As an emergency medicine physician in the ER department for the last 20 years, Dr. Adam Ankrum is no stranger to being on the front line to whoever comes through the door needing immediate medical attention.
And he has seen it all. From young to old, to those considered otherwise healthy to individuals deemed high-risk, tending and providing treatment to the injured and sick — in all its gory detail — is what he does best.
Dr. Ankrum graduated from medical school in 2000, then completed his residency in Michigan and worked in Wisconsin before relocating to the Big Island in 2013 with his wife, Laura, and their three athletic boys — Alec, Aiden and Archer.
He spent the last seven years on island in the ER department, two at Kona Community Hospital and then the last five at North Hawaii Community Hospital (NHCH) that is now an affiliate of The Queen’s Health Systems.
The 47-year old Holualoa resident is also an accomplished triathlete and runner. He was a hurdler in college with 400 meters being the longest distance before dabbling in 5K races and sprint triathlons in his twenties. But it was only after moving to Kona that he was able to fulfill a childhood dream when he became an Ironman World Championship finisher in 2015.
A few days ago I was able to catch up with Dr. Ankrum just after he completed a nine-hour night shift at NHCH. Dr. Ankrum was candid with his answers while providing insight on what it’s like to be on the front lines amid the COVID-19 crisis, some valid frustrations felt, testing and treatment, juggling family and training, and advice he would like to pass on.
Amid COVID-19 hitting the Big Island, overall patient volume down
As COVID-19 hit the Big Island mid-March so did a feeling of panic as witnessed with the long lines of people at local grocery and big box stores. Many visualized our hospitals also being inundated with new patients much like what is happening to other parts of the country.
But not so, says Dr. Ankrum. The biggest change he’s seen is an increase in the level of people’s uncertainty and anxiety, while the volume of non-COVID patients coming into the ER has been down.
“I work the night shift at North Hawaii and it tends to be quieter in general, but it was actually my easiest shift in nearly a decade with only two patients,” he said during our phone interview on Tuesday. “Hilo (Medical Center) is typically the second busiest ER department in the state of Hawaii, but their patient volume has been down as well. On the mainland, ER numbers across the board for non-COVID patients are down, other than the really hard hit areas like New York and New Orleans, the actual number of patients walking in the door across the country is down.”
Dr. Ankrum attributes two factors that have kept the non-COVID emergency room patient count lower than normal.
“First, people are doing right by not going into the ER for trivial things, and two, due to the lockdown and shelter-in-place, there is less driving, less accidents, less injuries in general and — this is true for both mainland and Hawaii — less tourists on island, and people are not getting sick from other illnesses due to the decrease in interaction.
“So overall, emergency room visits are down especially at North Hawaii since 50% of our numbers come from tourists. However, the biggest change is the uncertainty and the anxiety from patients and health care staff. We as doctors are getting overloaded with information, the public is also getting overloaded with information — we’re just saturated.”
So what about the patients coming to the ER for COVID-19? Dr. Ankrum explained that Hawaii is unique because we have influenza every single month of the year, which doesn’t happen on the mainland because it tends to be more seasonal there.
“We will see cases of influenza every month and around the clock, while on the mainland, they will see cases initially in the fall months, then see it rise during winter. So with this COVID thing, a lot of people who initially came in tested positive for the influenza, not COVID.”
As of Tuesday, the total number of those testing positive for COVID-19 on the Big Island was 23.
Being saturated with information on COVID-19
Dr. Ankrum said the biggest frustration felt across the board for both the community and those in the medical field is the amount of new information that continually changes regarding COVID-19.
“The one thing that’s been really frustrating for both non-medical and medical people is, every single day we get new information,” he said. “So the non-medical people looking at CNN, watching the news, looking on Yahoo and Facebook tend to get inundated with tons of information every day. While for those on the medical side of things, we get tons of information from local doctors, our hospitals and colleagues on the mainland. But we get it every single hour.
“I probably get 20 emails every hour on how or what way is the best way to do this procedure or treatment. So we do not have enough information — or too much information, as a health care provider, on what is the latest and what is the best way to do something.
“There are so many ideas and no 100% proven way, that’s why there’s a ton of information out there. Personally, I feel that it will be much better in about three months when we have actual real data to say: ‘Hey, this treatment is 80% effective.’ Hopefully by then we will have more concrete numbers, so yes, it’s been frustrating.
“What happened initially, both on the mainland and Hawaii, is we didn’t get test results back right away. Now, we are getting test results back within a day. So that’s been really big. That was not the case a few weeks ago.”
