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Doctor Reacts to the 'The Good Doctor' COVID Episode

— How true-to-life is it?

MedpageToday

, who goes by "Doctor Mike" on social media, is a board-certified family medicine physician at the Atlantic Health System's Overlook Medical Center in Summit, New Jersey. Watch him reacting to the recent COVID episode of "The Good Doctor."

Mikhail Varshavski, DO: "This episode of 'The Good Doctor' is a made-up story about a real battle still being fought. Honor the heroes: doctors, nurses, and other frontline workers, many of whom who have given their lives. Do your part. Wear a mask." Great message.

I love the way they're showing the viral particles as they're just spreading out everywhere. That absolutely does happen. That's why it's really important to dab when you cough to try and limit that spread. We've seen it actually spray six feet away from you when you cough or sneeze, and germs have hang time, so you can walk into an empty room that someone just sneezed in and be exposed to those germs. I don't know why I did that.

Till Operator: And there you go.

Varshavski: This is such a good example of how germs spread -- droplets, meaning someone coughs or sneezes or speaks; contact -- meaning they coughed on their hands, and they touch something, they give it to somebody else. When we talk about disinfecting your hands, wearing a mask, we are talking about decreasing droplet spread and contact spread.

Lea Dilallo: Have you seen my ID badge?

Dr. Shaun Murphy: No.

Lea: I had it last night, but maybe it fell out of my bag.

Varshavski: I lose my ID badge all the time. Like not permanently lose it, but have it in my car or in my trunk, in my suitcase, in my home. Sometimes Bear steals it. Sorry, Bear.

Dr. Morgan Reznick: Your temperature's almost 101. Your other symptoms?

Female Patient: First, it was a sore throat, then my body started aching, [COUGHING] and then there's this cough. I even had my flu shot.

Reznick: Unfortunately, influenza is constantly mutating. The shot always lags behind.

Varshavski: Both very accurate statements. In fact, during this timeframe in February, I was working in my primary care office. We knew COVID was around, but we didn't think it was everywhere yet. A lot of patients were coming to my practice with upper respiratory viral symptoms just like this -- fever, cough, muscle aches -- and we thought they potentially had influenza. We gave them antivirals for influenza. The reality is even if you had your flu shot, you can still get the flu, but your case should be milder.

Female Patient: My daughter is very worried that I might have this virus from China, what's it called?

Reznick: Have you been to China or been around anyone who's been to China recently?

Varshavski: Those are the questions we were asking. At that time, I think we were referring it to nCOV-19, right? Was it nCOV-19?

Dr. Audrey Lim: The virus has damaged your mother's lungs. Her body is working harder and harder to breathe, but her blood oxygen levels continue to drop.

Female Patient's Daughter: She definitely has corona?

Lim: We're doing everything we can to help her.

Varshavski: See, that patient was actually in a negative pressure air room. They were isolated from other people because at that point we were deciding whether COVID-19 was only needed to maintain a droplet precaution where you just cover your face and the patient's face with a mask, or do we need a negative pressure room because COVID was spread through airborne transmission where the virus just lived in aerosolized particles in the air all the time? What we came to realize is it's more of a droplet spread, but there are some instances where it can be spread through aerosolized particles, especially during medical procedures like intubations.

Murphy: You have COVID.

Male Patient: Okay, now what?

Murphy: Now you go home.

Male Patient: That's it?

Murphy: That's it. There is no treatment. Stay away from people. Come back if you have trouble breathing. Goodbye.

Varshavski: I forget because I don't watch this show regularly, how funny Shaun is. COVID-19 is a viral illness. If your oxygen levels are not dropping drastically and you just kind of feel lousy and you have a mild fever, your body is the one that has to fight this off. There is very little that we can actually do in the hospital systems, and by keeping you in the hospital, we're actually increasing the risk to healthcare providers and other patients.

Female Doctor: 25 tests? Per day? No, just give me one of tomorrow's. Hello? County Health Department, I don't have time for them and apparently they don't have time for me.

Varshavski: I remember in March I had a patient who I suspected to have COVID-19, but I didn't have a test available, so I was calling the Department of Health, trying to secure a test for them, eventually getting them a test, finding out that they were, in fact, positive. Luckily, everyone was wearing a mask at that point so we decreased the spread, we cleaned the room, sent them out the back door, tried to do our best to limit the spread of this virus. There is just a lot of things we didn't know in the beginning that we know now.

