In New York City, Dr. Brenna Farmer ’97 (far left) serves as site director for New York Presbyterian-Lower Manhattan Hospital’s emergency department. Photo courtesy of Brenna Farmer.As an emergency room physician at Wellstar Paulding Hospital 30 miles northwest of Atlanta, Dr. Sharon Amaya ’88 is trained to run toward the fire. So when the coronavirus began popping up in hot spots around the U.S. in early March, her first instinct was to head toward the emerging threat. But there was no need — the fire had already found her, announcing its presence with a fever, body aches, and shortness of breath. For the next month, as COVID-19 upended life in America, Amaya quarantined at home with her husband Greg, also an ER physician at a different Atlanta-area hospital, who had fallen ill with the virus at the same time. The doctors had become the patients. Amaya was well aware of all the ways things could turn bad for her and her husband. “That was in the back of our heads,” she says. “We were like, ‘Okay, we’re at day seven. They say day ten is when people start having heart problems and this horrible lung issue. So we were, ‘Okay, day 8 how are we feeling?’ Day 9 and day 10, and we got through day 10 and [thought] ‘Okay, maybe we’re over the hump, but we’re not out of the woods yet.’” Nine hundred miles away at New York Presbyterian-Lower Manhattan Hospital in New York City, NCSSM Class of 1997 alumna Dr. Brenna Farmer found herself in a different battle. As word had begun to circulate among healthcare professionals in the preceding weeks about a viral threat developing in China, Farmer, as site director of the New York hospital’s emergency department, shifted into planning mode. Soon the planning was put to the test as she and her colleagues became frontline healthcare providers near the epicenter of the COVID outbreak in the United States. Farmer had always thought she might face some sort of extreme situation. She and emergency room colleagues around the world are usually the first to deal with new disease processes and disasters as they emerge. Physicians around the world, Farmer included, scrambled to prepare themselves for the H1N1 pandemic of 2009 and the ebola outbreak in 2014. Such situations are exceptional, however, at least in the United States. General expectations are that something might last a short while, where you’re in and out in a relatively short amount of time. “But this,” Farmer says, “is on a scale like we haven’t ever seen before. Treating this illness and taking care of patients with this illness is something that we probably all saw ourselves doing at some point, but not expecting it to last as long as it will.” The magnitude and duration of this global health event is not the only thing that has surpassed initial expectations. “This is a whole new disease process, and we are having to approach clinical care very differently than what we thought we would be doing with patients with a lot of respiratory illness or pneumonia,” Farmer says. “My hospital, as well as a lot of the other hospitals in New York, are learning kind of on the job. This is so very different from some of the other disease illnesses we’ve taken care of. It’s made us rethink how we approach different types of respiratory failure or heart failure and even treatment along those lines for everyday common things like asthma and emphysema, because we’re learning so much more about pathophysiology than we thought we ever would. We thought we had it at least a little bit figured out, but this disease has kind of turned that on its head.” One of the most obvious ways things have changed is that every patient who comes through Farmer’s ER is now met by doctors in full gear — goggles or face shields with N95 respirators, plastic gowns, gloves, and sometimes, hair coverings. And every patient being admitted to the hospital is being tested for COVID-19, “even if they don’t have signs or symptoms consistent with the illness,” Farmer says. “A lot of those patients are testing positive.” Dr. Brenna Farmer ’97, site director for New York Presbyterian-Lower Manhattan Hospital’s emergency department, and Dr. Sharon Amaya ’88, ER physician at Wellstar Paulding Hospital, just northwest of Atlanta. Fortunately for Amaya and her husband, they were part of the estimated 80% of COVID-19 patients with mild to moderate cases of the virus. The severest of symptoms lasted less than a week. It’s a mystery where Amaya and her husband contracted the disease. One possible source is a trip they took to Vail, CO, just prior to falling ill in early March. Observing hospital protocol while on vacation was not in the forefront of their minds, so no facemasks or repeated hand-washing or wiping down surfaces. “I’m sure I touched my face without washing my hands,” says Amaya. “As we were leaving Vail, it was released that they had a huge outbreak at the resort itself, at the town,” Amaya says. “And we were like, ‘Oh, we were just there.’” And of course, the patients they saw in their hospitals are the other possible source. As COVID-19 began to spread throughout the country, Amaya and her colleagues were confident they were taking the proper precautions. Flu and cold season was also in play, and so healthcare professionals were already adhering to a more intense protocol for dealing with infectious diseases. But so much was still unknown about the virus. Prior to the publication of revised guidelines for treating COVID patients, Amaya and her husband had seen a number of patients come through the ER with minor symptoms that looked a lot like the common cold and the flu. “I distinctly remember seeing a very young, probably in her 20s, healthy female, and her only complaint was that she couldn’t taste or smell anything,” says Amaya. “She had no fever. Now it’s come out that, hey, that (the inability to taste and smell) is a symptom of this COVID-19. Well, at that time that was not known. I look back, and I’m like, ‘She totally had it.’ Of course now we would test all of those people, but it is just recently that we even have access to doing that.” “Of course, as it went on,” says Amaya, “it was like, no, no, no, you need to do this, you need to wear this, you need to put them in negative pressure rooms and all these other pretty extravagant things that we typically reserve for active TB patients and that kind of thing.” Farmer agrees that trying to catch up to the virus has been a challenge. It is so different from anything physicians have ever seen that learning how to treat it has been “like drinking from a firehose,” she says. Not since her first year of medical school has she had to acquire so much new knowledge in such a short time. But that steep learning curve may be the key to successfully meeting future outbreaks head-on. “There’s a lot of research that’s going to come out of this pandemic all across the spectrum of care from understanding physiology better to medication to how we actually take care of patients and how we deal with critical illness,” Farmer says. “How we approach patients is going to change based on what we learn from all those aspects of care.” Amaya’s time in quarantine was also a crash course in virology. An overwhelming amount of information on the novel coronavirus flooded her inbox from the American Medical Association, ApolloMD (through which she contracts her services), the hospital where she works, the Georgia Department of Health, and the Centers for Disease Control. The situation was changing so fast that guidance from the CDC and the World Health Organization sometimes changed within hours. “The WHO and CDC did a great job of warning appropriately; it’s just you don’t realize the impact until you’re actually in it.” Most challenging for Amaya was not the illness itself, but being sidelined at the exact moment she could have been of help. “My DNA as an emergency physician is that we want to be on the front line,” she says. “I actually struggled with that. Once I started feeling better from actually having the virus, I was raring to go. I was like, ‘Aagh! This is driving me crazy! I want to get in there and help.’” Tempering that strong need to be challenged, says Farmer, is the simple desire to help people no matter their standing or background. The pandemic is providing both. And it may very well turn out to be a defining moment in her career. She’s never longed for an emergency to put her skills to work, but she’s more than eager to help if something bad does happen. “Pandemic or no pandemic, I’m able to do that.” Amaya is now ready to take the fight to the virus. Just recently she was cleared to return to work. In a strange twist, however, she isn’t needed right now, at least in Atlanta. The city has yet to see the virus peak, and stay-at-home orders and fear of infection have kept chronic pain and minor injury patients away from the ER. The result is a greatly reduced volume of traffic through the ER, though admission rates are higher as those who are coming in are very sick. But in a city as large and busy as Atlanta, it’s just a matter of time before the tidal wave of the infected rolls in. Though driven in part by the adrenaline of such situations — “this is exactly what emergency medicine prepares you for is the worst case scenario,” Amaya says. She admits to some anxiety about the impending onslaught of patients. “I am nervous. Despite all this preparation — based on what we’re seeing in Detroit and New Orleans and New York — I mean they were trying to prepare the best they could — but I just feel like we may get overloaded, despite our best preparations. And that is frightening. No one likes to feel they are out of control. In the emergency room, something can happen in a second, somebody rolls in the front door completely unstable; you have to be prepared for that. But looking and knowing that that chaos is going to come is nerve-wracking. But I work with a phenomenal team at my hospital, and I think we’re going to be as prepared as we can be.” Preparation is something that has been on Farmer’s mind, too. Though it will be years before the long-term impact on approaches to healthcare is understood, the adjustments healthcare providers are making in their personal lives is obvious now. “I think the way it has changed for a lot of us healthcare workers is that we are thinking a little bit more about planning ahead and making sure that our wishes for our own health are known to our families,” Farmer says. “A lot of physicians are writing their wills or updating their wills or making sure that their life insurance policy covers x, y and z.” As parents of a 5-year-old son, she and her husband have updated their plans as well, just to be on the safe side. The pandemic is challenging societal structures throughout the world. Nearly every facet of life has been affected by it, and it will inevitably leave its mark on future generations as they adapt to new approaches to life where localized circumstances a hemisphere distant are merely one person and a commercial flight away from evolving into a global emergency. With jobs in healthcare being one of the top five careers for NCSSM alumni, countless Unicorns are on the front lines of this outbreak. Many more are researchers and engineers and scientists developing tools and treatments to help in the fight. “I have big respect for this virus,” Amaya says. “It is a beast. This is no joke. I have respect for this disease for sure.” — Are you a front-line responder to the coronavirus, or do you know of a story that we should share with the wider community? Email email@example.com and let us know!