Who should visit the ER?
Dr. Ankrum advised people shouldn’t come to the ER if they have mild flu symptoms.
“The caveat for COVID is if you are having breathing difficulties,” he said. “We see influenza all the time, and really, you don’t really need to go to the ER for influenza. You may be feeling terrible and in pain, but we don’t tend to treat for influenza except within the first 24 to 48-hours. Now if they are deemed a high-risk patient or a pediatric patient and they come in after experiencing influenza for 24 to 48-hours then I may prescribe medicine. If someone like an 80-year old has a lot of medical issues then yes, the flu can definitely push you over the edge.
“You can do a nasal swab and they can technically run an entire viral panel – influenza could be on that panel or separate and then COVID would be separate. What’s interesting is there is a panel that can run a dozen different viruses, and there’s multiple coronaviruses on there as coronavirus in general is one of the common cold viruses. But COVID-19 is one of the novel coronavirus and we have never had any exposure to it before.”
What is the treatment?
Dr. Ankrum said right now the treatment is fluids, rest, and for those who are really hurting or coughing badly, they may be prescribed a stronger pain and cough medication.
“I may also lean toward a prescription antibiotic along with the cough medicine for high risk patients who have other medical issues because a lot of times, one can become more susceptible to another bug because your immune system is weakened,” he said. “But we have been super lucky on the Big Island as our numbers have only been a handful compared to other places.”
Juggling family and training
When asked if he felt concerned that he may pose a risk to his family after each work shift, Dr. Ankrum replied, “Oh, definitely!”
“My wife, Laura, and I often talk about it. We feel grateful because our kids Alec (age 17), Aiden (15), and Archer (12) are older children. We have co-workers who have infants or very young children at home. So it’s definitely stressful. In our family, we are two health care providers as Laura is a family practice physician with West Hawaii Community Health Center. The West Hawaii Clinic also manned a COVID testing tent, which Laura worked in addition to her normal shifts, so it was pretty stressful that week.”
Trips to the grocery store have also added another level to take extra precaution.
“Because I’m on the front lines and definitely been exposed to people with COVID, I am always gloved and masked when I go into the store. In my situation, I do it more to protect others as much as to protect myself, because I know I have come across patients who have COVID. I think if you are a healthcare provider, you should be gloved and masked anytime you are outside. At the Queen facilities now, we have a mask on every time we are at work and every patient coming in gets a mask.
“If you have symptoms you should be at home. If you have no symptoms and have come across people who have symptoms, it’s better to be at home. Luckily we have neighbors who are Canadian and recently returned, and offered up their house to us to isolate if one of us ever got sick. And that was a huge relief being a health care family.”
As far as training goes, Dr. Ankrum feels that it’s important to keep himself active and healthy.
“Now because of time, I’m pretty much just running at a very low intensity,” he said. “I usually limit to three miles going very easy, and I rarely go over an hour as I don’t want to compromise my immune system. There are also no upcoming races so the intensity doesn’t need to be high. It’s important too, that I do not work out hard the day I have to go into work. Even more so with COVID, I don’t want to compromise my immune system.”
Dr. Ankrum’s advice
When asked what Dr. Ankrum would like people to know about COVID-19 he said, “It’s the real deal.”
“It’s something you don’t want. There’s professional athletes who may have scar tissue in their lungs for life, though not every one will get scar tissue. Influenza will not cause scar tissue but people can die from complications. This COVID is causing that kind of (complications and deaths) but at a higher percentage and that’s across the board. So that’s scary because we have never had any immunity to it.
“I personally feel that if our numbers stay pretty close to where they are now mid-April, then we might not get hit as hard like the mainland. But I think it’s two-fold: locking down the tourists and having the shelter-in-place in effect, although it’s killing people financially.
“I have a lot of colleagues on the mainland that I talk to and it’s really hell over there. We can read about these things, but I’ve actually talked to them on exactly what they are going through and right now, I can tell you that I’m really happy to be working in Hawaii.
“It’s real. We are so isolated from even non-medical things here that we sometimes tend to forget. I think we’ve been pretty lucky.”
As for advice to get through this tumultuous time, Dr. Ankrum says “try to stay happy.”
“I think every person is unique. Try to find something to engage in that is safe and brings you enjoyment. So try to stay happy — whether it’s reading a book, calling and talking to a friend, or going for a solo run. Your immune system works better. And you do need to disconnect a little bit because nobody is enjoying this time — there is nothing fun or uplifting about it. So try to look at the positives in your life and then make good decisions when you do need to go out.”