'The scary things that this virus can do': Doctors across NYC share the harrowing reality of caring for oxygen-starved coronavirus patients as equipment runs short
- New York City's hospitals are filling with coronavirus patients as the pandemic hits the city.
- In response, hospitals are finding new ways to add beds and increase the number of patients they can care for.
- The pandemic has transformed everyday life, creating a new reality for healthcare workers across the city.
- Visit Business Insider's homepage for more stories.
Dr. Trevor Pour, an emergency medicine doctor at Mount Sinai Health System, feels like he has a different job now.
In the ER, Pour would usually see a vast array of health problems: broken bones and scrapes, coughs, stomach woes. This week, none of that. Pour is now a "full-time coronavirus doctor," he told Business Insider.
On Thursday, Pour was headed into a night shift. He said he anticipated that 95% of his cases would be respiratory-related, stemming from breathing problems from COVID-19, the disease caused by the coronavirus.
"The hospital is basically turning into one giant COVID unit," Pour said.
Across New York, hospitals are contending with that new reality, with overworked staff, a lack of proper protective equipment - and, perhaps most jarringly - a looming shortage of hospital beds and the ventilators needed to keep patients with COVID-19 alive.
'New York is the tip of the spear'
"New York is the tip of the spear, so to speak," Gov. Andrew Cuomo said in one of his daily press conferences that have become required viewing for many in New York and around the world.
How New York responds to the crisis, in other words, is a potent window into how other cities and towns will fare when the virus inevitably makes its way to them. Already, cities like New Orleans are confronting rapidly growing outbreaks.
Cuomo said on Saturday he expects the peak of New York's outbreak to be sometime in the next four to eight days. Once New York has gotten through the worst of the pandemic, he said it's important to redeploy resources to other states, which will be facing unprecedented strains on their health systems.
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New York's deadliest day
Already, New York is being hit hard by the coronavirus.
On Saturday, the state had its deadliest 24-hour period since the outbreak started at the beginning of March, with 630 patients succumbing to the disease. Since March 1, 3,565 New Yorkers have died.
There are now over 113,704 confirmed cases statewide, with over 15,000 people hospitalized. More than half of those are concentrated in New York City, now the global epicenter of the pandemic.
"It's hard to go through this all day and then it's hard to stay up all night, watching those numbers come in and the number of deaths tick up," Cuomo said.
The cases are piling up in New York City's hospitals. They're reopening shuttered buildings, adding beds to lobbies and conference rooms, and staffing up to cope. Makeshift hospitals are going up in Central Park and in the Jacob K. Javits Convention Center.
Already, the hospital has more than 200 patients, 90% of whom are being treated for the novel coronavirus, Dr. Pia Daniel, an emergency medicine physician and clinical professor told Business Insider. It's been designated a COVID-19-only location by Cuomo.
To help, the emergency department has doubled its staff to keep up with the work, Daniel said. Many non-COVID-19 cases are getting redirected to outpatient clinics. The ICU, which typically has 10 beds, has expanded into four additional units.
Northwell Health System, which operates 23 hospitals in New York, was up to 3,000 COVID patients as of Friday morning, from 1,800 or so a week ago. Already, 500 are on ventilators.
Dr. Mark Jarrett, Northwell's chief quality officer anticipates he'll need 1,200 to 1,600 more beds.
At Maimonides Medical Center in Brooklyn's Borough Park neighborhood, Dr. Patrick Borgen said the hospital's anticipating needing 400 ICU beds. As of Tuesday, it had 150.
To help hospitals that are overwhelmed by the virus, Cuomo has directed the state to take actions that would have been unprecedented just weeks ago.
On Friday, he signed an executive order empowering the National Guard to take ventilators and other protective equipment from private hospitals and other companies and give them to hospitals in need.
The shortage of ventilators and hospital beds remains a problem in New York. Some hospitals in the state are working on guidelines to ration resources - and in extreme cases, pick and choose which patients get treatment based on who is most likely to survive.
"This is an invisible beast. It is an insidious beast," Cuomo told the assembled troops and National Guardsman last week.
"This is going to be one of those moments they're going to write and they're going to talk about for generations," he said. "This is a moment that is going to change this nation. This is a moment that forges character, forges people, changes people."
The new reality of treating patients
At SUNY Downstate, Daniel said, she's seeing a lot of graduates of the program take a week of vacation from their current jobs to come back and help in the ER.
At Northwell, staff who otherwise might be doing administrative work or work in other areas of the hospital are now taking care of coronavirus patients.
"It's expected that everybody will do what they need to pitch in," Jarrett said.
It can be a big adjustment for workers who aren't used to seeing such sick patients.
For Borgen, the chair of surgery at Maimonides, the hardest day so far in the pandemic was Friday, March 27.
That day, he was helping move patients onto a floor that was typically used for recovery by people who've had routine surgeries like gall bladder and appendix removals. Those patients tend to recover quickly.
Now, however, the patients occupying the beds were there with the novel coronavirus. They were "unbelievably sick," Borgen said, and he knew a number of them would not get better. And there was an additional weight on the minds of the staff.
"What was really palpable was that the healthcare team was also at risk," Borgen said. That day, the hospital also had several patient deaths. "That kind of thing is just devastating to the healthcare team."
'Our ERs are ICUs'
In emergency rooms across the city, patients with trouble breathing are now a constant fixture.
"Our new reality is unreal" Dr. Craig Spencer, an emergency-room doctor and the director of global health in Emergency Medicine at New York-Presbyterian/Columbia University Medical Center, wrote in a tweet Thursday night. "The people and places we've known so long & so well have been transformed. Our ERs are ICUs."
At SUNY Downstate, Daniel said, she's intubating patients at the rate of one per hour. Amid the pandemic, she might do eight in a shift, up from one or two.
Putting a patient on a ventilator is a labor-intensive process. It involves two doctors, a respiratory therapist, a nurse, and the machine. The whole process takes about an hour.
The reality of putting patients on ventilators at such a frequency is a new normal for ER doctors like Mount Sinai's Pour.
"Most of my shifts, I don't intubate anyone," Pour said. "The fact that I'm going in tonight and i'm sure I'll intubate is new to me."
'The scary things that this virus can do'
There's also new challenges to the job, such as the difficulty of not knowing exactly the best course of treatment for patients with a new virus.
"Our knowledge of this virus is about three months old," Maimonides' Borgen said. "We're learning as we go the quirks and the eccentricities and the scary things that this virus can do."
For instance, within the last week the hospital has changed its approach to using oxygen for patients who are having trouble breathing.
Now, instead of progressing quickly to ventilators, doctors at Maimonides are relying more on high-flow oxygen therapy, with the hope that by keeping patients breathing on their own and able to move, they might be able to keep their lungs functioning better.
There's also hard decisions to make, such as determining which patients might be stable enough to go home.
"There are hundreds of patients we're seeing in a week that are right on the cusp of maybe being sick but aren't sick yet," Pour said.
Admitting everyone who comes to the ER isn't an option, so the health system is working on protocols to help decide who to send home.
"I have a fear that I'm sending patients home that'll be coming back in a day or two," he said.
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