COVID-19 has thrown the world for a loop. It has been challenging, confusing and shocking all at once. Suddenly we were bombarded with science and medical jargon unfamiliar to many of us—cytokine storm, spike protein, mitigation. Experts told us not to wear masks, then told us we must wear masks. We had to learn the difference between a ventilator and a respirator. And three letters, PPE, became our best friends.
Dr. Farah Fourcand tries to make sense of it all in a 75-page book she has written and titled Pandemic Manifesto: COVID-19 Basic Training From The Frontlines.
Fourcand, a neurologist in New Jersey, is a Miami native and a 2015 graduate of the Herbert Wertheim College of Medicine. Here, in her own words, she discusses her book, her life as a physician during the pandemic, and why she’s never felt more like a doctor.
Why did you write the book?
COVID-19 is the epitome of information overload, mostly misinformation from people not on the front lines. I am by no means an expert. No one is. But, by taking the "I know nothing" approach to my time in the COVID-ICU, a solid foundation of medical knowledge, and the perspective of a regular young person looking for answers, I was motivated to write this book and do my part.
Who should read this book and why?
The book is intended for medical and non-medical readers. It has a “fight the power” theme, but, for once, the enemy is not one another. The book is concise, and every line counts. It is a compilation of the human experience and over 200 cited sources, from COVID-19 randomized controlled trials to pre-COVID basic science research. This book helps the educated citizen develop a framework to fill with whatever new information will come. And as we have all seen during this time, recommendations, warnings and headlines change constantly, so learning how to fish is key.
What kind of information is in the book?
I took a deep dive into COVID-19 and pandemics at large. I delve into vaccine development, antibodies, testing, reinfection, hydroxychloroquine and current treatments (i.e., plasma, tocilizumab, remdesivir, steroids, ECMO). I discuss alternative medicines such as melatonin, vitamin D, zinc, the cytokine storm, key biomarkers, proteins (IL-6, ACE, spike protein), flattening the curve, re-opening strategies. Also, I discuss risk factors for COVID-19, including hypertension, diabetes, obesity, asthma, sleep apnea, and immune system dysfunction; ventilators, intubation, proning, and ‘ARDS’ in severe cases; and COVID-19’s effect on the heart, blood, kidneys, guts, skin, and brain. I focus on the link between severe COVID-19, male gender, testosterone, COVID-19 in children, and certain blood types, evidence-based medicine, how clinical trials work; and, of course, the elephant in the room: the psychological impact of COVID-19.
As a neurologist, how did you end up on the front lines of the COVID battle?
Our team primarily treats acute neurological emergencies. Because of our experience in critical care, albeit neuro, physicians from our Stroke and Neurovascular Center and Neurosurgery Department volunteered to step up and out of our comfort zones in the ICU as the ‘COVID-Brain Team.’ The learning curve was steep. But the tenets of localization (nerd-talk for targeting a root cause) in neuroscience, and a systems-based approach in critical care, helped guide us in managing some of the sickest patients our most experienced physicians had ever seen.
Where do you work?
I work at Hackensack Meridian JFK University Medical Center in Edison, New Jersey. At the peak of the pandemic, our 499-bed hospital had over 300 COVID-19 patients.
How many COVID patients have you treated?
I treated over 100 COVID patients in the ICU during the peak of the pandemic. Unfortunately, mortality was high in the COVID-ICU. Beds would almost immediately fill as one person passed, and another critically ill patient took their place. In March 2020, before it really hit home that COVID-19 could be, well, ‘at home,’ and before PPE protocols, we treated many patients with strange signs and symptoms. Looking back, they may well have had COVID-19. During the peak, although elective surgeries and interventions were on hold, our team treated strokes and other neurological emergencies, some associated with complications of COVID-19.
Is there a “most memorable” patient story you can share?
Yes, most definitely. It is actually a day I will never forget. I call it Extubation Day and discuss it at the beginning of my book. It was a few weeks after our COVID-Brain Team started. We made a plan to extubate (removing the breathing tube and ventilator) patients who were ready by the end of the week. That Friday, we extubated 25 percent of our COVID-ICU in one day. That was a first for our hospital. I remember each one of their stories and carry them with me still.
You say that you’ve “never felt more like a doctor.” What do you mean by that?
So much of medicine is evidence-based and guideline-driven, in fields including stroke and neurocritical care. Of course, that is extremely important to standardize care and optimize treatment. On the flip side, COVID-19 is a diamond in the rough. Especially early on, we had a sheer lack of evidence. But it created the impetus to think logically and for ourselves, understand mechanisms of action and make connections, and use the history of medicine to guide the here and now.
COVID-19 humbled the most experienced doctors and empowered younger doctors such as myself. The level of teamwork squashed hierarchies. The motivation to save lives trumped the burnout of working in shifts to cover the COVID-ICU 24/7. The director of our center brainstormed a non-neuro COVID-19 clinical trial that we designed and spearheaded from start to finish in the middle of the pandemic.
What’s it like to work in a hospital during the pandemic? Were you concerned about your own health?
The COVID clinical trial led by our team was, in fact, motivated by the need to protect frontline workers and eventually extrapolate those findings to the community at large. I was the trial study director and swabbed dozens of front liner workers for COVID-19.
In the ICU, there were inevitable breaches in PPE and exposure to intubated COVID-19 patients. I remember one case in particular. A few days after an intubated COVID patient’s secretions somehow made it passed my face shield. I had shortness of breath that kept me up at night for days.
When the team found out, they mobilized and constructed a makeshift pulse oximeter [device to measure oxygen in the blood] to ensure I was not hypoxic [low oxygen level]. I was not, and I tested negative for COVID-19.
Regarding life outside of the hospital, there was none. Our team lived in a quarantine hotel for the first wave of the pandemic away from our families. I am now more grateful than ever for my team.
Fourcand’s book is available on Amazon.