Dec 17, 2020 10:53 AM

COVID 19: My Story-Special Episode-Dr. Humayun Ashraf transcript

Posted Dec 17, 2020 10:53 AM

Nick Gosnell:

Welcome to this special edition of COVID-19 My Story. I'm Nick Gosnell. The vaccine is here for frontline workers. The first doses of the Pfizer-BioNTech vaccine got here on Wednesday, December 16th, and we actually had a chance to talk to one of the specialists who received the vaccination first. Dr. Humayun Ashraf is a pulmonologist and critical care specialist at Hutchinson Regional Healthcare System, and while he was waiting his 15 minutes out to be sure there was no allergic reaction, we grabbed him to talk a little bit about treating COVID-19 patients and also about the vaccine and why he was one of the first ones to get it on this special edition of COVID-19: My Story.

Nick Gosnell:

"This is maybe the light at the end of the tunnel," that's what one of the folks from the hospital said.

Dr. Humayun Ashraf:

Absolutely. So when we talk about allocating resources as a regional healthcare center, we get the people from throughout our county and surrounding areas. We get pretty close to a point where we don't have enough staff to provide the care to all the people that walk through our door. We are lucky that we have never hit that point just because all of our staff, the administration, the doctors, the nurses, everybody came together and work extra hard, where we were taking care of 10 people. We increased to 15, to 25, to now at the maximum, I think we were up to 45 somewhere around there. We continue to care for the people that are around. We did worry about not being able to provide them the medications or the ventilator support or the high amounts of oxygen and the non-invasive ventilation modes that we use.

Dr. Humayun Ashraf:

But fortunately enough, we did receive more ventilators from the state itself and we have not had to make those decisions. I hope that we are at the right time with use of the vaccine becoming available, that the time never comes and we are able to turn this around and head in the right direction. As somebody stated earlier, light at the end of the tunnel, that's exactly how I see it. It is a light at the end of the tunnel, and it's been a very dark tunnel so far. So anything that we can take, we will take.

Nick Gosnell:

Okay. Obviously, you wouldn't be getting the vaccination if you didn't think it was safe, so maybe that's the obvious question. But the follow-up is, why you first? Or one of the first?

Dr. Humayun Ashraf:

I got a call today that we got some vaccines in and I've been looking forward to this. I told... I think it was just yesterday, I sent an email out asking, "What is the status of the vaccine?" My first line was I feel like the child waiting for that Christmas day to be able to open that gift. That's exactly how I felt until we received it today. So when I got that call, I ran over. Because I not only think it will be safe, I think it's much needed for us frontline workers to be able to continue doing what we can and avoid the vaccine. I'm sorry, avoid the disease itself, and to be able to continue providing the care to the people that need it.

Nick Gosnell:

Boy, there's a limited amount of it, obviously for everybody, but the frontline workers end up getting at first for obvious reasons, because if one of you goes down, then there's just not somebody to replace you at this point. Not just doctors, but nurses and techs and so on. So you've had a lot of appoints over the last few months. I heard you on the public call a few weeks back, and you were really quite frankly emotional about where you might have ended up. What are the emotions now, saying to yourself, "At least I know now that me and the people I work with have an opportunity to maybe not feel like we're risking our life every time we walk into one of these rooms as much, maybe not at all." Obviously, there's always a risk, but as much.

Dr. Humayun Ashraf:

I think the vaccination does help. It does keep us in the work field longer and continue to take care of these people because we did worry, and we still worried up until... We'll always continue to worry that we only have four critical care and pulmonary physicians. Let's say if two of us get sick, the other two will have to pick that up. So now this prevents us from getting this illness through a good degree and we can continue providing the care. I do get emotional. It's been a very emotional ride and I don't think it's over yet, but I think anything we can do to mitigate our risk and decrease the number of people getting sick, coming through the hospital in the community, I think we will take anything and everything. But I think the vaccine might be that answer that we have been waiting for.

Nick Gosnell:

Okay. You wouldn't know off the top of your head, but can you give me a rough estimate as to how many patients you've treated over the course of the pandemic?

Dr. Humayun Ashraf:

Oh gosh, yeah. So when it started, I kept track of, for not only the people that I treated. I used to write down what we did for them and as it got busier, and of course, our debts were so low. I remember the day that we were sitting and two people that died for such a long time. Then it got busy and busy and busy, not only that I lost track of the people I treated. If I were to go back and see the number of people, it would fall between maybe 150 to 200. Now, the other sad part is I was keeping track of the people that we lost, and somewhere along the way, I lost that track. I don't know where that stand, but I know at least 30 to 40 people that have died that I provided care to on one-to-one basis, taking care of them every day. You see them go through the disease. Sometimes it's days, sometimes it's weeks. It's sad that I lost count, but unfortunately the numbers got so high that there's no reason to keep a count.

Nick Gosnell:

Dr. Ashraf, explain what your specialty is.

Dr. Humayun Ashraf:

I am a pulmonologist, and at the same time, half of my specialty is critical care medicine. That is the intensive care that people receive when they go to the ICU. So it's half and half and further divided, my pulmonary practice is divided into outpatient practice, where I have patients in the clinic that I see. Then the other half of it is seeing patients on the floor here in the pulmonary unit and throughout the hospital for any lung related issues. Then if they get sick enough to end up in the ICU, that's where I also pick up there too.

