I want to thank you readers who are doctors and medical personnel. I appreciate the e-mails you’re sending, and I also appreciate you trusting me not to reveal your identities. Some of you have asked for Wyoming Doc to give an update. I passed that request on to him. He said he would try to get to it, but that he’s so busy now he doesn’t know when he’ll be able to. What readers should understand is that many doctors, nurses, and others working in hospitals often cannot speak on the record, without risking their jobs. I only publish things from medical personnel whose identities I can verify, and whose testimonies I trust.

This e-mail just came in. I changed it slightly at the doctor’s request, to protect his identity:

I did not sleep a wink last night. I arrived in my office today at about 4:45AM .I had to check on some patients in the hospital this AM, and make sure all is well. I am so tired now it is hard to sleep.

I saw 39 patients yesterday, seven of them in the office, the rest on the computer. (That is a new thing — I think this crisis is going to be the birth of telemedicine.) Pre-crisis, I usually would see about fifteen or so people in a day; now it’s up to almost 40. Most of these are basically well, but who have sniffles, and are worried. I had to test ten of them for COVID yesterday, so that means another ten families are now in quarantine. We won’t have results for another five to seven days. All the pie-in-the-sky promises last week about testing are out the door. I simply no longer have any concept of the problem here. This is going to make a career-defining book for some enterprising journalist.

I have third-year medical students with me all the time doing their clinical work. As if I did not need something else to trouble my soul, I was reminded yesterday that my profession has now been completely taken over by the managerial class. The leadership of these students had a teleconference yesterday with all the remote instructors. This person in charge was clearly a member of the “woke” contingent. We instructors were informed that the medical students were being triggered by what they’re seeing unfold, and and are now scared to death. Therefore, they are pulling all the students off clinical rotations for the time being. They are very concerned about the students’ mental health, and processing the events that are going down.

Just, wow! My experience with AIDS when I was 25 was largely responsible for the doctor I am today. I just cannot believe these morons. These kids are ready, able and want this challenge. I find it insulting that their elders do not believe in them.

Of course, the real reason may be much more problematic. I learned that other universities are pulling their medical students because they simply do not have the PPE [personal protective equipment] for them. That is another concerning problem, but that is far more understandable and appropriate. PPE was never mentioned in our tele-meeting yesterday — not once! It was all about triggered medical students. I have personally spoken to several of these students over the past weeks. They are most definitely not triggered, and are tired of being treated like babies.

I am now learning a very important lesson in life. I am now the old guy. I am the one who has to marshal the troops. I am the one who has to put on a good face for the young peoplem and show resolve and strength. I never realized how hard this was,  until now. To be totally terrified in your soul, but to have everyone looking up to you for leadership and strength. I saw my mentors doing this all those years ago during AIDS. I have now a completely newfound respect for them.

An even more drastic issue is a drug that we have been having increasing issues securing for patients: albuterol. This is a very common drug used for emphysema and asthma, but is also used to maintain ventilated patients in the hospital. It would be really problematic not to be able to use it in a crisis situation with multiple vented patients, and we certainly do not need a bunch of undertreated emphysema patients crowding the ER right now.

In the past week we have been having very troubling problems getting this filled here in our city. I called all the pharmacies in town. One pharmacy is reporting that they have a few inhalers left and a few bottles of the nebulizer solution left, but both are becoming very difficult to obtain from their wholesaler. Another pharmacist told me that patients have been especially demanding multiple inhalers at a time just since Saturday, and they are running very very low because of that. They are also being forced to wait for days for supplies to be replenished. One told me that he had very limited supplies and was already rationing, and making sure that his known emphysema and severe asthma patients were taken care of. Another pharmacist actually had me look at the computer while he tried to order both the solution and the inhalers. All five of his suppliers had either none or just one left — and usually, he says, this number is more like 50. I have spoken to the hospital pharmacist, who said they are fine for now, but don’t have a lot of cushion, and that it’s very difficult to resupply at this time.

I have no problem what the backorder problem is. I was told by two of these pharmacists that this is likely related to the China supply issue, but the true answer will lay with the pharmaceutical companies. They are run by the managerial class too, so good luck getting any information about this problem until it is way too late.

