STEAMBOAT SPRINGS — In the wake of a deadly, global pandemic, Dr. Dave Wilkinson has reverted to routines.

An emergency medicine physician at UCHealth Yampa Valley Medical Center, Wilkinson has worked on the frontlines of one of the worst public crises in recent history. The outbreak of a novel coronavirus has been scary enough for members of the general public who are sheltering in their homes. 

Those whose jobs demand close contact with the sick and injured must grapple with the daily fact that they face the highest risk of exposure. As thousands of people die from COVID-19, the illness caused by the coronavirus, first responders and medical workers are doing everything they can to protect themselves and their loved ones while still doing their essential work.

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“There has been nothing like this in my career that has directly affected my practice like this,” Wilkinson said.

To keep himself and others safe, Wilkinson has practiced the same routine every day until it becomes habit, the same as brushing his teeth in the morning or cleaning the dishes at night. Except that following these habits could become a matter of life and death.

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Establishing a routine

Each morning, when Wilkinson drives to the hospital for work, he wears a personal protection mask. He wears medical gloves to open and walk through the front doors of the hospital. Once inside, he exchanges his mask for a new one that offers even more protection. In the staff locker room, he changes out of his personal clothes and dons freshly cleaned hospital scrubs. 

“Each of these steps keeps in mind that this is an infectious disease,” Wilkinson explained. “The routine becomes really important so that you’re not missing steps and allowing errors to occur.”

While medical experts are still learning more about COVID-19, data from China, where the outbreak originated, suggests it is about twice as contagious as the seasonal flu. Each person who gets the virus transmits it to an average of 2 to 2.5 additional people, according to Routt County Public Health Officer Dr. Brian Harrington.

Data also shows that the virus is about 10 times more lethal than the flu, Dr. Anthony Fauci, director of the National Institutes of Allergy and Infectious Disease, said in congressional testimony March 11. As of Saturday, the global death toll from COVID-19 had surpassed 12,700, according to data from John Hopkins University.

Because the virus is new, no one has a pre-existing immunity to it, Wilkinson explained.

“Anyone could potentially get infected and consequently pass it on,” Wilkinson said.

Flattening the curve

With a backlog in diagnostic testing and little success with containment measures, priorities have focused on slowing the spread of COVID-19 through social distancing and isolation. This strategy of preventing new cases of the virus has become known as flattening the curve. It comes as countries like Italy and Spain combat a massive acceleration of disease spread that has overloaded health care systems. 

“What we are really doing is buying time to better fight this disease,” Wilkinson said.

His disease prevention routine does not end at work. At home, where the doctor lives with his wife and three children, he has implemented sanitary measures to ensure he does not expose his family to any illness. 

He set up a hand washing station at every entrance to the house. He uses a separate door with an entryway that is blocked off and secured. When he gets home from work, Wilkinson changes his clothes and washes the ones he wore to and from the hospital. At night, he sleeps alone.

Despite these drastic measures, Wilkinson remains optimistic.

“I don’t think these are scary precautions,” he said. “It actually is really empowering when you take the steps you can take to mitigate the spread of infection in your own home.”

As the number of infected continues to climb, it has become ever more important to prevent doctors, nurses and first responders from becoming patients themselves. 

In Wuhan, the Chinese city where the outbreak began, 1,300 health care workers became infected while helping patients, according to a recent article from The New Yorker. Their risk of getting infected was more than three times that of the general population. As doctors and nurses went home sick, the city had to bring in 42,000 additional health care workers to be able to treat the infected. Due to stricter protocols, none of the new medical workers have gotten the virus. 

In Routt County, the stakes have gotten higher since the first resident tested positive for COVID-19 on Friday, confirming evidence of community spread.  

The hospital closely monitors its staff, Wilkinson said. Policies require health care workers to stay home for up to two weeks if they feel sick. If anyone runs a fever, they have to self-quarantine until their body temperature returns to normal for a period of at least three days before going back to work.

Recently, YVMC has taken further measures to limit the number of people who pass through its network of hospitals and clinics, including those in Steamboat. Starting Friday night, no visitors were allowed, with exceptions for people visiting maternity wards, neonatal intensive care units, pediatric and end-of-life care.

“These new restrictions are in place for the health and safety of patients and their families, visitors and health care workers,” UCHealth Communications Specialist Lindsey Reznicek said in a news release about the new policy.

Most other hospitals in Colorado have enacted similar restrictions, encouraging patients and their families to instead connect via video, texts and phone calls.

Protecting first responders

Local first responders have taken similar measures as hospital staff to protect themselves from infection, as recommended by the state and the CDC. Many calls require them to make physical contact with patients before they know what is wrong. The potential for a first responder to get sick while helping a patient is always a concern, but it gets graver during a public health crisis.

“Everybody working here has a level of fear,” said Interim Fire Chief Chuck Cerasoli with Steamboat Springs Fire Rescue.

Cerasoli has been on call every day of the week, holding daily video conferences with this staff to brief them on any updates of the pandemic and to alert them to any new health protocols. 

One firefighter has been staying home after exhibiting symptoms similar to COVID-19, though officials have not confirmed he has the virus. Others have stayed home to care for family members who are sick. Still others are staying away from their family to avoid exposing loved ones to any illness they may have contracted at work. 

Steamboat Fire Rescue is the primary responder not just to fire-related emergencies within the city but also to emergency medical calls. Many firefighters double as medics and paramedics. 

Lt. Joe Oakland said all personnel have been operating under the assumption every patient has COVID-19. That includes wearing surgical masks, goggles and gloves. Oakland showers when he leaves the fire station and showers again when he gets home. 

“We are highly susceptible to getting (the virus), so we are doing everything in our power not to spread it,” he said.

Coping mechanisms

Amid these uncertainties and fears, medical workers and first responders have relied on several coping mechanisms to ease the stress. 

On Saturday morning, Cerasoli took a break from work to hike up and ski down Howelsen Hill with his wife and daughter. He tries to find time every day to unplug from the news about the coronavirus pandemic.

“When your whole life is talking about this, it’s important to be able to turn it off, at least for a few hours,” Cerasoli said.

The entire crew at Steamboat Fire Rescue considers each other family, not co-workers. That sense of community has helped with morale. Those on shift eat dinner together, one of few things that hasn’t changed during the pandemic. Firefighters keep a healthy distance apart from one another during meals, but they still take the opportunity to share stories and laugh.   

The other night, Wilkinson watched a movie at home with his family, also making sure to keep the 6 feet of recommended space from one another.

“It was interesting, but we laughed. We cried,” Wilkinson said. 
“You control the pieces that you can control. The fabric of life goes on.”

To reach Derek Maiolo, call 970-871-4247, email dmaiolo@SteamboatPilot.com or follow him on Twitter @derek_maiolo.