Dr. Wendell Hoffman watched as the SARS and MERS coronaviruses emerged during his career. He helped with planning during the H1N1 influenza pandemic. But the infectious disease specialist for Sanford Health currently is immersed with other health care providers in the struggle to understand, prevent and treat COVID-19.
Our knowledge has come far since the virus first came to the United States, said Dr. Hoffman, but we’re still “engulfed in complexity right now.”
He recently shared his perspective of handling COVID-19 with host Alan Helgeson on the Sanford Health radio show “A Better You” on KSOO in Sioux Falls, South Dakota. Topics ranged from the unknowns, to planning amid the unknowns, to the protection of health care workers and the at-risk public.
‘In the fog of COVID’
At the beginning, there was a lot about this brand new virus to mystify scientists and medical experts. No one had immunity to it. Questions centered on its characteristics, the populations it most affects, how it spreads, who and how it kills, how it may be treated and how it can be prevented.
“I think we’re getting a sense of reality of this virus,” Dr. Hoffman said. As we gain information, theories and guidelines change to meet the new understanding.
While insights have been gained, we’re still “in the fog of COVID,” Dr. Hoffman said.
“The fog has to lift before we can actually understand” things like the spread and the impact.
As an example, he said to consider all of the people who traveled to all parts of the U.S. from China and Europe in late 2019 and early 2020.
“Who knows? We probably had cases here in South Dakota far prior to the first declared case because we just have not known how big the iceberg is,” Dr. Hoffman said. “We’ve been focusing on the tip of the iceberg, and we’ve really not understood the iceberg beneath the surface.”
Planning for COVID, treating everyone
Imagine trying to model and plan for the worst-case scenario of peaks of patients amid all of this uncertainty.
Without any community efforts to reduce that peak, the modeling begins with the understanding that the virus might run through 60% to 80% of the population, including those at high risk for complications, Dr. Hoffman said.
He likens modeling to a game of chess. “In checkerboard, you’re worried about the next move. A chess master, though, is anticipating the next 10 moves,” he said.
Surge planners need numbers, he added, so hospitals can consider where they would be able to put potential patients. At the same time, they must consider how to treat the non-COVID patients they already have.
“We’re coming up with all kinds of really fascinating and interesting ways to … still address their needs,” Dr. Hoffman said.
“It’s just amazing to me some of the ways in which we’re trying to handle not just the COVID problem but the larger issue of health care that’s affecting people,” Dr. Hoffman said, such as heart attacks, diabetes and other disease conditions.
“So we have to figure that out, and we are.”
The evolution of understanding
Time gives the advantage of being able to study how the novel coronavirus functions in populations. That can lead to changes in beliefs about COVID-19.
For example, it’s more infectious than first thought, Dr. Hoffman said. Also, transmission eventually was discovered possible by people who displayed no symptoms. And even the list of symptoms has evolved beyond the original fever, cough and shortness of breath.
The Centers for Disease Control and Prevention now also lists chills, repeated shaking with chills, muscle pain, headache, sore throat and new loss of taste or smell. But the CDC adds that even this list is not inclusive.
Dr. Hoffman, who rotates through the hospital and clinic, said some of the patients he has seen, as well as some across the U.S., have symptoms that are quite varied. He has encountered diarrhea and upset stomachs, severe weakness and fatigue.
“Some of these patients are coming in because they just can’t make it any longer,” he said. “They’re struggling to get along. Their appetite is gone.”
Protecting health care workers, at-risk groups
One key task of planners is to consider ways to best protect health care workers, Dr. Hoffman said.
So at Sanford Health, internal social distancing means people meet over technology now and avoid large groups. Other methods include face masks for workers with any patient contact, “relentless hand hygiene and continuous environmental cleaning,” Dr. Hoffman said.
Small examination rooms are a challenge, he acknowledges. “It’s tough to practice social distancing in an exam room.” He’s glad face masks have become a routine guideline now to help address this.
At age 66, Dr. Hoffman is a member of the age group considered at greater risk.
“People, beginning after the age of 60 … between 60 and 70, 70 to 80, and north of 80 are at risk. And the reason why that is is a term called immunosenescence, which is the decline of overall immune function as we get older,” Dr. Hoffman said.
Other risk factors for complications can be chronic health conditions such as heart disease, lung disease, diabetes, obesity and asthma, as well as people receiving therapy that compromises their immunity.
“Those are the groups that are so important to protect,” Dr. Hoffman said. “The principle of mitigation says that I must mitigate, where I can, the spread of the virus to those people who are at risk.”
It’s not easy, he admits. “I have my mother-in-law, who I love dearly, is 96 years old, and we’ve not been able to see her in weeks. That’s tough for a lot of people.”
In the meantime, he works to help patients and co-workers through the fog of this pandemic, which has blurred time for many since it began to affect their lives directly.
Certainly it has for Dr. Hoffman.
“It seems like it’s one big, long day to me.”
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