Frontline medical workers in New York are braced for a surge of patients unlike anything they have seen in their careers, with the state at the center of the coronavirus pandemic in the United States.
New York City’s infamously bustling streets have almost emptied of pedestrians and cars, but inside its hospitals, emergency departments and critical care units are already busy with Covid-19 patients.
“We’re trying to expand the capacity in our intensive care unit, knowing we will continue to see a lot of critical cases,” said Erick Eiting, vice-chair of emergency medicine and professor at Mount Sinai Beth Israel, a 700-bed hospital in lower Manhattan. Eiting’s days are now filled by the pings of an app, which notifies doctors when a Covid-19 test comes back positive. He says it pings constantly.
Dr Craig Spencer, an emergency medicine doctor at Columbia University Medical Center, described hearing a “cacophony of coughing” in the facility. Nearly every patient he saw in a recent day had Covid-19.
Walk in for your 8am shift: Immediately struck by how the calm of the early morning city streets is immediately transformed. The bright fluorescent lights of the ER reflect off everyone's protective goggles. There is a cacophony of coughing. You stop. Mask up. Walk in.— Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020
“I certainly have not seen anything like this so far in my career,” said Dr Daniel Fein, a respiratory specialist at Montefiore Medical Center. “This seems like certainly an exceptional circumstance for doctors and everyone else in our global community.”
Forecasters warn the greatest surge of patients is yet to come. Governor Andrew Cuomo has said efforts to “flatten the curve”, or slow the spread of Covid-19 so hospitals are not overwhelmed, may be having an impact, though cases continue to increase at a quicker rate than previously forecast.
New York officials expect 140,000 hospital beds will be needed to deal with the pandemic, 30,000 more than predictions a few days earlier. New York state had about 53,000 hospital beds at the beginning of the pandemic.
New York authorities are preparing to open field facilities, including a 1,000-bed hospital inside New York’s Jacob Javits Convention Center. Primary care doctors are directing patients with lacerations and broken bones to private practices to relieve “gridlock” in hospitals.
Nearly everyone you see today is the same. We assume everyone is #COVIDー19. We wear gowns, goggles, and masks at every encounter. All day. It's the only way to be safe. Where did all the heart attacks and appendicitis patients go? Its all COVID.— Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020
“The anxiety and stress that I think all of us in society are feeling right now — we are feeling it all the more so in the hospital,” said Dr Joseph Habboush, an emergency room doctor at New York University Langone Medical Center told the Associated Press this week. “How can we deal with the idea that this is going to be worse and worse before it gets better?”
Meanwhile, a global shortage of protective equipment including N95 respirator masks, and lack of ventilators has led to “palpable anxiety” in the emergency department, Eiting said.
Cuomo promised to “turn this state upside down,” to find needed staff, equipment and capacity, and said he is exploring whether hotels and dormitories can be turned into makeshift hospitals. He also called on retired healthcare workers to volunteer as a “surge health force” to staff those beds, and has even said New York hospitals will experiment with trying to use one ventilator for every two patients in need.
“If you walk around here, you don’t have a sense of a medical health crisis taking place,” said Dr Mary O’Brien, a primary care doctor at Columbia University. O’Brien has worked in New York City for 35 years, including in emergency medicine for 10 years. She, along with thousands of others, has volunteered to be part of that “surge health force”. In her Manhattan neighborhood, foot traffic in “streets and the number of cars – and everything has plummeted”.
However, inside hospitals, her colleagues have reported “chaos”, she said.
“In general, the hospitals in New York City run close to capacity,” under normal circumstances, she said. “Most of them are close to 90% capacity, especially for the critical care units,” she said. That makes the additional Covid-19 cases a “huge influx”.
Her work has now turned to telemedicine, including counseling patients who might otherwise go to the emergency department to go to private practices. For a patient in need of stitches, she asks a hand surgeon to stitch them up.
“If someone falls and it looks like they have a fracture, I will contract orthopedics in private practice and have them seen there, and we can relieve the gridlock,” she said. “The triage part of it is really important.”
Above all, doctors stressed the need for the public to continue physical distancing to protect healthcare workers and supplies.
“We’ve seen plenty of young patients who came in and are critically ill,” said Eiting, as well as other patients whose symptoms are atypical. “We’ve had plenty of [Covid-19] patients who have come in with abdominal pain or nausea, vomiting and diarrhea – and those are their only symptoms.”
Patients with few and mild symptoms have tested positive. Critically ill patients have tested positive. Every patient, Eiting said, is treated with some degree of caution in case they, too, are positive.
“The most important piece is people really need to take the recommendations to stay home and self-isolate very seriously,” said Eiting. “Much more seriously than we’ve been taking them.”