Editor’s Note: This interview was done with Richard V. Smith, MD, professor and interim chair of the department of otorhinolaryngology–head and neck surgery at Montefiore Health System, Bronx, N.Y., on March 31, 2020, right after his self-isolation for COVID-19 ended. It has been edited for length and clarity.
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May 2020Q: You recently tested positive for COVID-19. How are you feeling? Do you know how you were exposed?
A: I don’t know how I got it. It’s been a source of discussion at the family table. It’s really impossible to tell if it was at work or outside—I have friends and patients who have tested positive. I believe that, to a large degree, it’s irrelevant, because it doesn’t change the fact that I tested positive, and the challenge always is how to deal with that in your family life and at work.
As far as my symptoms, they’re atypical. I had a lot of severe muscle pains in the lower extremities and midsection area, which wasn’t part of the classic COVID-19 symptoms of an elevated temperature, cough, and shortness of breath. I had an accident six years ago and I do routinely get pain in that area, as a sequela of the accident, so that made it harder to differentiate.
Although I followed our institutional and New York guidelines of monitoring my temperature twice a day, I never had a fever, cough, or shortness of breath for the four days after the muscle pains began. I did lose my sense of smell on the fourth day, which by that point was actively discussed in the otolaryngology community to be associated with COVID-19. The rapid communication among our otolaryngology colleagues was pivotal for me to be able to identify COVID-19 infection. It’s what prompted me to get the test, and then to self-isolate once the anosmia developed. I found that the anosmia isn’t something that’s easy to recognize for me—I didn’t realize I couldn’t smell anything until someone made a comment about how our office eating area smelled strongly of disinfectant. I realized I couldn’t sense that at all. After that, I went around trying to smell things; I had some sense of smell in the afternoon, but by the time I got home it was completely gone.
My self-isolation—being in a separate area of the house, wearing a mask—started the morning following my anosmia, after I had my COVID-19 test, even before the results came back. The challenge with isolation is remembering that you can’t do the things you usually do, or need to do, because you don’t want to be a vector to transmit it to somebody else. I was very careful to stay away from my college-age children and my wife, who is also a physician practicing in the Bronx.
I started back to work yesterday [March 30], as that was 10 days after my original symptoms of muscle pain—recommendations from the Department of Health, the CDC, and others are seven days after symptoms begin if you haven’t had fever or any symptom progression. I wear a mask when I’m outside of my office area because my biggest fear is that I could give it to somebody else, although in analyzing the limited data that’s available, it doesn’t seem like I’m contagious at this point. However, I don’t want to take any chances. Sometimes that emotional concern overrides the scientific information.
Q: In some institutions, otolaryngologists have been pulled into other areas of practice to fill the gap. Has that happened at Montefiore? What has it been like for your otolaryngologists and residents?
A: We’ve volunteered and done shifts in other areas, but we haven’t been called en masse yet. We’re the second wave of mobilization, after some of the other specialties. Many of our faculty have volunteered to be in other areas, and our faculty have been part of the national effort to develop protocols for how to safely perform a tracheotomy and care for otolaryngologic diseases in COVID patients. Within our residency, every week we have a group covering otolaryngology emergencies, but two thirds of them are now being called into other areas—actually starting this week in the ICU. (Since the interview, all Montefiore otolaryngology residents have been rotating through the ICUs.)
I personally haven’t been redeployed to another area at this point. But in talking with our residents and the other faculty, besides some initial anxiety from working in an area where they’re not accustomed to being and caring for non-otolaryngologic conditions, they are all committed to delivering the best possible care to their patients. Our otolaryngologists aren’t currently at the front line of COVID-19 or at an increased worry about getting infected, but we are in an area where we’re doing things other than straight otolaryngology. We’ve been preparing for it with some additional online education, and we know that we’re in a supportive environment with other people who are specialists in that area. We’re there to help them and to extend their ability to take care of patients, as our inpatient numbers become higher and higher with the COVID-19 crisis. (Since the interview, Dr. Smith and his colleagues have had universal otolaryngology faculty training on site in the ICU, and have begun redeployment to provide 24/7 coverage to newly created ICU spaces in the hospital.)