Justin Hall struggles to sleep at night. Between the non-stop calls from nursing homes and long-term care facilities begging for supplies, masks and gloves, and his fears of the potential impact of the coronavirus, Hall has averaged three hours of sleep a night for the last two weeks.
As a respiratory therapist, the 33-year-old Decatur man stands on the front lines of the fight against COVID-19. He is the one who slides a tube down the airway when a patient struggles to breathe. He operates the mechanical ventilator, ensuring oxygen flows into the patient's lungs.
For Hall, the seriousness of the coronavirus, which has killed more than 30,000 people worldwide and infected more than 650,000 as of Saturday evening, set in two weeks ago. As of Saturday evening, the Alabama Department of Public Health had reported 712 cases in Alabama and three deaths. Morgan County reported 15 cases, Limestone County reported 16, Lawrence County reported three cases and Madison County reported 62. Jefferson County had the most reported cases at 206.
"As a respiratory therapist, I am exposed to all types of respiratory diseases, such as tuberculosis, the flu and RSV, things that people die from every year. I know what that looks like," Hall said. "COVID-19 is different. It was scary when we got a glimpse of what was going on with these patients and how quickly it attacked them."
The virus attacks in the form of ARDS — acute respiratory distress syndrome.
Typically associated with a traumatic illness, such as pneumonia, the flu, and near drowning, ARDS happens when the lungs fail to get oxygen.
"They start to fill up with fluid, and you are not able to breathe. You start smothering and suffocating. Without a mechanical ventilator, people don't have long to live. ARDS is scary," Hall said. "The worst experience in my years as a respiratory therapist is to witness someone gasping for air while dying and you can’t do anything to help them."
For the past five years, Hall served as a respiratory manager with Specialized Medical Services, overseeing therapists in 10 states at nursing homes and long-term care facilities.
With only 122,00 practicing respiratory therapists in the United States, when the coronavirus appeared in the country on Jan. 21 in Washington state and started spreading, Hall traded in his managerial role to work with patients.
"I got into the trenches with my therapists to take care of the patients. That's where I am needed," Hall said.
He is seeing patients primarily in Birmingham, for now. But if therapists working under him contract COVID-19, Hall could receive an assignment to facilities in Tennessee, Florida, Georgia, Mississippi or Louisiana.
Health profession's risks
Currently, 40% of the 70 respiratory therapists Hall oversees are exhibiting symptomatic signs of COVID-19.
"The health care profession depends on respiratory therapists to run ventilators because that is our skill. If respiratory therapists are getting sick and we are not able to see patients, who will do our job?" Hall said. "This makes me fearful."
Along with a potential lack of respiratory therapists, Hall worries about the number of ventilators available.
"That's the last line of defense. If you have ARDS and don't have a mechanical ventilator, you probably don't have long to live," Hall said.
In a press conference last week, Decatur Morgan Hospital CEO Nat Richardson said the health care facility has the ability to access more ventilators, if needed, through its affiliation with Huntsville Hospital. While Alabama currently does not have a ventilator shortage, the state is working with the Alabama Hospital Association to create a system of shared resources, if the coronavirus worsens. According to the association, Alabama has 1,344 ventilators.
To prepare for the uncertain future, Hall is working on a protocol for hooking nine patients up to one ventilator.
"It's not ideal, but if we need to do that, I want to be prepared," Hall said. "If the numbers keep rising, we need to know how we will treat these patients."
Hall pleaded with the public to follow the directives of health care officials, including State Health Officer Scott Harris. Practice social distancing, wash your hands, avoid congregating in large groups and stay home if you feel sick.
Hall also asked people over-buying and hoarding supplies, such as gloves, masks and hand sanitizer, to donate the items to health care facilities.
"We are going to treat the patients no matter what, but, if we don't have the supplies we need, we are at risk of getting it and taking it home to our families," Hall said. "We are struggling as health care professionals, just scratching our heads trying to figure out where we are going to get our supplies from."
Along with treating patients, Hall, via the internet, is teaching employees at high-risk areas, such as nursing homes and long-term health care facilities, about respiratory care and ventilator use.
"Just do your part and take this serious," Hall said. "Yes, we are seeing it in older patients and younger patients with respiratory illnesses, but we are also seeing it in adults who never had a respiratory illness. This virus doesn’t care about your age, race, sexuality, income or your political status."