Pregnant Patient: If I'm sick, is my baby sick?

Dr. Alex Park: This disease doesn't really seem to affect children and babies like it does adults. Should we admit her?

Female Doctor: She's probably safer at home.

Park: What's at home? Do you have a support system? Can anyone come help you ...?

Varshavski: Good question.

Park: ... in case you get worse?

Pregnant Patient: It's just me and the little one.

Varshavski: Good doctors always ask questions like this. If I am sending a patient home that I'm sort of questionable on, and let's say they had a concussion, I always want to make sure that there's someone to keep an eye on them. That if they become unconscious, they have someone to call for help and to check on them.

Park: If I come home, do you want me living with you?

Mia Wuellner: Of course. That's the point.

Male Doctor: Every night after 12 hours of COVID patients to hang out with you and Kellan, and his asthma?

Varshavski: Interestingly enough, we've seen conflicting reports on how COVID-19 affects those with asthma. Now, if it's just asthma alone, it doesn't seem to be as bad as we expected it to be, but those who are asthmatic and have other comorbidities -- like heart disease, obesity -- those are the patients that seem to be experiencing worse symptoms and worse outcomes.

Male Executive: We do everything we can. We hammer at official channels and every manufacturer's rep that we deal with and see what companies, if any, have any...

Female Speaker 2: Nuts or no nuts?

Male Executive: I'm sorry. I'm in the middle of a meeting with the board.

Female Speaker 2: Hey, everyone! I'm just baking banana bread.

Varshavski: One of the most searched terms in the height of this pandemic was how to make sourdough bread. Go figure. I have never made sourdough bread, I've never Googled it. I don't know who's sitting at home Googling it, but apparently sourdough bread was the thing everyone was making, not banana bread.

Murphy: Your husband's blood oxygen level is dangerously low.

Male Patient's Husband: That can't be.

Varshavski: One of the hallmark symptoms of COVID-19 is decreased oxygen saturation in your blood, where you're actually not getting enough oxygen from usually the edema or the scarring that's happening in your lungs as a result of the inflammation that occurs with this virus.

One of the dangerous parts of COVID-19 is not only are you infected with this virus that you're fighting off, but some people have an overreaction or a cytokine storm where all these inflammatory cells come to the lungs and actually cause a bigger problem where you can't get enough oxygen going and being delivered to the rest of your body, your vital organs, your liver, your kidneys, your brain, and so forth.

Our solution to that was to ventilate -- meaning intubate all these patients. As we did that more and more often without treating them with proper medications like we have now -- and we know which ones work -- patients actually got worse on ventilators because we were over-ventilating people. It's not because we're stupid or we were intentionally harming people, but it was simply because it's a novel virus and we did not have guidelines on how to best treat patients with it. We were learning about it on the go.

Female Doctor: We have a surplus of EKG leads?

Lim: No, we've got a shortage, but that's a problem that can wait.

Varshavski: The PPE situation was really dire in the beginning of this pandemic, because China was hit first and a lot of our manufacturing facilities are in China, and because of that, they actually redirected all their shipments to their country because they needed them. As a result, we were facing a lot of shortages for gloves, for EKG leads, for swabs, for test kits, antibacterial wipes, the vials for injections, the wiring, and the tubing for ventilators. There were so many shortages that were happening simultaneously. It was a truly dire situation, especially here in the New York City area.

Varshavski: Him rubbing his ears like that is from the mask. Oh my God, in the beginning, just wearing the mask for countless hours, my ears hurt so much. I just remember being so sore. But as we learned to use those little headpieces in the back where you could actually have the mask stay on there as opposed to on your ears, it made a world of difference.

For those of you who haven't ever worn an N95 mask, they are uncomfortable because they offer more protection. They are more form fitting, you have to get them fit-tested, but they also put a lot of pressure on your face. They leave marks. That's why all those pictures were making the rounds of nurses, doctors who were having bruising in that area from just wearing them day in and day out, and a lot of times they were reusing equipment that was meant to be disposable.

Female Speaker 3: Do you work in a hospital?

Lim: Yes.

Female Speaker 3: Could you wait for the next elevator? I appreciate you.

