Edward Kim ’89 is yet another Punahou alumni with front-line insight of the COVID-19 epidemic. The Bay Area nephrologist, who has worked at the Centers for Disease Control and has a master’s degree in cardiovascular epidemiology, recently wrote a personal Facebook post that sounded the alarm of health care workers. Here’s his post:
I’m anxious and scared to return to work, not because of COVID-19, but because for the first time in my career, I don’t feel prepared. I wasn’t scared or anxious on my first day of internship because I knew med school prepared me. I wasn’t scared or anxious on my first day of fellowship because I knew residency prepared me. I wasn’t scared or anxious on my first day as an attending because the fellowship prepared me. Today, I’m scared and anxious because the system has failed to provide protection to me and my colleagues.”
Our Podcast Editor Allen Murabayashi ’90 spoke to Kim about the post and his thoughts about the COVID-19 crisis. Listen to the interview above:
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AM: Dr. Edward Kim works in nephrology, the study of the kidney, but saying he’s a nephrologist doesn’t give him sufficient credit for his academic path. After receiving a BS in biology from the University of Michigan, he received an MPH from the Tulane University School of Public Health and Tropical Medicine, followed by a stint at the Centers for Disease Control. Upon the urging of his more senior CDC colleagues, Ed earned an MD from the University of Hawai‘i John A. Burns School of Medicine, and then followed that up with a master’s degree in cardiovascular epidemiology, while simultaneously pursuing a fellowship in nephrology. In a Facebook post dated March 22, 2020.
Ed wrote: “I’m anxious and scared to return to work, not because of COVID-19, but because for the first time in my career, I don’t feel prepared. I wasn’t scared or anxious on my first day of internship because I knew med school prepared me. I wasn’t scared or anxious on my first day of fellowship because I knew residency prepared me. I wasn’t scared or anxious on my first day as an attending because the fellowship prepared me. Today, I’m scared and anxious because the system has failed to provide protection to me and my colleagues.”
EK: Hi, I’m Edward Kim. I am class of 1989 from Punahou. I am now a nephrologist in private practice in Northern California outside of the Bay Area in Walnut Creek.
AM: We’re talking in part because you wrote a little essay on Facebook. I was wondering whether you can describe that post and tell me what led you to write it in the first place.
EK: So I guess first off, it was kind of a little therapy for me, because this is a scary time and everyone’s a little anxious and a little scared about working in the health care field, not because of what this is, it’s because of the lack of protection. I think all of us in health care, we took an oath. We knew what we were getting into, and I think a lot of us are prepared to do what we need to do. But the concern that that I have, and a lot of health care people have is that we don’t have that equipment. And that includes PPE or personal protective equipment, things like face shields, masks and N95 respirators, gowns, gloves, bonnets for your head, the coverings. Those are all things that you need for something like this infectious disease that can easily be transmitted that has no cure.
So, I just noticed on some closed Facebook groups that I’m in for medical doctors and other health professionals. The conversation changed. It went from how do you screen people to what treatment options are you guys doing to how do you make your own N95s. How do you reuse these N95s. How do you guys make face shields? Here are some 3D printer programs on how to make your own face shields. It started to go into things that as a health care provider, you shouldn’t really be thinking about.
You should go into your place of work expecting that you’re going to have that. And it’s not that these hospitals aren’t buying it, it’s that the health care system can’t really take so many patients like this. And that’s what we’re seeing in New York. That’s what we’re seeing in Seattle. That’s what happened in China. And that’s what happened in Italy, where you don’t have those resources. So that’s why you have to tell people, unless you can get thousands of test kits out there where you can just mass screen everybody and figure out who has the infection, and you can try to quarantine them. You can’t really do that because we don’t have the test kits available now, so people would just have to stay home.
Because like any infection, there’s no host. The infection’s going to die. And an infectious disease is one of those very few things in medicines that you can cure. You think about all the chronic diseases, there’s no cure for it. All we do as doctors is we manage the signs and symptoms associated with the disease. But with infectious disease, if there’s an antibiotic, some kind of antiviral, you give it, you cure the patient. But there’s nothing like that for this. So that’s why we have to do our part to just mitigate. But also we need those tests too. And that’s another part that I think people think, ‘oh we just get the test, and we’ll be fine.’ But there’s another step after that. If you test people, what do you do with that information? And that – that part people need to understand too. It’s not just that, oh you test and everything’s fine.
AM: When I was speaking to Dr. Jason Fleming, who’s an ER doctor here in Honolulu, he looked at the problem from a systemic viewpoint, saying that at least in the U.S. hospitals, for the most part, are operating on pretty thin margins and for various reasons, you have a finite amount of supplies that you can order and store within the hospital facility itself. Do you think that this is an indictment of the us health care system, or is the problem so big that no amount preparation could have accommodated an infected population as large as we’re seeing?
