Treating COVID-19 South of the Border

By Trisha Kholiya

In some ways, San Diego has been lucky: The rise in COVID-19 cases in the county was initially delayed compared to many other places around the U.S., which bought some time for health care providers to aggressively prepare to be as ready as possible when the spike came.

However, just south of the border in Tijuana, Mexico, a combined shortage of resources, along with less strict social distancing and governmental outreach, caused the virus to spread more quickly. As more people with COVID-19 arrived in Tijuana's hospitals, many physicians providing care to them in the intensive care units also got sick with the disease. Although other physicians and care providers stepped in to volunteer, many lacked training in ICU care.

That was when UC San Diego Health Pulmonary Critical Care, a division of the UC San Diego Medical School, set up a working relationship with the Tijuana General Hospital for cross-border collaboration in fighting COVID-19. The program recruited Drs. Allison Berndtson and Jessica Weaver, who have surgical subspecialties in surgical critical care and do general ICU care. Their role is to act as ICU consultants, providing support and giving advice to physicians in the ICU.

Dr. Berndtson has worked in hospitals around the world and said that Mexico, like many developing nations, does not have as many clinical resources as does the United States. Dr. Berndtson also noted differences she saw in Tijuana in terms of preparedness and resources for treating COVID-19. But she also commends the commitment of physicians and nurses in Mexico, many of whom are volunteering their free time to take care of patients – even with limited training – because nobody else can.

"COVID-19 is so much bigger than other diseases have been," Dr. Berndtson said. "Everyone is affected by it, and it's this scale of the disease that is the difference."

For Dr. Weaver, this was her first cross-border health experience.

"It was definitely a profound realization to see a hospital 20 miles away from my house without as many resources as we have here," Dr. Weaver said.

Both doctors say the experience has been an emotional one. On Dr. Berndtson's second day in the Tijuana General Hospital's makeshift ICU COVID-19 unit, three patients died during her shift, one of whom passed away as they were watching him and discussing his health.

For Dr. Weaver's part, since the Pulmonary Critical Care Division has been leading care of COVID-19 patients at UC San Diego Health, she said she hadn't seen many patients with the disease prior to this trip. She noted that while she was there, she was also surprised by how many of the patients were young, healthy individuals, and surprised by how many doctors and nurses had to work outside their chosen specialty to accommodate this surge of sick patients. She was also saddened by how the hospitals were missing basic resources such as pain medicine and pillows. Although she felt like there was nothing she could do to make a big difference, the physicians in Tijuana appreciated all of the support she provided. Nurses that were there at the beginning of the cross collaboration noticed lots of positive changes in the hospital and management of COVID patients.

Both of the doctors agreed that physicians from UC San Diego should help in this effort and acknowledge how privileged San Diego is to have the clinical resources it does compared to a hospital barely 25 miles away. And after being in an environment where they saw the drastic effects of COVID-19 on patients and communities, the doctors urge people to maintain social distancing and to be as safe as possible when they do leave the house.