In the Trenches Against COVID-19

This story originally appeared on the website of the Rutgers School of Arts and Sciences–Newark.

Dr. Carlos Remolina (SASN ’73) has had an illustrious 40-year career as a pulmonologist in northern New Jersey, holding down a private practice while serving as Division Chief of Pulmonary Diseases at Trinitas Regional Medical Center in Elizabeth, NJ, as well as Medical Director for Care One, a healthcare company that runs long-term acute-care facilities within Trinitas and other hospitals. He’s also President of the Medical Staff at Robert Wood Johnson University Hospital in Rahway, NJ.

When Covid-19 hit New Jersey, his life and that of the healthcare professionals around him changed dramatically. He’s been on the frontlines of the pandemic since early March, working seven days a week at both hospitals while coordinating care with doctors and senior hospital officials across the region.

“I’ve been in practice the last 40 years. I’ve never ever seen anything like what we’re going through now,” said Remolina, who majored in biology at Rutgers-Newark and earned his medical degree at the University of Medicine in Zaragoza, Spain.

To handle the flood of patients coming into their emergency rooms (ERs), both hospitals have converted elective-surgery areas to Covid-19 care, adding beds to augment their Intensive Care Units (ICUs). And both have done everything possible to ramp up staff as stress, exhaustion and illness have taken a toll on healthcare workers.

At Trinitas, Remolina oversees the Department of Pulmonary Medicine, with an ICU expanded from 25 to 40 patients and staffed by dozens of ICU nurses, five pulmonologists, 30 respiratory therapists, and a cadre of residents who have been his “boots on the ground,” monitoring and updating him on patients.

In his Trinitas Care One role, Remolina employs 30 nurses to help run a 25-bed unit that has been expanded to 40, taking over a post-op area no longer being used for elective surgery. The staff includes four respiratory therapists, along with social workers and speech therapists. Some 25 doctors spanning many specializations round out the team, a portion of whom help with Covid-19 patients.

As President of the Medical Staff at Robert Woods Johnson, Remolina is responsible for 200 doctors, working with the administration to ensure smooth functioning of the hospital and set up their Covid-19 unit with 17 doctors of varied specializations: pulmonology, infectious disease, and cardiology, to name a few. Unlike at Trinitas, he has no residents to help with the 15-bed ICU filled with Covid patients, which has spilled over into an ER area now dedicated to the pandemic. The hospital has hired additional doctors, nurses and anesthesiologists to deal with the flood of patients, expanding privileges to 50 new staff.

Remolina’s combined caseload at the two hospitals exploded from 30 patients per day in early March to between 75 and 100 at the peak of the Covid-19 pandemic in late April. It’s down 25 percent now.

“It was five going and five coming,” said Remolina. “Now patients are going and not as many are coming.”

They’ve ranged in age from 30s to 80s. And while the vast majority have been older with co-morbidity issues, Remolina has seen his share of healthy young and middle-age patients, some of whom have fared poorly. Most have been Hispanic and African American, living in close quarters with few resources. In his caseload, about 90 percent of intubated patients over 80 have died, as have many over 70 who have been on a ventilator.

While Remolina has had some remarkable successes in treating Covid patients, the virus itself has been a formidable opponent, causing doctors like him to feel that no matter what they do, no matter how many treatments they try, it often won’t be enough.

Covid-19 attacks the lungs and kidneys, causes blood clots, and creates major inflammation issues due to the body’s massive immune-system response. And the things that make Covid-19 a silent transmitter, turning people into carriers without them knowing it, also make it very difficult to treat: Those who develop Covid pneumonia don’t feel short of breath, even as their oxygen levels fall, and by the time they do, they have alarmingly low oxygen levels and moderate-to-severe pneumonia. This oxygen deprivation, known as “silent hypoxia,” means patients show up at hospitals in critical condition and often die soon thereafter.

“This is not like any other type of viral infection: It destroys the organs and lungs,” said Remolina. “The lungs are sponges that move back and forth, and now they become dried out and rock-hard, with no movement or exchange of gases and air. When you try to open them up by pushing oxygen in with a ventilator, the lung doesn’t expand. It follows path of least resistance, and where the lung is weak, it pops, and air gets into the area outside the lung, which is very dangerous. We’re seeing this with not all patients but a lot now.”

Remolina also has seen many patients with Covid-related blood clots, which have caused kidney malfunction, strokes and loss of limbs. They also can result in pulmonary embolisms, or clots in the arteries of the lungs, which usually travel up from the legs. Consequently, every Covid-19 patient of his gets blood thinners to prevent clots from developing in the first place.

The stress of treating these patients also has been immense, as healthcare workers like Remolina put their own lives and the lives of their families on the line every day, not knowing if, while bending down to listen to a patient’s lungs or intubating them, they’ll contract the virus. The shortage of Personal Protective Equipment (PPE) isn’t helping. Neither is the lack of widespread, reliable testing or the difficulty accessing plasma for antibody therapy, says Remolina.

And dealing with patients’ families has been especially hard.

“They’re separated from the patient, who’s all alone, and they make us feel like we’re gods. They place so much faith in us,” said Remolina. “We see this in normal times, but now it’s multiplied by a thousand. It’s a tremendous responsibility to handle.”

One bright spot amid all the devastation has been Remolina’s fraternity brothers from Rutgers-Newark, where he co-founded Kappa Phi. The brothers recently celebrated the fraternity’s 50th anniversary by creating an endowed scholarship at SASN.

Early on in the pandemic, when Remolina spoke about PPE shortages, his Kappa Phi brothers offered support, and one from California sent him a box of N95 masks.

“Throughout the years, I have had great friendships with these folks, totally different from what I do every day,” said Remolina. “Kappa Phi has been very important to me, and the satisfaction I receive from these friendships has meant so much over the years.”