Winter is Coming

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Time to stop reacting to COVID challenges and become proactive in order to thrive.

I have over 15 years of clinical experience in Emergency Medicine and never did I imagine I would witness the significance that one illness could have on such a global scale. I am working in one of the epicenters of the pandemic and while the predicament constantly plays out on the news, it is difficult to truly grasp how inescapable the situation is without seeing it first-hand.


While the predicament constantly plays out on the news, it is difficult to truly grasp how inescapable the situation is without seeing it first-hand.

The Current State

At the time of this writing, many of the hospitals in the city are out of beds. The emergency room has become a de facto holding unit: in other words, in a typical 30-bed emergency room, there are 30 admissions waiting for beds upstairs. This of course leaves no room for any newcomers, which means that if you present to the emergency room, the only way you will be put into any sort of room is if you are admitted to the hospital.


The alternative for all other patients is to be seen in the waiting room or pulled back to a triage room. Tests will be ordered, you will be sent back to the waiting room, and updated when a plan can be made. If someone is sick enough to warrant an overnight stay in the hospital, they will be kept in the waiting room until an inpatient is either discharged home or to a morgue.

It is not uncommon to have more intensive care-level patients waiting in the emergency room for a bed than are actually in the intensive care unit. These patients are being cared for by excellent nurses that are stretched to their limits and at times, beyond their normal work demands. Patients are in rooms ill-equipped to deal with airborne diseases. This fact may align with the World Health Organization’s reluctance to embrace the idea that COVID-19 is airborne.

On top of issues with physical space, hospitals are once again facing shortages of personal protective equipment (PPE). For months, many healthcare workers have been given ‘used, but sterilized’ N95 facial masks, and some are considered fortunate if they receive a ‘cleaned’ mask that does not have makeup stains on it from the previous user. Disposable plastic gowns are a relic of the past and hospitals are now ‘washing’ them for re-use.

If all of that sounds less than ideal, here is something that’s really going to hit you in the gut: these will be remembered as the good old days.


Bracing for the Worst

As a nation, everything we have done to this point has been reactive as opposed to proactive. The curves showed that we were behind the scourge afflicting Italy by approximately two weeks. Italy sent preternatural messages from the future of what we would soon be facing. Inexplicably, the United States was stupefied and unprepared, with images of nurses wearing trash bags for protection and bodies piling up inside of morgue trucks.

In Houston, Texas, for instance, NRG stadium was converted to a COVID overflow unit at a cost of over $15 million. Despite all indications that the surge was coming, the unit was dismantled and the stadium now sits empty — empty at a time when hospitals currently have nowhere to put those patients we knew were coming. At a time when we should have been galvanized into preventing unnecessary suffering, we were caught unawares.

While our elected officials gave false hope that the country would be operational again by Easter, the reality is that Easter was just another holiday whose celebration was diminished in light of the pandemic. Eid al-Adha, traditionally a community celebration, took place at home with close family members. Most firework celebrations were canceled for Independence Day.

Halloween has no chance this year, and Thanksgiving and Christmas celebrations will come down to how much risk people are willing to take with travel and relatives. At some point, COVID-fatigue will settle in and people will give up trying so hard to avoid the illness. It is essential that we stop taking a short-term approach to this problem and embrace what is unavoidable: winter is coming.

Winter Warning

It’s a well-known fact that emergency room volumes spike in the winter season. It’s a time of year typically reserved for Influenza, and staffing is increased to account for the surge in the number of patients that seek help. What’s going to happen when patients develop a fever and are unsure if they have Influenza, COVID-19 or one of the other plethora of illnesses that might be responsible? They will turn to the Emergency Department for answers.

The same Emergency Departments that now in the summer months are running out of rapid test kits daily and subsequently having turnaround times of over three days rather than 30 minutes. Throughput will only worsen as patients wait even longer for results and more employees will be quarantined home from work while awaiting results in a half-baked attempt to avoid exposure. In the meantime, we argue over masks.

Benjamin Franklin is credited with quoting, “In this world nothing can be said to be certain, except death and taxes.” I’d like to update that quote for 2020: “Nothing can be said to be certain, except death, taxes and news of a vaccine for COVID-19 by Nov. 3.”

Is Relief in Sight?

The discovery and research phase for a vaccine is typically two to five years. This particular situation has been met with unprecedented fervor: there are over 100 vaccines currently being developed and with SARS coronavirus in the rear view mirror, we aren’t starting from scratch. In other words, it is perfectly reasonable to expect that a two-year time frame to be much less.

A sense of desperation coupled with a potential financial windfall is unlikely to be compatible with quality. Early reports touting successful trials have largely ignored adverse effects. If a vaccine is developed too soon without adequate scientific support, people have every right to be reticent of its effectiveness.

Warm weather and summer months were supposed to be the downfall of COVID-19. Instead, the three hottest states in America have become its new epicenters. We missed our chance to flatten the curve. We ran out of personal protective equipment while facing the first surge. We are squandering our opportunity now by arguing over masks. Winter is coming — it’s time to stop reacting to these challenges and become proactive if we are to thrive.


Sajid Khan is the author of The Ultimate Emergency Medicine Guide and How to Not Kill your Patients and hosts a website at

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