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'Individual actions matter too': ICU Doctor on states stepping up COVID-19 restrictions as cases climb

Dr. Lakshman Swamy, ICU physician at Boston Medical Center, joined Yahoo finance to discuss the rises number of COVID-19 cases in the U.S. and how states can respond to mitigate the spread.

Video Transcript

ADAM SHAPIRO: Let's move this discussion forward with Dr. Lakshman Swamy. He's the ICU Physician at Boston's Medical Center. Good to have you here, doctor. And as we talk about these potential upswings and we see cities like ours taking a step back, what's the most important thing you would want the people who are watching us right now to consider?

DR LAKSHMAN SWAMY: You know, I think the most important thing right now is for people to realize that you can get away with doing a lot less in terms of pulling back on indoor dining and all of this without having to do a full lockdown if you do it sooner, and it's already, I think, past soon for many states in the country. We're certainly feeling that up here in Massachusetts as well. We're starting to see the roll back happening, but I think the economic pressure is real everywhere. So I'm worried that the delays in pulling back are pretty serious. Individual actions matter too, right? You know, just because indoor dining is open doesn't mean everyone has to go and use it.

SEANA SMITH: Doctor, what are the metrics that you're looking at just to determine, I mean, we're talking about how these government officials are a little bit delayed in their actions to pull back on some of their efforts. When should they be taking action at this point?

DR LAKSHMAN SWAMY: Yeah, I think, you know, one of the challenging things about COVID is there's so much nuance involved. There's so many different metrics that are used for different purposes. I'll tell you as a clinician, what I'm thinking is, how many patients am I seeing in the ICU? And I'm seeing more. It's radically different across Boston, across the state than it was, you know, a month or two ago. We're feeling it, right? We're seeing the case counts go up, you know, in our region, across the country. So I think all of the metrics are to some degree lining up, and you can always make a case for, well, this one looks OK, that one doesn't. On the whole, I think we know what we're seeing.

ADAM SHAPIRO: Doctor, as we see the case counts go up, we're seeing the ability, I don't know how to phrase it, is it the death rate? We're seeing fewer people die. Is that because we have better treatments, or is that because it's younger people being admitted to the hospital?

DR LAKSHMAN SWAMY: You know, I would say all of the above and more. I think compared to the spring, in spring, you know, the first thing that I would say is that the hospitals were under extreme strain. And when you hit that point, I think the care that's delivered is just, it's frayed, it's fragmented, it's diluted, it's hard to give people the attention they need. So the first thing is that. The second thing is certainly, as you said, younger people. The infection is kind of spreading widely in a different way.

We know what we're doing, I think, better. We certainly don't know everything, but we've improved our practices significantly. We've published on this a good bit, you know, not intubating people quite as early, quite as aggressively, using alternate technologies to get oxygen in without the breathing tube, without the ventilator. You know, dexamethasone, remdesivir, we have more knowledge, more skill now than we did in the spring too.

SEANA SMITH: You're with Boston Medical Center. Do you have enough tests? Do you have enough PPE equipment to get you through a scenario that some are describing could get dramatically worse over the next couple of months?

DR LAKSHMAN SWAMY: Yeah, you know, fortunately I actually work at a number of hospitals across the city right now, and what I can say is that everywhere I work, I think now compared especially to the early spring, we have a certain degree of comfort in knowing we have enough for right now. There's always this real, you know, we're still rationing everywhere. I'm still reusing N95s all the time.

And I think what's especially concerning is that we're, you know, I'm wearing the N95 for the entire shift now. So everything is getting a lot more use out of it, and we're reusing it a lot. But on the other hand, it doesn't feel like the supply is going to fall out from under our feet like it did so much in the spring. This is all in the setting of rising cases without a real surge though still, so of course we're worried.

ADAM SHAPIRO: There was a report, I think I heard it on NPR, that talked about the change at the federal government, that not getting the data out there that allows hospitals within one community to share the kinds of things they might have available with one another. Is that true, and is that hindering our effort to treat Americans who are coming down with the disease?

DR LAKSHMAN SWAMY: I can tell you that, you know, COVID absolutely exposes all of the vulnerabilities in our health care system, especially how fragmented and siloed we are within an institution, between institutions, between regions, between states. And we've advocated for really take senior leadership at the federal level to be able to say, we need to move the resources to where they're needed, not just ventilators, but people. We need staff. How many people had to come in from other regions to help New York, to help Boston. And we need to have those pipelines ready and ready to go, because staff everywhere are still exhausted, and we're dreading that kind of over overworked, volunteer work, double, triple shifts, all that stuff that we know is coming.