At the Quality Urgent Care clinic in Schertz, Dr. Teresa Godinez spends most of her shift examining, testing, counseling, and ushering patients through a COVID-19 testing circuit that can be replayed as many as 80 times a day.
The work is exhausting and disheartening for doctors like Godinez. The challenges of a relentless stream of patients and the uncomfortable PPE she’s in for hours at a time are compounded by the defeating realization that she can’t really help those suffering from COVID-19 symptoms.
“There’s nothing that I can do for them,” she said, besides offer advice – take Tylenol, drink plenty of fluids, and if you have any difficulty breathing, go the emergency room right away.
While most come for answers – to learn whether they have contracted the virus that causes COVID-19 – even those who test negative find little peace. Many are re-screened with a more intense test that takes three days for results. The process can be tedious and dejecting and come with more uncertainty than assurance.
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“COVID is almost like a weed that’s uncontrollable in your backyard,” she said. “It’s overgrowing everything else and taking over the healthcare system so that we can’t take care of patients who have other disease processes.”
June 3 is when Godinez saw her first patients test positive for coronavirus – two people who had no fever — so Godinez at first thought they might have a common cold.
Since then, she’s seen a steadily growing number of people with a range of symptoms from mild to severe, all seeking tests – up to 80 patients a day. “That is a really bad flu day in the winter, and that’s a high number,” Godinez said. “Usually, around this time, we wouldn’t expect more than 25 or 30 [patients]. It’s overwhelmed our capacity. We don’t have the staff to accompany what the public is demanding.”
As a doctor who ordinarily enjoys working in urgent care, Godinez admits the pandemic has made her dread going into the clinic. It’s not the risk, which she says comes with the job, but rather sending patients away without effective treatment.
“It’s a risk I accept,” said the mother of three. “I think our role sometimes is to help reassure and to educate as much as possible and to be optimistic, even when we’re discouraged.”
On a recent afternoon, one of her patients was a woman who explained to Godinez she travels frequently for her job and several coworkers had been diagnosed with the virus. After a trip to Washington, she came down with a sore throat in late June and felt pressure in her chest beginning July 4. She complained of a bad headache.
The day before she showed up at the clinic, Metro Health reported nine new coronavirus-related deaths, men in their 20s, 30s, and 40s. June had seen Bexar County’s coronavirus cases grow exponentially, prompting Judge Nelson Wolff to mandate county businesses enforce mask usage, and forcing Gov. Greg Abbott to backtrack efforts to reopen the Texas economy.
“I’m not scared, I’m concerned that I would spread it to [others],” the woman told Godinez. It was her second go-round with testing, the first one negative after a visit to Bexar County’s mass testing site at Freeman Coliseum in April.
Dressed in a blue protective gown that enveloped her small frame, and wearing gloves, a mask, and plastic face shield, Godinez checked the woman’s pulse, blood pressure, oxygen saturation levels, and temperature. She looked in her mouth, nose, and ears, listened to her breathing.
Then came the test – a quick nasal swab in both nostrils, causing the patient to cough lightly and say it tickled. Godinez left the room with the samples.
At the nurse’s station, Godinez inserted the specimen into a tube with a reagent solution, then used a pipette to drop the solution onto a testing cassette before placing it into one of three small testing machines sitting side-by-side on a counter.
The rapid antigen test is less sensitive than other kinds of tests and produces false negatives 10 to 20 percent of the time. And while some might find that problematic, Godinez said it makes for a good screening tool.
When Godinez returned to the expecting patient after running the test, she didn’t deliver a verdict, but rather a more pressing message.
“We need the room,” Godinez said. More people, sitting in the vinyl waiting room chairs in the narrow lobby of the clinic, were waiting for their turn to see the doctor. Godinez asked the woman — as she had asked patients before her, and would ask patients after her — to wait in her car for results. The cycle had to keep moving.
When a test comes back negative, but Godinez feels there’s reason to believe the patient might have the virus, she orders a more reliable PCR (polymerase chain reaction) test, which takes three days for results.
Despite the heavy patient volume, Godinez is just as concerned for the patients she doesn’t see as the ones she does – the ones who have other medical problems, but aren’t coming in, she said.
One recent patient with an irregular heartbeat had waited three weeks before seeing a doctor, afraid she would contract the virus while in the office. When Godinez finally saw the patient, she found that the woman had atrial fibrillation and was at risk of having a stroke.
As Godinez’s clinic and others around the county three or four weeks ago started seeing an influx of COVID-19 patients, many came in with a familiar refrain that they had been out drinking and socializing at bars. She started calling the governor’s office every day to call attention to the problem.
“I’m thankful the bars are now closed,” Godinez said. “Opening up Texas too quickly was unconscionable.”
Others seeking tests, she said, worked at nearby warehouses and distribution centers in the Schertz area. Only one patient who has tested positive told her that he had been at the Black Lives Matter protests in Austin.
As for the woman Godinez had tested, it was good news – negative for coronavirus. Now the patient will wait at home for the results of a PCR test while she cares for her sore throat and headache with rest and over-the-counter medicines.
In Godinez’s current climate, the patient is considered lucky — the doctor sends between one and two patients a day straight to the hospital — and if the patient stays lucky, she might not get worse.
“I’ve never seen anything like this,” said the 20-year physician. “I’ve never seen a disease process that could be either asymptomatic or so serious that they need to be admitted to the hospital.”