Speaker 2:

Okay. I know just enough about pulmonary medicine to be incredibly dangerous. My wife and one of my sons is asthmatic. In fact, she was Dr. Sourk's patient when she was a child. She's from here. But I talked to Dr. Mo on the radio about the consequences of the disease previously. But I guess, what have you learned about treatments and therapeutics and so on that gives you a more of a fighting chance until everybody can get the vaccine?

Dr. Humayun Ashraf:

I think it's early recognition of the disease, monitoring at home. When somebody is sick enough, unfortunately, we have a lot of these emergency use authorizations for some of the medications, but working with our infectious disease physicians, we have to weigh in the risk and benefit that the person gets. I think the biggest tool that we have to treat... this is I'm talking in the hospital specifically, we are using steroids. Decadron, I think that has made one of the biggest differences in improving people to the point where they can go home.

Dr. Humayun Ashraf:

The second one we are using is Remdesivir. This is routinely used currently in the hospital for anybody being admitted, who has any degree of hypoxia, meaning oxygen levels are low. Apart from that, it's the delivery of oxygen. It's different modalities to do it. Then if everything else fails, the last resort is the ventilator. We also do use some blood thinners to prevent and at certain times treat blood clots. I think those combination of those is where we are right now. Unfortunately, we don't have that much more, wish we did. I'm sure in the future we will, but that's where we stand. We really don't have much.

Nick Gosnell:

I'm trying to think if there's anything I haven't asked you. First of all, thank you so much for being so open about this. Since the beginning of the pandemic, the entire staff in Hutchinson has been so open about the issues that come before them. I even had to ask Chuck Welch, the VP at the hospital, "How many ventilators do you have? How many BiPAPs do you have? How many air volts do you have?" I never thought that I would ask a hospital administrator about the number of machines and they'd answer me because it was that close to being out. That's a sobering thought I'm sure, when you're sitting here going, "Okay, this patient..." When you have to flip them back and forth on these different ways to deliver oxygen because of the lack of ventilators. Now, the states helped out with that. But the way that that worked from time to time.

Dr. Humayun Ashraf:

Yeah, from the start, I know we have just continued to increase our capacity on terms of the ventilator. Also, we started off with less what we call heated high-flow nasal cannula, as we ordered more. Of course, it was such high demand it takes forever. We received some more, in terms of our non-invasive ventilation, the BiPAPs I know health equipped locally donated some as well, which are home ventilators called Trilogies, and that helps out. So our respiratory therapist, all their department has continued to get us more and more. I will remember one night when I got a call that we were pretty close to maximum amount. This is before we were able to expand more. Got the call that we have two people who are probably going to end up on the ventilator, but we have one available. We were able to move things around.

Dr. Humayun Ashraf:

We were able to extubate somebody and that never happened that we had to make that decision. I think that's where your first question was. Although we got close there for a few minutes, scary moments, but we'd never actually got there, which I'm so proud of. Otherwise, doing your job is not the hard part, it's not being able to do anything for somebody who can benefit from it. I'm so glad we never got there. I'm so glad I never got there, and we're still in the middle of it. I think this is not over. This is just the beginning of an end if you were to say. And then meanwhile, on the next month to two months, it's still going to be very hard and who knows? Even thereafter, only time will tell. So hopefully, we never get there where we have to make those decisions.

Dr. Humayun Ashraf:

But I think for now, we are adequate with our equipment and staff as well, although we can always use more. I talk with our CEO and the chief operating officer. They know that we're never happy. We're always asking, we need more, we need more, we need more ventilators. We need more machines. We need more medicines. We need more and more and more. They have really helped a lot, also with the personal protective equipment. They have helped out a lot and made sure that adequate supplies are there for us to do our job.

Nick Gosnell:

I'm going to ask you the question, because this audio is going to go out for regular people who may have been touched by this disease. They may not have been, they may not even know what a pulmonologist does for a living. What do members of the community who have not been infected or at least they don't know that they have been with COVID-19 need to continue to do during the period before we get a dose for everybody? Because right now, all we've got them for is you guys.

Dr. Humayun Ashraf:

Yeah. So this question always comes up, and then we always refer back to, "Let's listen to our health experts." We have been saying that again and again. I think it's the reinforcement, so I would say the same exact things that we were always been saying, because we do know that they work and they have been working for the people that do it. Social distancing, limiting gatherings, wearing a mask, general hygiene, washing your hands frequently and just help out and control the spread of the disease.

Dr. Humayun Ashraf:

Once you get it, everybody reacts differently. Some people get worried sick, some don't, and there's no way to tell. The best way to manage this disease is to actually prevent it. Those are only the measures that we have. We don't have anything else to prevent it until today, if maybe the vaccine. That's the other thing that will help, but until everybody can get it, we still have to stick with the basics of disease prevention.

Nick Gosnell:

All right, thanks to Dr. Humayun Ashraf for talking to us immediately following receiving the Pfizer-BioNTech vaccine on Wednesday, December 16th. And our thanks to you for listening to COVID-19 My Story every week and to this special edition of COVID-19 My Story on huffpost.com and your favorite podcast app.