Selected Podcast
First COVID-19 Case: Doctor's Experience: Part 1
Dr. Jignesh Modi discusses his experience treating the first patient with COVID-19 at Genesis.
Featuring:
Jignesh Modi, MD
Jignesh Modi, MD is a Genesis Infection Disease Specialists. Transcription:
Scott Webb (Host): Welcome to part one of a special two part podcast series brought to you by Genesis Healthcare System. In part two of the series, we’ll here from COVID-19 survivor Dennis Robbins about his ordeal with the virus and how the team at Genesis Healthcare saved the life of their first COVID-19 patient. Today in part one of the series, we’re speaking with the leader of the Genesis Healthcare team that successfully saved Dennis’s life, Infectious Disease Specialist Dr. Jignesh Modi. Thanks for listening to part one of our series. I’m Scott Webb. Dr. Modi, thanks so much for joining me. How sick was Dennis Robbins?
Jignesh Modi, MD (Guest): I’m sure he would tell you he was quite sick, but he didn’t start out that way. What we found is that patients with COVID-19 vary quite a bit. We’ve had people who were tested for reasons other than illness and were completely asymptomatic and tested positive and were just as surprised that they were positive as we were. And then you get to the other end of the spectrum with some similar to Dennis now he was a kind of interesting first patient in that he’s one of our two sickest patients that we’ve had with COVID-19, so it didn’t start out slowly, it started out with quite a bang. He started out on a regular patient floor and within about 36 to 48 hours, his respiratory status worsened, and he required placement on a ventilator. He was pretty sick for about I would say a week, maybe ten days and then slowly started recovering. You could see the changes that you would want to see as he recovered and when he recovered and turned the corner, he turned the corner pretty quickly.
Host: Great to hear that he responded to treatment and that you all could really see that your work was having a positive effect on him. And this was undoubtedly a team effort. So, I’d like you to tell us how the entire Genesis staff worked together to save Dennis.
Dr. Modi: This was a process that every hospital in the country has gone through over the last few months. And treatment of this patient actually starts well before your first patient shows up. Because you have to have a strategy in place for getting that patient seen not only quickly, but safely. You have concerns about not only the patient but other people in is household and other people he works with. That’s where the Health Department comes in and they’ve been a very good partner for Genesis through this effort. And discussions with the health department actually probably started a good month before Dennis first showed up. There were many meetings that happened within the hospital between not only physicians and nursing and administration but people at every level on how to manage this problem when we first saw it. And those discussions and meetings went on for weeks and there was actually a very good plan in place.
I think he was identified quickly as likely having COVID-19 and placed into isolation appropriately and then when he decompensated or got sicker, he was transferred to the intensive care unit and placed on a ventilator and things actually went very smoothly. From that point, there really isn’t a lot in terms of treatment that we can provide. There are things that people have tried with very questionable efficacy. The most important thing is buying that person time so that they can recover. And the nursing staff did a very good job. There are things called Rotoprone beds which we’ve used over the years in various illnesses and what they do is they turn patients kind of like on a wheel. Those are currently unavailable because they are in such demand. So, what the nurses actually have to do is combine three or four staff members, safely turn him from side to side because we don’t have availability of one of those beds. I would say that’s the single most important thing that got him through besides just being on a ventilator. Because you can watch someone’s oxygenation improve when they are flipped onto their belly and it happen fairly quickly. And then when we are able, we flip them back off to their backs. It’s a challenge. But that’s actually a big part of getting through when they do get that sick.
Host: Wow, this is really amazing hearing this. I haven’t heard all the news and social media and everything that I’ve been following, I haven’t heard about the flipping the patients from their back to their stomachs and back again. And it does sound challenging. But it also sounds like you guys were really on your game like you figured something out pretty quickly there and everybody was working together. It’s really amazing. So, I’m sure you’ve learned a lot after having the first COVID-19 patient, but let’s share with everybody what have you learned moving forward as potentially new COVID-19 positive patients come through?
Dr. Modi: I think we’ve learned quite a bit actually and not just from our own personal experience but the experience of others. I think it is safe to say we are all still learning. I think we were on the mark in a lot of ways early on. This has been compared to the flu. It is definitely not the flu. But people early on compared it to the flu and I think in many respects, they were correct because it is a respiratory illness. The flu season tends to vary quite a bit in severity. Every year we see patients who end up on a ventilator and even this sick with the flu. So comparing it to patients we’ve had like that, using that type of a model to manage them seems to work. Now with the flu, we do have treatments available that are very effective. We don’t have that luxury with COVID-19 at this point.
