But even that experience could not have prepared me for working at the epicenter of America’s coronavirus outbreak as our hospital is already nearing its breaking point, with the peak of this outbreak still weeks away.
The first thing you should appreciate is the speed with which our hospital went from no covid-19 cases to being inundated with them. I saw my first covid-19 positive case a little over a week ago. Forty-eight hours later, I had seen dozens. Two weeks ago, we had zero confirmed positive covid-19 patients in the entire hospital. Today, three-quarters of our Emergency Department space is reserved for people with confirmed or suspected covid-19. Over the past 10 days, the number of patients on ventilators has nearly quadrupled.
In light of this impending shortage, we were recently sent a protocol to help guide us in determining which patients will get access to the dwindling number of ventilators in our hospital should we indeed run out. Following it would mean disconnecting some people from ventilators because they have not improved over their first few days. In some circumstances, it could mean allocating lifesaving ventilators by drawing lots.
Our supply of personal protective equipment is running dangerously low. We wear N95 masks intended for use with a single patient for our entire shift, when we see dozens of them. I was told to clean and take my eye protection home because there might not be more when I returned.
We wear the personal protective equipment we have whether we are in the covid-19 areas or in the sole remaining non-covid-19 space. That’s because even patients triaged to the non-covid-19 area may well end up testing positive. One of my trauma patients recently reported no respiratory or infectious symptoms — it was only the chest CT scan that tipped us off. The images were filled with the “ground glass opacities” characteristic of the coronavirus’s wanton rampage through the lungs.
The crush of covid-19 patients has dangerous consequences even for those with other health conditions. The area of the hospital where we usually run traumas or cardiac arrests is necessarily devoted to the care of covid-19 patients in extremis. So we care for critically ill, presumably non-covid patients in an area of the emergency department not designed for that purpose. Last week, we had a patient who came in altered, with signs of significant head trauma — we were concerned they might have a brain bleed and need to be intubated. But when the patient arrived, no ventilators were available in that area of the department.
But we aren’t just running low on ventilators; we’re also running low on more banal therapies. This week, I tried to get one of my asthma patients an albuterol inhaler only to be told by multiple pharmacies that this common medication was on back order and might not be available for another week.
Some in positions of authority have recognized and acted on the need for ventilators, for hospital beds and for more personal protective equipment for front-line medical workers. But it is likely the need will be far greater than even most of these leaders realize. We stand now at a pivotal moment when acting rapidly to manufacture and distribute this equipment will save lives, and when not doing so will mean abandoning thousands to needless death.
Meanwhile, our waiting room fills with the mildly ill and even the worried well — over 100 patients at any given time. Some have waited for more than 10 hours to be seen, all the while exposing themselves to a waiting room crawling with viral particles. The 1986 Emergency Medical Treatment and Labor Act requires we give each patient a full medical screening exam if they show up to the emergency room. In ordinary times, there is no question of the law’s salutary effect. But it also prohibits us from issuing blanket statements that people should go home if they have no symptoms. I have seen hospital staff seek to overcome this prohibition by stressing to those in the waiting room that we would not be testing the asymptomatic and emphasizing the risk they were taking just sitting there hour after hour. But these warnings appeared to have little impact.
It’s been a surreal experience to work in covid-land by night and then emerge into daylight, my N95 mask and goggles saved in a plastic bag for later reuse, only to see people still congregating in groups.
Despite this epidemic we are facing in New York City, there are some still skeptical of the gravity of the crisis before us and the pressing need for each of us to do our part in curtailing the virus’s spread. Already, there are rumblings in various corners that our response is overblown — President Trump himself has begun hinting as much. This is deeply, dangerously wrong.
New York City is in worse shape than the rest of the country, no doubt a result of unusual levels of urban density and multigenerational living patterns. But it would be naive to assume that other areas throughout the nation will not experience a similar spike, and soon.
Grim as this is, there is cause for hope — the efforts of other countries at widespread social distancing and mobilization of resources have borne fruit. If we follow such a path, we can slow the spread of disease, giving ourselves time to get additional equipment and perhaps even run the trials needed to find lifesaving treatment protocols. But it will only work if we keep at it and ignore the siren calls we are already hearing to downplay this epidemic just as we are recognizing its true severity. The lives of many of our friends and family members depend on it.