REUTERS/Andrew Kelly
Health workers in protective gear peer from a tent which was constructed to test people for the coronavirus.
- New York City's hospitals are bracing for a more coronavirus cases by adding additional beds, pulling in additional staff, and getting more equipment.
- Since March 15, Dr. Craig Smith, the chairman of the Department of Surgery at NewYork-Presbyterian's Columbia University Irving Medical Center, has been writing daily letters to staff detailing how the health system is responding to the pandemic.
- The updates give a day-by-day account of the pressures facing a health system as the outbreak unfolds.
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Dr. Craig's Smith's April 1 letter featured lines from the TS Eliot poem "The Waste Land."
"April is the cruelest month, breeding / Lilacs out of the dead land, mixing / Memory and desire, stirring / Dull roots with spring rain," he quoted from the poem. The rest, he said, is "too long, too grim and overwrought for my taste."
Smith said he chose the lines for their mentions of mixing memory and desire.
"In an April that may be apocalyptically cruel, that is how we are poised, desiring spring," he wrote.
Smith, the chairman of the Department of Surgery at NewYork-Presbyterian's Columbia University Irving Medical Center has been writing daily updates on the state of the health system since March 15, the day the organization decided to stop doing elective procedures.
Posted on Twitter, the letters have been a source of poetry and inspiration, as well as information, as New York City has been hit hard by the coronavirus pandemic. The Wall Street Journal called Smith "the pandemic's most powerful writer."
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On March 30 for instance, Smith said the organization expected that it needed to almost triple its intensive care unit capacity - going from 400 beds to 1,100 - to confront the rising cases caused by the COVID-19 virus.
"Field hospitals are familiar elements of forward areas in armed conflicts and in natural disasters," Smith said on March 30. "Yes, it is getting that serious." Smith declined a request for an interview for this story, saying that he won't be doing interviews during the crisis.
New York Gov. Andrew Cuomo on Saturday said that he's expecting the peak of new coronavirus cases in the state will come in the "seven-day" range between April 4 and April 11.
Confronting a massive outbreak
Over the course of the weeks Smith has been writing updates, he's included key facts about what the health system is doing to confront the pandemic.
At the start of his dispatches, he spoke mostly about the logistics of calling off elective surgeries.
"Let me emphasize that we're not overwhelmed yet! It's a beautiful sunny day," he wrote. "We have our families and friends. No matter how many of us get infected, the vast majority will do well."
Early on, the challenges of healthcare providers becoming ill were a fixture of his updates. On March 17, he noted that 20% of the emergency-medicine faculty were out sick or quarantined. "In case you had any doubt, this is serious," Smith wrote.
As the coronavirus outbreak ramped up that week, he noted that it was still in the "terrifying, accelerating phase."
That weekend, on March 20, Smith said he expected the peak in 22-32 days, by which point the health system would need anywhere from 700 to 934 ICU beds. He called the data "alarming."
Read more: A leaked presentation reveals the document US hospitals are using to prepare for a major coronavirus outbreak. It estimates 96 million US coronavirus cases and 480,000 deaths.
At that point, the health system was caring for 300 people who'd tested positive for coronavirus
A lot had changed in the course of just a week.
"One week ago I was optimistic that our health care systems could avoid being overwhelmed, even as we began eliminating elective surgery," Smith wrote on March 21. "Yesterday I realized that only planning, cooperation, execution, personal sacrifice, and maybe a little luck will allow us to avoid being overwhelmed within a few weeks. "
A colleague, he noted in a March 27 update, had been intubated. "The enemy is inside the wire."
Smith that week noted logistical changes happening in the hospital. He wrote that as of Wednesday, the organization had converted empty operating rooms into ICU rooms, each holding two to three patients with COVID-19. Some, he said on March 25, were sharing ventilators.
In an April 4 update, he described seeing "his" operating room, OR 22. Inside, a place where he had done thousands of procedures he wrote, were several critically ill patients who were being taken care of by a cardiac surgeon and a cardiac anesthesiologist who had been redeployed.
'We got this'
The updates often include poetic observations about the response to the pandemic.
By March 31, Smith described the scenes of the public spaces in the medical center as "calm." That's not to be mistaken as a "calm before the storm" given the state of the hospital's intensive care units, he noted.
"For a better metaphor imagine being part of an expedition paddling downstream on a vast and unexplored river," Smith said. "Tornadic rapids have been surmounted, torrential rain has been tolerated, blisters are healing, loss of life has been acceptable, all consistent with the plan. We got this."
Around the hospital he said, he sees surgery residents deployed to help care for patients. They project optimism and energy, he said on March 31.
"What everyone has done to get us to this point of preparedness is breathtaking, and makes us all infinitely proud, but it is horribly precarious."
A week earlier, on March 24 Smith had discussed the rate of new admissions to the hospital. At the time, it had been 10% increases each day, 20% of which were sent to the intensive care unit. Redeployments of surgery staff at that point were just starting.
And almost a week later, on April 6, he worried about the pressures facing ICU nurses. By April 3, the health system had 2,000 COVID-19-positive patients.
But Smith also wrote that the data - namely the rate of change in new cases coming to the hospital - suggests we're approaching a peak in the number of cases.
Even so, Smith wrote the day before, "we are hurtling into weeks predicted to be our worst."
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