The other thing that we’ve clearly learned over the last couple of months is there’s a large population of people who are either asymptomatic or minimally symptomatic. Now even those asymptomatic people are capable of transmitting which is part of the reason that people have been encouraged to wear masks even if they are not symptomatic not necessarily to protect them but to protect others and I think one of the things that we’ve also learned is the measures that we put in place actually I would think have been highly effective. The question going forward will be how can we adapt to our needs going forward because we can’t maintain our current intense level of staying home and those types of interventions.
Simple things like masks, I mean that’s fairly easily done. Keeping a little bit of distance is easily done. Avoiding large group gatherings, maybe not desirable, but I think that will be necessary for a while going forward. So, we’ve actually learned quite a bit.
Host: Yeah, you know what, you are so right Doctor, there’s so much we have learned and so much more that we need to know about COVID-19, and it sounds like you guys are really on top of things there and kind of prepared for everything. So, kind of in your own words here, what cautions would you like to share with listeners about the virus moving forward. What do you suspect that we need to know and how can we best just sort of deal with all of this mentally and physically?
Dr. Modi: Be prepared for the long haul. I have not way of knowing for sure. But I suspect that using just a baseball analogy, I think we’re probably in the bottom of the first. We have quite a bit of game if you want to use that analogy, left to go. It may go into overtime. In fact, I suspect it will go into overtime in the sense that even a couple of years from now, we may be seeing cases here and there. I have no idea what treatment or vaccines will be available over the next 12 to 18 months. But that’s clearly a priority. And I would actually suggest that people maintain some patience, respect for each other and maybe tone down some of the controversy because I think we all have the same goals in mind. We may not approach them in the same way. There is no right or wrong, but I think most of us would like to get things back up and running in the safest manner possible and there will be some steps backwards that we will have to take. We’ll have to rein some things in as problems crop up. But it will require patience and some degree of trust amongst each other.
Host: Thank you so much for sharing the story about how you treated Dennis Robbins, how you saved his life, how everybody work together, and it sounds like people are in good hands there in Muskegon County and at Genesis. Really, thanks so much and stay well.
Dr. Modi: Same to you. I think Genesis and the county, and the state have done a very good job of getting us to this point and I thank you for your time.
Host: That’s Dr. Jignesh Modi, Infectious Disease Specialist for Genesis Healthcare. We hope you join us for part two of the series with Dennis Robbins. Visit www.genesishcs.org to learn more about his incredible story. Thanks for listening to part one of our series brought to you by Genesis Healthcare System. I’m Scott Webb. Stay well.
Scott Webb (Host): Welcome to part one of a special two part podcast series brought to you by Genesis Healthcare System. In part two of the series, we’ll here from COVID-19 survivor Dennis Robbins about his ordeal with the virus and how the team at Genesis Healthcare saved the life of their first COVID-19 patient. Today in part one of the series, we’re speaking with the leader of the Genesis Healthcare team that successfully saved Dennis’s life, Infectious Disease Specialist Dr. Jignesh Modi. Thanks for listening to part one of our series. I’m Scott Webb. Dr. Modi, thanks so much for joining me. How sick was Dennis Robbins?
Jignesh Modi, MD (Guest): I’m sure he would tell you he was quite sick, but he didn’t start out that way. What we found is that patients with COVID-19 vary quite a bit. We’ve had people who were tested for reasons other than illness and were completely asymptomatic and tested positive and were just as surprised that they were positive as we were. And then you get to the other end of the spectrum with some similar to Dennis now he was a kind of interesting first patient in that he’s one of our two sickest patients that we’ve had with COVID-19, so it didn’t start out slowly, it started out with quite a bang. He started out on a regular patient floor and within about 36 to 48 hours, his respiratory status worsened, and he required placement on a ventilator. He was pretty sick for about I would say a week, maybe ten days and then slowly started recovering. You could see the changes that you would want to see as he recovered and when he recovered and turned the corner, he turned the corner pretty quickly.
Host: Great to hear that he responded to treatment and that you all could really see that your work was having a positive effect on him. And this was undoubtedly a team effort. So, I’d like you to tell us how the entire Genesis staff worked together to save Dennis.
Dr. Modi: This was a process that every hospital in the country has gone through over the last few months. And treatment of this patient actually starts well before your first patient shows up. Because you have to have a strategy in place for getting that patient seen not only quickly, but safely. You have concerns about not only the patient but other people in is household and other people he works with. That’s where the Health Department comes in and they’ve been a very good partner for Genesis through this effort. And discussions with the health department actually probably started a good month before Dennis first showed up. There were many meetings that happened within the hospital between not only physicians and nursing and administration but people at every level on how to manage this problem when we first saw it. And those discussions and meetings went on for weeks and there was actually a very good plan in place.
