It’s 7 o’clock in the morning. In three hours, Dr. Angelica Honsberg, the division chief for the UNLV Pulmonary Critical Care Division, will begin another shift overseeing clinical care for patients with COVID-19 in the intensive care unit.

Some of the patients are on ventilators. “These are people who can no longer breathe on their own, so machines must be used to help them breathe,” said Honsberg, who has more than 20 years of experience in pulmonary/critical care medicine. “They’re in critical condition, on life support. Their lungs are affected by COVID-19 — there’s fluid in their lungs.”

Nevada's confirmed cases of COVID-19, the disease caused by a new strain of coronavirus first detected in China on the last day of 2019, continue to grow rapidly as testing expands. The Southern Nevada Health District reported the first case on March 11. Two weeks later, on March 25, there were 350 cases and 10 deaths in Southern Nevada.

“Unfortunately, there is no medication to treat the underlying infection,” said Honsberg. “We have to wait for the body to fight the infection.” 

National and International

The World Health Organization (WHO), which declared the outbreak a pandemic on March 11, now says virtually every nation has been touched by the virus, with deaths passing more than 20,000 globally.

“We currently don’t know how long patients will require mechanical ventilation,” Honsberg said. “Hopefully, over time, their lungs will heal as the infection is controlled.”

Honsberg said the ICU physician team from UNLV consists of about 10 practitioners — attending physicians along with doctors in specialty training as fellows and residents. They work with nurses and respiratory therapists to care for patients with the novel coronavirus. “When patients are this ill” one nurse is assigned to one patient in the ICU, she said. Respiratory therapists are frequently adjusting the ventilators and giving breathing treatments.

“It’s an amazing team,” she said, noting that an ICU pharmacist joins the team for morning rounds during which a treatment strategy for each patient is discussed. “I couldn’t ask for more. You have to communicate well and we do.”

Because of the virulence of the virus, Honsberg said, loved ones of patients cannot visit them.

“We communicate with the family on the phone,” she said. “It can become very emotional. We try our best to describe what’s happening with the patient.”

Patients on ventilators — all of whom are on general anesthesia — alternate twice a day between lying on their backs and stomachs. Honsberg said seven to eight medical professionals are needed to turn the patient over. The practice helps open up lungs that may have been compressed in one position, Honsberg said.

“It is very labor-intensive — you have to be very careful,” she said. “You can’t dislodge support equipment — all their tubes that include tracheal tubes.”  

Personal Precautions

A native of Delaware, Honsberg earned her medical degree from the Sidney Kimmel College of Thomas Jefferson University in Philadelphia. She completed her training in pulmonary medicine at the University of Arizona Health Science Centers and did a subsequent fellowship in critical care medicine at the University of Nevada School of Medicine. She joined UNLV in 2016.

Honsberg, whose husband also is a physician, describes herself as a “little germaphobe.” 

“I leave my shoes and outer clothes in the garage when I get home from work,” she said. “I always wash my hands before coming in the house.”

With her two sons now at home doing their college coursework online, Honsberg said the coronavirus outbreak has caused her to stop her parents from visiting.

“It’s hard on me and harder on them,” she said. “I told them they can’t visit for safety reasons until this epidemic has gone away.”

Throughout her years as a physician, Honsberg said she has trained for a pandemic, adding “but something you never want to see.”

Though this is a particularly stressful time, where long hours can be the norm, Honsberg said she’s glad she’s a doctor.

“You spend so much of your time training, continuously learning. It is gratifying to use all of my experience to try and help patients.”