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Photo by Jonathan Ernst/Reuters

For Miller, the stakes of this situation didn’t fully set in until he saw his first atypical presentation of the disease. In the early weeks of the pandemic, a woman with an erratic heartbeat came in to his ER. She had a history of what’s known as atrial fibrillation. And her heart was beating wildly, at almost twice the normal rate.

Miller and his colleagues focused on that; they wanted to get her heart rate under control. “A few hours later she spiked a fever and then we realized, ‘Oh gosh, there’s more to this story than just atrial fibrillation,” he said. They sent her for a swab. She had COVID-19.

“Theoretically, you know that this is going on,” Miller said. “And it’s something we’ve been talking about. But to actually see that happen right in front of me was like, ‘Oh my God’. I was fortunate that I had taken appropriate precautions with her. I was wearing a mask, I was wearing a gown. But I was just kind of going through the motions, just doing it because everybody else was doing it. And then when she spiked a fever, it really became much more internalized.”

Miller and several colleagues recently published a paper on early lessons learned from the pandemic in the Seattle area. He said the message to take from this is not that it’s useless to separate COVID from non-COVID patients. “You can do it,” he said. You just can’t assume that because you’ve done that, the rest of your ER or your clinic is COVID-free.

“Somebody was telling me, ‘Oh, this is our clean zone, that’s our dirty zone.’ And we made the point like, ‘No, that’s your more dirty zone and that’s your less dirty zone,” Miller said. “There’s certainly patients where it’s high risk, and there’s patients where it’s low risk. But at this point, there’s no patients where it’s no risk.”