March 26, 2020
UNLV Medicine's ICU Team:
On the Frontlines of COVID-19 Crisis
UNLV Medicine's ICU Team, comprised of attending physicians along with residents and fellows and a U.S. Air Force Physician Assistant, are caring for a growing number of COVID-19 patients. Pictured L-R: Dr. Kush Modi, Dr. Rajany V. Dy, Dr. Angelica Honsberg, Dr. Elizabeth Au, Dr. Alfredo Iardino.
Editor’s Note : UNLV School of Medicine faculty physicians, fellows, residents and students care for our community in several hospitals in Southern Nevada.  

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, which literally can be lifesavers. 

“These are people who can no longer breathe on their own, so machines must be used to help them breathe,” says Honsberg, who has over 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.”

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 in Nevada as testing expands. The Southern Nevada Health District reported the first case on March 11. Less than two weeks later, there were 190, with two deaths. 

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

Nationally, there are more than 54,000 cases and 700 deaths. 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,” says Honsberg. “Hopefully, over time, their lungs will heal as the infection is controlled.” 
UNLV School of Medicine resident physicians play a key role on the ICU team. They are L-R: Dr. Jason David, Lindsey Schmelzer, P.A., Dr. Pallavi Satuluri, Dr. Jaclyn Matsuura, Dr. Amit Sanyal, Dr. Yen Cao.
Honsberg says the UNLV ICU physician team 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. She says “when patients are this ill” one nurse is assigned to one patient in the ICU. Respiratory therapists are frequently adjusting the ventilators and giving breathing treatments.

“It’s an amazing team,” she says, noting that an ICU pharmacist joins the team for morning rounds when 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 says loved ones of patients cannot visit them.

“We communicate with the family on the phone,” she says. “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 says 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 says.

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

A native of Delaware, Honsberg earned her MD from the Sidney Kimmel College of Thomas Jefferson University in Philadelphia. She completed her training in pulmonary medicine at the University of Arizona Health Sciences 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 is also 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 says. “I always wash my hands before coming in the house.” 

The mother of two sons who are now at home doing their college work online, Honsberg says the coronavirus outbreak has caused her to stop her parents from visiting. 

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

Throughout her years as a physician, Honsberg says she has trained for a pandemic.

“It’s something you train for,” she says, “ but something you never want to see.” 

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

“You spend so much of your time training, continuously learning. It is gratifying to use all of my experience to try and help patients.”
UNLV Medicine is the affiliated clinical practice of the UNLV School of Medicine