EK: I think that nothing could have prepared us for this. There was a CDC document in 2007 explaining what do you do for a pandemic influenza outbreak and mitigation. What we’re going through right now, where is the shelter and place orders there that this was thought up of over 13 years ago and I’m sure probably even before that. The reason why is because no matter how many resources that we had, there were just so many people. You think about what we know of of COVID-19 now. Eighty percent of people usually have mild symptoms and they get better, but 20 percent of the people don’t, where they get pretty sick. So you think about 20 percent of population going to the hospital. The hospital can’t take that. Your hospitals don’t have enough beds, don’t have enough ventilators, don’t have enough equipment for physicians.
Because it’s not just the doctors that go in to see a patient. You’ve got the nurses there. You’ve got the phlebotomist that go there. You got the technicians that go there. You got the therapists that go there. You’ve got so many different people who have to put on these PPEs that right now hospitals are just limiting the amount of people that can go in there. In fact, CMS has also said that you should probably do telehealth visits for these people. If they’re not that sick and you take a look at the CDC guidelines, they’ve loosened it, and part of it, they’re trying to figure it out as they go along too. But part of it is because the resources are going down, and we need to figure out what we can do.
AM: You’re working in private practice, does that mean you’re never in a hospital setting or do you visit at all?
EK: No, private practice means that once you’re a partner of the group, you’re an owner of the group. So not an employee of a healthcare system like Kaiser or Queen’s or you guys in Hawai‘i. We still go to hospitals. I mean basically for you to go to a hospital, you paid the hospital medical dues to have the privilege of of working in the hospital. So we still cover four different hospitals in our part of Northern California here, along with over a dozen dialysis units as well as three different offices.
AM: And so if you’re not an employee of the hospital and you’re paying for admit privileges, what access do you have to PPE? Do they just treat you as any other doctor the moment you walk in the door?
EK: Oh yeah, absolutely. I’m sure the hospital administrators are working on this nonstop too and they’re keeping track of the PPEs. I remember a month ago, for you to get any, you had to start going through the charge nurse on every floor because the hospital was already starting to be aware that if this thing blows up, we’re going to have a shortage. So these started rationing pretty early in the hospital that I’m at. I’m not sure with other hospitals, how that worked out, but you know that they’re giving me access to the PPEs that I need, like they would for their doctors that they employ.
AM: Part of your mini rant on Facebook was a pretty stern directive for people to stay at home. I’m seeing a lot of people at home who are saying, ‘What’s the best way we can help? We can sew masks. We can print things for the doctors.’ At the end of the day, it really is, ‘Hey everyone, just stay home.’
EK: Until we can test thousands at a time, that’s what we have to do. We have to assume, especially in endemic areas, that everyone has the virus. Until testing becomes more universal, you basically have to approach it that how is the test result going to affect the care of the patient. For example, with the dialysis patient, that’s what I’ve been working with, because people who are on dialysis have to go to a dialysis center like hemodialysis three times a week. So it’s not like they can suddenly not go if they’ve got symptoms and fever. They still have to go to dialysis. But how do we take care of them when they’re in a dialysis unit where there are 20 other people there? So we’ve set up some policies and protocols to try to continue to dialyze these people, but also keep in mind the safety of their fellow patients and also the safety of the staff.
AM: I know you’re not a practicing epidemiologist, but you’re a doctor who’s working in the health care field. You talked to a lot of other doctors. You are reading the news like the rest of us. You’ve studied public health. How do you think this thing ‘quote’ ends?
EK: It’s not going to happen anytime soon. I know the President says he’s hoping by Easter. People are thinking maybe the summer is going to get rid of it, but you take a look at the Southern Hemisphere, it’s summer down there and you’ve got a lot of cases and people will say, ‘Well, what about Africa?’ And it may be a question of just testing the infrastructure to report and test too. So I would say, ‘How does this stand?’ I think it really depends on how good we are as citizens. I take a look at Asian countries that border China and how they were able to flatten the curve as they say. One argument is that they’re already a mass square in culture. You’ve got some police states like Singapore, China, obviously, but I also feel like you’ve got pretty good citizens there.
People are willing to do what they have to do. That idea of sacrifice is not foreign to a lot of people in Asia. And this is just a broad generalization, whereas for Americans, people don’t want it to impinge on their freedom. I feel like, and it is hard, but I want people to realize, you know what’s pretty hard? It’s pretty hard for people in health care to go through this too, not because we’re working like this, but you look at moms who are doctors, nurses, unit secretaries in the cleaning staff – they’re working and their kids are at home. They have to do homeschooling.
So when do they homeschool their kids? Think of the spouses, like my wife, who’s here with the kids. I’m not there to help her out. So it is hard, and everyone’s making a sacrifice, and I think people have to understand that until we can get thousands of tests out there, so that we can figure out how to take care of people, until we get a treatment that is known to work, I think that this is going to be around for a while.