Last week, we published a profile on Dr. Carlos Remolina (SASN ’73), a sought-after pulmonologist in northern New Jersey who wears many hats. This week we have a follow-up Q&A with Remolina, who has a private practice in Linden, NJ, and serves as Division Chief of Pulmonary Diseases at Trinitas Regional Medical Center in Elizabeth, NJ. He’s also Medical Director for Care One, a healthcare company that runs long-term acute-care facilities within Trinitas and other hospitals, and President of the Medical Staff at Robert Wood Johnson University Hospital in Rahway, NJ.
In his 40 years of practicing medicine, Remolina had seen it all—until Covid-19 hit New Jersey in mid-March. The virus has presented numerous challenges for him and his staffs, and since the start of the outbreak, he’s been working seven days a week at both hospitals—with no time off—while coordinating care with doctors and senior hospital officials across the region.
We recently sat down with Remolina to discuss what it’s like on the frontlines of the pandemic, as well as developments and challenges with testing and treatment, and the toll the virus is taking on families, medical staff and hospitals.
When did you see your first case of Covid-19?
Around March 14 in my office, I saw a relatively healthy 83-year-old who had a cough and shortness of breath. A chest x-ray showed Covid pneumonia. He ended up on a ventilator and died. In my practice, I have many, mostly older, patients with co-morbid diseases such as asthma, pulmonary fibrosis or other bronchial issues, and many have gotten Covid.
Covid-19 is affecting younger, healthy patients as well, correct?
Yes. I had a 30-year-old who had never been sick who developed respiratory failure, was intubated and died. There was a 32-year-old who was similar and also received dialysis who died. And a 42-year-old who had never been sick in her life, had three kids, and came to the hospital with an upper-respiratory infection and shortness of breath. No meds worked. She had renal failure, blood clots and ended up on a ventilator and died. This virus is affecting everyone. It’s very sad.
The blood clots have been a big problem.
That’s right. Clots in the legs can knock out a patient’s kidneys, and cause strokes and loss of limbs. Several patients have lost limbs because of clots. It’s very upsetting. We put all patients with Covid pneumonia on blood thinners to prevent clots. We hope it helps but don’t know for sure.
What are some of the treatments you’ve been using to fight the virus, and how are they working?
We used chloroquine with a 49-year-old woman from Nigeria, along with other meds, and nothing helped, though she got better. We’ve tried remdesivir, an antiviral drug that blocks the RNA chain, upsets viral replication and causes the virus to die. Studies have shown that patients on it take 31 percent less time to recover. We just got permission to start using it at Trinitas. We’re using it with two patients. We’ll see what happens.
Have you used blood-plasma infusions from recovered Covid-19 patients to treat this?
We’ve tried on two patients at Rahway. One patient was doing okay. He was a healthy 66-year-old with Covid pneumonia. We tried many things: an interleukin-6 inhibitor, plasma treatment, dialysis. He spent over 10 days in the hospital, and nothing helped. Eventually his blood pressure dropped, and he went into cardiac arrest and died. So, we’re not seeing much progress with this therapy. And the trouble is getting the plasma itself. We got New York Red Cross plasma for Rahway and have registered with the Mayo Clinic. We just have to wait and see.
Inflammation is also a huge problem, as Covidi-19 often causes a massive immune-system response that can be worse than the virus itself. You mentioned interleukin-6: Is that helping to tame this response? How about other remedies?
We haven’t seen much success controlling inflammation with interleukin-6 inhibitors. It’s not a panacea. We’ve also been using corticosteroids on a lot of people. Some respond, but many don’t. And we’ve tried human umbilical-cord stem cells, which have been used with SARS and Ebola: We just started a patient on this treatment today. We’ll see how it goes.
We fell behind the virus because of no testing. Many deaths could have been prevented. The U.S. is the richest country in world. Yet you have a better chance of getting tested in Congo than here.
Testing has been a big issue in the U.S. It’s still not widespread and can be unreliable. What are your thoughts on this?
It’s a big problem. We fell behind the virus because of no testing. Many deaths could have been prevented. The U.S. is the richest country in world. Yet you have a better chance of getting tested in Congo than here.
That brings us to antibody testing and whether having Covid-19 gives you immunity. That looms large now as reports of relapse cases pour in.
With antibody testing, we still don’t know how we’ll do it. There are no federal government guidelines or protocols for consistency. We’re falling behind. The question now is: If you have Covid, will you be immune? We don’t know. It will take time to know about relapses. I haven’t seen any true relapse cases yet.
How has it been dealing with patients and their families during the pandemic?
The saddest thing is that so many people come in and die by themselves. They’re separated from their family. The nursing staff and doctors are the only folks who are with them. One patient called his family before intubation to say goodbye. My heart was broken.
Given the stress you and your colleagues have been under, do you think there are long-term mental-health ramifications for medical professionals?
This will likely have long-term effects. It’s changed all our lives. When you see the devastation, it just breaks your heart: A 30-year-old dies no matter what you do. You talk to the family, who cannot see them. It’s very depressing. And the doctors and nurses can catch the virus; we’re exposing ourselves every day. I have friends who’ve gotten Covid pneumonia, one doctor in Rahway. At home, it’s my wife and me, and she’s stressed out because she sees me upset. I’ve had no days off since March 14, and we’re in contact with our kids but can’t see them. It’s been very tough.
Is there mental-health support in place for the staff at your hospitals?
There’s a chaplain at Trinitas—it relaxes me to talk to him—and there is a hospital psychiatrist as well, and my Kappa Phi [fraternity] brothers [from Rutgers-Newark] have been very helpful. But there’s no formal system in place. But I will now bring this up with my colleagues. We deal with death and destruction every day. We take care of others but rarely ourselves.
If you had to summarize what’s changed since the outbreak, and the challenges that you and the hospitals have faced, what would they be?
The disease itself, the precautions we’ve had to take, the PPE shortages, the number of patients, the emotional strain of caring for people with this virus: From a doctor’s perspective, you don’t want to miss anything for critical-care patients. If they die, I want to be sure It’s not because of something I missed. Dealing with families who cannot see their loved ones is another big issue. The hospitals themselves are also strained: They've lost a tremendous amount of revenue from canceled elective procedures and have added costs from hiring hire staff to care for Covid patients. And the strain on those doctors who cannot practice. The financial, physical and emotional toll it’s taking on us is tremendous.
What’s it going to take for us to get ahead of this virus?
Testing. That’s the most important thing. We need to know how many people are carriers so we can treat and quarantine. We need antibody testing protocols so we can see the kind of response we have with plasma. We need to be able to use [the antiviral drug] remdesivir to give patients a chance and make a dent in the disease. And we need to support people like Dr. [Anthony] Fauci. He’s under duress dealing with this administration but has been doing a great job not only now but since the 1980s AIDS epidemic.
Do you have any final thoughts or advice you’d like to share with readers?
Prevention, prevention, prevention. Social distancing. Stay away from people. Believe that you and others are carriers. Wear a mask to protect others. Wash hands frequently with soap for 20-30 seconds, and use hand-sanitizer. There’s a reason we haven’t seen more deaths: social distancing. We’ll recover from the financial strain but not if we die.
Thank you for spending time with us and sharing your unique perspective on this. And thank you for your service.
Thank you very much.