Varshavski: You know, it's funny. In New York, if you ever wore your scrubs out during that period, everyone wanted to say thank you and was quite grateful, and that's amazing. But at the same time, everyone wanted to keep their distance, rightfully so. I understand you don't want to put yourself or your family members at risk, but it didn't feel good that you were being alienated like that, so it's part of the process.

Female Patient's Daughter: My mother is in there all alone, hooked up to a machine. I just need to see her and tell her that I love her.

Varshavski: There is a human toll that it takes on family members, not being able to see your family member, and if you're the one ill, not seeing your family members. I will also venture to say, and I don't have evidence for this, but I will say that hospital errors do go up if you do not have family members present and advocating on your behalf, especially if you're unconscious.

Now, what we've learned from that is we're trying to keep families more updated, trying to keep them involved. If they are not there at the bedside, through virtual care, giving them scheduled regular phone calls. Because we realize that when we're in better communication with the family, we actually get better outcomes for our patients.

Nurse 1: Pushing epi.

Varshavski: Why is no one doing chest compressions? I don't understand. Do some chest compressions.

Female Doctor: 120 joules, clear.

Varshavski: Do some chest compressions.

Nurse 1: Refib now.

Varshavski: Did you see those horrible chest compressions? She just put her hands on the chest, didn't even compress.

Female Doctor: 200 joules, clear.

Varshavski: Okay. I don't know why ... these people have high-end experts on set. You start chest compressions and then you use a defibrillation. I have heard in the beginning of the pandemic -- because I wasn't in the hospitals, I was seeing patients, outpatient -- that they were decreasing the amount of chest compressions being done because they were worried about aerosolizing the virus.

I actually just looked this up from the Red Cross, performing chest compressions while wearing proper medical protective equipment, N95 respirators, or like how they have the whole body suit on, still means you should do chest compressions. Like do them. Do them. Do them. I don't know why they weren't doing them. I was trying to make excuses for them. They should have been doing chest compressions from the start.

Male Doctor: Any cough?

Female Doctor: Any fever?

Walk-In Male Patient: No.

Male Doctor: Any shortness of breath?

Female Doctor: Sore throat, loss of smell?

Walk-In Male Patient: No, none of that, just searing abdominal pain and the runs. I'm pretty sure it's my diverticulitis acting up. My roommate is deeply into pandemic baking. I have avoided coming in. I don't want to catch COVID.

Varshavski: One of the biggest problems we faced during this pandemic was patients not coming into the hospitals. In the beginning, when we were really overwhelmed, that made a lot of sense. But as we became safer for patients to come in -- we had different policies in place in order to decrease spread, our testing improved, our capacity improved, our PPE improved -- we wanted patients to come back because a lot of times when patients delay care, their diseases and conditions get more advanced, and as a result, become more difficult to treat. Patients who were having some signs of heart attacks were coming in much later, and as a result, some of our mainstay treatments weren't working as well and the recoveries took longer.

One of my main messages over the last 2, 3 months has been to encourage patients to call their primary care offices, to call hospitals, to come in for the symptoms that are bothering them and not wait.

Male Doctor: He is pink, and active, and breathing great.

Varshavski: In the midst of our research with COVID-19, we actually found that there was limited spread from mother to fetus of COVID-19, meaning that the mother could be testing positive for COVID-19. The baby was usually safe. Now that doesn't mean there was no spread. There were some case reports of it happening. But for the large majority, we did not want mothers to panic because it wasn't happening and children in general seem to fare better with this virus anyway.

The numbers of children below the age of 10 dying with COVID-19 were spectacularly low. That doesn't mean it's completely benign for them, because they could also spread this virus and be vectors, but it is reassuring for mothers, especially with the levels of anxiety that they were facing for themselves.

Varshavski: Please don't put your masks on the floor and then put them back on your face. Shaun, you're a doctor, buddy. Don't put it on the floor.

I talked about germs having hang time, about them hanging out in the air, but folks after they hang out in the air for those minutes or hours, where do they go? [LAUGHTER] Right on the floor. Especially if you've been walking around a hospital setting and then you come home with your shoes on, guess what's on that mask? Man, couldn't they just have me on set for one of these things? I could have helped them make it so much more accurate.

My hospital actually created a state-of-the-art COVID-19 ward. Check it out as I give you the tour for that in a , or check out all of my "Good Doctor" reviews here in a I made just for you.

As always, stay happy and healthy, and stay alert, not anxious.