The snowflake med student story is appalling, but I appreciate that the doctor here does not blame the students, but the program administrator. The albuterol shortage is terrifying, though.

Again, I invite e-mails from people on the front lines of this crisis: rod — at — amconmag — dot — com. Let me know who you are and where you work. I will keep all of it confidential. The important thing is to let people know what’s going on. Remember, readers: these men and women are and will be what stands between life and death for tens of thousands of us in this crisis. Pray for them.

UPDATE: A reader who is a physician (I know his name) who teaches at a medical school writes:

Yesterday the AAMC, the major accrediting body of US medical schools, asked all students nationwide to be removed immediately from clinical rotations.  This is primarily for patient and student safety: to plan better training for them, and to reduce demand for PPE (masks gowns etc).  You can see the full release here, with the rationale:

https://www.aamc.org/system/files/2020-03/Guidance%20on%20Student%20Clinical%20Participation%203.17.20%20Final.pdf

Nowhere was it said that this done “for their mental health”.  I have since sat in on two large faculty conference calls about our Michigan medical students, and not one person implied “they’re snowflakes, they can’t handle it mentally.”  Keep in mind that we have a lot of liberal faculty. None of my student groups mentioned that as a rationale either.  All are concerned about the safety of our patients and community, as are you.

If there was a reference to the “snowflakes” made (excerpt from your post), it was likely in isolation.  Posts such as this, I fear, bring disrepute to the hard work of our students and faculty at this time.  I think you owe your readers a clarification, or at least a statement of the other side of the story.

UPDATE: Doctor in Nashville:

First, I want to thank you for your outstanding and accurate reporting on this crisis. You are about 3-4 days ahead of the national news media on this story, and everything you’ve written about has turned out to be correct. I actually read your column first before turning to the national news.

I’ve been an ER doctor at my hospital for 25 years. I’ve been through the anthrax scare, the SARS and MERS crisis, and more recently the ebola outbreak, and I knew I would never see cases of those illnesses at my hospital (and I didn’t). But when you started reporting on the coronavirus I knew it would be coming my way, and now it has arrived.

My ER is unnaturally quiet right now. You know how the tide goes out before the tsunami strikes? That’s where we are this week. This is especially unusual for the week of Spring Break, when we typically get pummeled. Despite the fact we have very few patients in the ER, the hospital is already running low on the N-95 face masks. My facility has always shown a lack of imagination in dealing with high volume situations, and I fear we are going to be crushed by an influx of patients in the next two weeks.

Morale is high among the physicians and nurses right now. We are a close knit, dedicated group, but I feel like there’s a sword dangling over our heads. We are bracing for impact.

Thank you again for the excellent reporting you are doing, and for helping to keep me prepared.

UPDATE.2: From a doc in Pennsylvania:

I can confirm what the other ER doc reader said: volume in the ER has been very low for the last week. Partly this is due to the fact that we set up a COVID-19 testing tent in the ambulance bay, and this is diverting some traffic.  But mostly I think it’s that people are now afraid of coming to the hospital and contracting novel coronavirus. This past Monday — typically the busiest day of the week in any ER — was the slowest Monday I’ve ever worked in any hospital in the past 8 years of doing this. I spoke with some ER doc friends in Philly and they said it was similar there.

I’m curious to see how this plays out. My main concern, along with everyone else, is that hospitals will get overwhelmed if cases spike all at once. Folks here have been pretty good about social distancing though, and life is quiet, so we’ll see if it flattens the curve.

I’ve read that the way to think about this virus and its spread is that it will explode in particular places, according to a particular timeline. So you’ll have some places that are quiet now, while others are taking off.

UPDATE.3: You people who are defending the “right” of the elderly and anybody else to choose whether or not they will risk getting the virus need to understand that if you or they get sick enough to go to the hospital, this is the burden you are putting on health care workers, and others who are sick. Forget about your rights; think of your duties!

Just received word from an ICU doctor at a small NY hospital: They are officially out of ventilators and are now double venting patients with COVID (using the same ventilator for 2 infected patients). Do everything possible to avoid infection. PLEASE ISOLATE as best you can.

— Peter Attia (@PeterAttiaMD) March 18, 2020