I think he was identified quickly as likely having COVID-19 and placed into isolation appropriately and then when he decompensated or got sicker, he was transferred to the intensive care unit and placed on a ventilator and things actually went very smoothly. From that point, there really isn’t a lot in terms of treatment that we can provide. There are things that people have tried with very questionable efficacy. The most important thing is buying that person time so that they can recover. And the nursing staff did a very good job. There are things called Rotoprone beds which we’ve used over the years in various illnesses and what they do is they turn patients kind of like on a wheel. Those are currently unavailable because they are in such demand. So, what the nurses actually have to do is combine three or four staff members, safely turn him from side to side because we don’t have availability of one of those beds. I would say that’s the single most important thing that got him through besides just being on a ventilator. Because you can watch someone’s oxygenation improve when they are flipped onto their belly and it happen fairly quickly. And then when we are able, we flip them back off to their backs. It’s a challenge. But that’s actually a big part of getting through when they do get that sick.
Host: Wow, this is really amazing hearing this. I haven’t heard all the news and social media and everything that I’ve been following, I haven’t heard about the flipping the patients from their back to their stomachs and back again. And it does sound challenging. But it also sounds like you guys were really on your game like you figured something out pretty quickly there and everybody was working together. It’s really amazing. So, I’m sure you’ve learned a lot after having the first COVID-19 patient, but let’s share with everybody what have you learned moving forward as potentially new COVID-19 positive patients come through?
Dr. Modi: I think we’ve learned quite a bit actually and not just from our own personal experience but the experience of others. I think it is safe to say we are all still learning. I think we were on the mark in a lot of ways early on. This has been compared to the flu. It is definitely not the flu. But people early on compared it to the flu and I think in many respects, they were correct because it is a respiratory illness. The flu season tends to vary quite a bit in severity. Every year we see patients who end up on a ventilator and even this sick with the flu. So comparing it to patients we’ve had like that, using that type of a model to manage them seems to work. Now with the flu, we do have treatments available that are very effective. We don’t have that luxury with COVID-19 at this point.
The other thing that we’ve clearly learned over the last couple of months is there’s a large population of people who are either asymptomatic or minimally symptomatic. Now even those asymptomatic people are capable of transmitting which is part of the reason that people have been encouraged to wear masks even if they are not symptomatic not necessarily to protect them but to protect others and I think one of the things that we’ve also learned is the measures that we put in place actually I would think have been highly effective. The question going forward will be how can we adapt to our needs going forward because we can’t maintain our current intense level of staying home and those types of interventions.
Simple things like masks, I mean that’s fairly easily done. Keeping a little bit of distance is easily done. Avoiding large group gatherings, maybe not desirable, but I think that will be necessary for a while going forward. So, we’ve actually learned quite a bit.
Host: Yeah, you know what, you are so right Doctor, there’s so much we have learned and so much more that we need to know about COVID-19, and it sounds like you guys are really on top of things there and kind of prepared for everything. So, kind of in your own words here, what cautions would you like to share with listeners about the virus moving forward. What do you suspect that we need to know and how can we best just sort of deal with all of this mentally and physically?
Dr. Modi: Be prepared for the long haul. I have not way of knowing for sure. But I suspect that using just a baseball analogy, I think we’re probably in the bottom of the first. We have quite a bit of game if you want to use that analogy, left to go. It may go into overtime. In fact, I suspect it will go into overtime in the sense that even a couple of years from now, we may be seeing cases here and there. I have no idea what treatment or vaccines will be available over the next 12 to 18 months. But that’s clearly a priority. And I would actually suggest that people maintain some patience, respect for each other and maybe tone down some of the controversy because I think we all have the same goals in mind. We may not approach them in the same way. There is no right or wrong, but I think most of us would like to get things back up and running in the safest manner possible and there will be some steps backwards that we will have to take. We’ll have to rein some things in as problems crop up. But it will require patience and some degree of trust amongst each other.
Host: Thank you so much for sharing the story about how you treated Dennis Robbins, how you saved his life, how everybody work together, and it sounds like people are in good hands there in Muskegon County and at Genesis. Really, thanks so much and stay well.
Dr. Modi: Same to you. I think Genesis and the county, and the state have done a very good job of getting us to this point and I thank you for your time.
Host: That’s Dr. Jignesh Modi, Infectious Disease Specialist for Genesis Healthcare. We hope you join us for part two of the series with Dennis Robbins. Visit www.genesishcs.org to learn more about his incredible story. Thanks for listening to part one of our series brought to you by Genesis Healthcare System. I’m Scott Webb. Stay well.