Tabacco had never performed curbside care like this, but the 38-year-old felt prepared in that frantic moment. As an internist for the Washington Redskins, he was accustomed to working around obstacles in chaotic locker rooms, and he knew how to communicate with injured players while diagnosing ailments on a football field.
Just a month ago, Tabacco was tending to young teen athletes with concussions and elderly retirees with aching knees in Falls Church, Va., at PMA Health, an immediate care facility that specializes in sports injuries. Now he was trying to do his part on the front lines of the novel coronavirus pandemic, joining sports doctors across the country who are applying their skill sets in ways they never would have imagined.
In Massachusetts, a sports medicine office morphed into a coronavirus testing facility. In Texas, a prominent sports medicine specialist left his practice to work shifts in an emergency room. In Ohio, an athletic physician is helping lead his county’s response to the crisis. In hot spots from Washington state to Indiana to Michigan, athletic trainers signed up to help shorthanded hospitals through an app that normally helps them find work on fields or in gyms. And in Florida, Tabacco’s mentor, renowned orthopedic surgeon James Andrews, suspended Tommy John surgeries for athletes at his clinic to comply with the state’s ban on nonessential medical procedures.
So when Tabacco determined the woman in the car had a kidney stone and not the coronavirus, he felt he had contributed to the cause in some small way, offering immediate care to keep her from an emergency room bed that is becoming a dwindling commodity for virus-stricken patients.
“What we do in sports medicine, seeing people in locker rooms, seeing people in their houses, that really is Coronavirus 101,” said Tabacco, who alongside his duties with the Redskins also serves as a team sports physician at George Washington University. “It’s going to see people in the parking lot, seeing people in their houses. I’ve done a number of home calls since coronavirus hit. I think we’re really flexible physicians when it comes to how we see people.”
Tabacco’s operation has been a practice in flexibility since a long weekend in the middle of March, when he and his staff conducted hours of conference calls to revise protocols on how to respond to patients who might have contracted the virus. They had a shortage of personal protective equipment and would have to survive through donations, yet Tabacco knew a high percentage of the patients he had helped over the years — with knee or hip problems, diabetes or chronic lung disease — would also be those most susceptible to the virus. His staff devised a complex algorithm to search patient records and identify who might have dangerous underlying conditions.
Tabacco, along with his 15 partner physicians and an accompanying staff of 100, made hundreds of cold phone calls, leaning on telehealth like never before, even though some of the older patients were unsure how to video-chat. Other patients were unaware that Medicare was covering their visits by phone. Tabacco’s fail-safe has been to encourage those patients to cut through technological challenges and engage in the visits over video and, if necessary, to come to the clinic parking lot to receive care in their cars.
“We really had to rewrite our entire playbook,” he said, and it included providing curbside assistance for an average of 25 patients per day, many of whom have shown presumptive symptoms of the coronavirus.
Sports medical personnel around the country have joined the effort. The National Athletic Trainers’ Association connected nearly 10,000 athletic trainers with the opportunity to assist understaffed hospitals and stressed-out health facilities with the help of Go4Ellis, a mobile per-diem job platform. The app provided a flow of trainers who can help hospitals with skills they might use on fields and in gyms — including triage, intake, patient care and assessment, and sterilization.
“We’re hearing great stories of athletic trainers who are making a huge difference where the pandemic is the worst,” said NATA President Tory Lindley, who also serves as Northwestern University’s director of athletic training services. “They’re putting in really long days; they’re able to deliver a lot of covid tests; they’re able to communicate throughout the day with other providers.”
In between shifts last week, Tabacco received a text from a Redskins player about an injury unrelated to the virus, and when he returned the call to offer advice, he was reminded of the blunt professional transition he has made over the past month. Tabacco, who grew up in Rockville, Md., has leaned both on the inspiration of his lineage — in his family, he’s a fourth-generation doctor — and also on advice from mentors such as Andrews, who Tabacco said “is the king of sitting down with patients and getting a really good history in very tough scenarios, maybe on the football field or on the sideline, in a tense locker room. … You’re dealing with that to some degree with patients who are afraid.”
Another Andrews mentee, Umar Khan, confronted the same anxiety in patients over the past month. A sports medicine specialist with extensive experience serving professional and college athletes, Khan’s private practice was affected by Texas’s mandate to postpone all medically unnecessary surgeries and procedures to preserve resources for the fight against the coronavirus. Khan left his clinic, Stratton Sport & Spine, in March to focus on his duties as a physician in the emergency room at San Antonio’s Methodist Hospital Texsan, which on the final night of March had 24 patients with covid-19, including eight on ventilator support, he said.
“I’ve gotten myself away from doing anything in the clinic now because I consider myself an asymptomatic carrier,” he said. “I don’t want to potentially give it to my patients or my staff or anyone else.”
Tabacco carries that weight every time he leaves his clinic in Northern Virginia. His wife distracts their three young kids when he arrives home each night, and he immediately bolts for the basement to take off his scrubs and clean himself.
“We’re pretty on edge,” he said, so at night he has been sleeping alone in a side room in a child’s-size bed as an extra precaution.
He wakes by 5:30 a.m. to return to his clinic, parking his car in the same lot where he will serve his patients later in the day.