One, we broadened criteria. So my first week trying to get a test was quite difficult — we had particularly strict CDC guidelines:  symptoms plus travel to a certain area or plus/minus exposure to someone with known coronavirus. So, many people were looking for tests and they were just not there. We also had a testing kit issue. And we’ve seen the mass productivity of that. So I’m feeling a little bit better about that as we move forward. 


The other issue is — in my heart of hearts I’m a public health guy, I love the emergency room, the excitement, the acuity of what you see. But in my heart of hearts, I’d like to see good public health principles being practiced. And right now what we need to do as a community is practice social distancing. That’s making sure people stay at home, decrease their contacts with other people, and help decrease spread of the virus to hopefully flatten the curve. Some people are calling for a state-wide shut down. Is that something that you’d like to see?

Jon Santiago: I think everything should be an option right now. I think there’s a good chance that we are getting there. Over the past week, you saw people still out on the weekend, still going to bars and still going to restaurants. And that was concerning to me. 

Again, this virus is particularly asymptomatic in young individuals. So my concern, the big concern, is that young people who are relatively healthy will be spreading the virus amongst themselves. But also amongst their fathers, mothers, their grandparents, people who are more vulnerable as well. So that’s a big concern of mine, and I think the message hasn’t quite gotten down to those people who need to hear it the most. You wrote about your concerns for under-served communities, such as kids not getting school lunches, suffering with this outbreak. What are you concerned about right now for populations or communities that might be impacted by some of the measures taken to stop the spread of the virus?


Jon Santiago: I think first and foremost of the homeless community. I think about how BMC disproportionately treats their fair share of homeless patients and this past weekend I saw a number of them. And shelters were not allowing them to come back if they exhibited symptoms. 

So what do you do? As an ER provider, I’ve learned that the emergency room is the last place where people end up when no one accepts [them], when there’s no one who wants them, when they can’t even get into a shelter. So you have a number of homeless people with symptoms — I’m not saying they all had COVID-19, [but] could they? Potentially. So it puts an extra strain on the hospital. Where are you going to put these patients? Where are they going to be triaged? How are they admitted? So that’s a particularly tough strain on hospital systems. Not just at BMC, but across the city, across the state. What measures do you think need to be invented or started to address that issue?

Jon Santiago: I think there’s going to be partnerships between homeless shelters, hospitals, and some innovation. Carney [Hospital] came on board as somewhere that’s going to be a designated care center for COVID-19. I think that’s what we need right now. We need to find space to admit people and to watch them and provide some surveillance as they end up becoming positive, or not, for COVID-19. If they are [positive], a place where they can quarantine. You can’t send a homeless person back on the streets with a positive test, right? You can’t evict people who need to quarantine. So that’s my concern as a person who treats folks who are primarily underserved. 



<h2>What are the symptoms of coronavirus, and how is it treated?</h2>

<hr> As you mentioned, BMC is known as a safety-net hospital. Has the work in the ER changed drastically because of this outbreak? Are you seeing problems that were there before now exacerbated by this outbreak and the measures being taken? Is it still a little like business as usual or has it changed a lot?

Jon Santiago: It’s changed a lot … I just had a friend text me, who wanted to get an MRI. And just to enter into the hospital, he had to go through a line, he was asked a number of questions, whether he exhibited symptoms of COVID-19. Everything has changed — that’s now the new normal. 

And for sure, patients who have underlying health conditions, patients who have not been seen by a doctor for years, they’re going to present differently. And they’re very challenging to deal with from a medical standpoint at the get-go, never mind the concern for COVID-19. And as I said, working in the BMC emergency room for the past five years — it’s a challenging place to work. There are some real issues — it’s a reflection of what’s going on in our society right now. The lack of a safety-net system. 

So to have people show up with undiagnosed diabetes or with heart failure that hasn’t been properly treated or with asthma or COPD, and they’re not getting the care and the treatment they need, and on top of that to put them at risk for COVID-19 because of their social situation, because they can’t quarantine or because they’re homeless, it creates a very challenging system. And unfortunately things will get worse before they get better. 


So we’re in for the long haul. I know the folks at BMC, from leadership on down, and they are committed to working with these people. They’ve devoted their lives to, many of us have, serving those most underserved. And we’re committed to do the work, and I’m going to be there Friday, Saturday, and Sunday again. And my guess is that over the course of this next week, cases will increase, testing will increase as well, and we’re going to do the best we can to take care of these folks. What can the public do to help support medical professionals who are on the front lines doing this work?

Jon Santiago: It’s not just about the folks at the hospital and the community health centers and the medical staff — doctors, nurses — it’s about all of us. There’s a shared sacrifice we have to make. And if social distancing is what we have to do as a community, as a commonwealth, as a country, well then, we need to take it very seriously. I’m asking everyone — if you don’t need to be outside, stay home. If you can work from home, fantastic. If you can keep kids home, the better. Because really, decreasing the transmission of this disease should be the priority right now. And at the hospital we’re going to work to mitigate what we can. But if we can stop the transmission of the disease right now and put in the work right now, it’s going to pay off in the next week or two or three weeks. 

Advertisement: Are there any actions that still need to be taken state-wide that you see as crucial? Or nationally? What remain the biggest concerns that need to be addressed?

Jon Santiago: For me, again, number one it’s the social distancing. I think we have to follow it, whether it’s elected officials, folks in leadership, folks in government, and  just to really speak to people and let them know how important this is. And pass on the message — that this will be life or death for a lot of people in this country. And I’m not sure that message is getting down to some communities, particularly the younger folks. So I want to see more of that. 

The second thing is testing. We got off to a very sluggish response as a result of the federal government. And now we are quickly scaling up testing. I know the Secretary [of Health and Human Services Marylou Sudders] is working extremely hard to expand testing in the private sector and within the Department of Public Health. I’m satisfied with where we’re going — I’m not completely satisfied, but we’re heading in the right direction. So over the course of the next couple weeks, I think testing is going to pick up. 

But again, if we don’t practice social distancing, if we don’t limit the transmission of the virus, we’re not going to make much headway. What else do you think is important for people to remember?


Jon Santiago: I want people to understand that things could get very bad, very quickly. And you only have to look across the pond to Europe to see what’s going on and the stories that are coming out of Europe, particularly Italy. In one day, they had close to 350 people die. And things don’t seem to be abating. In France, Spain, they’ve quickly quarantined parts of their countries and cities and towns. And I think that’s kind of where we’re heading. But I want people to understand that if we don’t do what we need to do right now, that we could quickly become the next Italy.

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