The view from the ER: 'We're all drowning'

A New York City emergency room physician compares her experience fighting COVID-19 to that of post-hurricane relief efforts as the city continues to deal with waves of patients.

“I’ve done disaster medicine trips before,” Dr. Celine Thum told Yahoo News. “I volunteered in Puerto Rico after Hurricane Maria and it was also the same kind of feeling, where we had limited resources and we did what we could. The surreal part of this response is that I’m at a large hospital with every specialty and the thought is this should be an environment where we have every resource.”

Yahoo News is not identifying the hospital.

Thum said that the shortages of personal protective equipment (PPE) in her hospital is a legitimate problem, echoing reporting of similar issues across the country. She canvassed local hardware stores herself — walking, to avoid taking the train — successfully getting respirator masks donated to help her department. Still, she said doctors in other departments were steaming their masks or stretching single-use ones out for an entire day.

“We have very limited supply,” said Thum. “We wear the same thing the whole time. Sometimes I’m afraid to go to the bathroom, or even when I take a break or get hungry and need to eat, to take off things and make sure I’m not touching or contaminating things.”

The limit on supplies isn’t just a shortage of PPE: Thum said they are running short on everything from nurses to beds, making it feel “very much like war-time medicine.”

“A lot of the logistics and the limited resources have really drawn away from clinician attention to the disease itself, unfortunately,” said Thum. “We’re supposed to be focused on treating and managing but right now we don’t have enough beds sometimes, we don’t have enough monitors, so we’re constantly reassessing people — who is more sick and should be on monitors, who can we eyeball more. We’re extremely short of nurses and respiratory therapists. It’s like in Puerto Rico, where what I had in my pocket was really all I had.”

“There are [personnel] who aren’t doing aerosolizing procedures like intubation who are getting sick. I think just because the entire hospital is such a hot spot I’m going to be more cautious than not. [Given] the limitations on PPE, I’m seeing a lot of hesitation, that brings a lot of anxiety to everybody and then a lot of improvisation.”

Doors lead into the Emergency Department at St. Barnabas Hospital on March 23, 2020 in the Bronx borough of New York City. (Photo by Misha Friedman/Getty Images)
Outside St. Barnabas Hospital in Bronx, N.Y. (Misha Friedman/Getty Images)

Thum said the magnitude of the pandemic in New York City is so great that the decision on what precautions to take is now obvious: You wear every piece of PPE you can obtain. “Cities who are not yet where we are have to understand that because otherwise they’re going to lose a lot of their workforce,” she said.“We’re operating in emergency setting. We protect ourselves and we save as many patients as we can with what we have.”

There are 47,439 confirmed cases in New York City, including 1,096 deaths, as the area has seen a higher spike in confirmed cases than anywhere else in the world. Unfortunately, that has left little opportunity for coordination between hospitals.

“There hasn’t been much [coordination] because we’re all drowning,” said Thum. “We’re not even the worst hit and we just ran out of ventilators the other night. The morbid thing about that is someone passed and it freed up a ventilator, but we just continue operating. We divide up resources as we can.”

The city is adding bed capacity as fast as it can, with makeshift hospitals at the Javits Convention Center, in tents in Central Park and aboard the Navy hospital ship the Comfort. While those are intended to house the overflow of patients without the virus, Thum thinks COVID cases will eventually take over even those spaces.

“I think what everyone is missing: No one’s respecting the disease. It is sneaky, contagious [without] symptoms, the testing is so behind that it’s everywhere and if they’re going to try to screen people and only people who don’t have COVID, they’re going to realize quickly everyone will have it.

“Unfortunately, in this country we can’t even protect our doctors,” said Thum.

Although more and faster tests for the virus are being made available, Thum thinks it’s too late to make much of a difference in New York City.

“We missed the ball on [testing],” she said. “That would have been great when the numbers were low and we could focus on isolation and contact tracing,” she said, but now it is basically an epidemiological tool rather than a clinical one. “I know who has it without the test. If you have symptoms and you can be managed at home, there’s no use going to a hospital to get tested. We’re still not able to test people that we send home, because honestly it’s not going to change anything, as we’ll still say ‘quarantine, take Tylenol, God forbid you can’t breathe then it’s time to come to hospital.’”

On Wednesday, Mayor Bill de Blasio said the city needed 3.3 million N95 masks, 2.1 million surgical mask, 100,000 isolation gowns and 400 ventilators by Sunday. De Blasio said the city will need 15,000 ventilators and an additional 65,000 hospital beds by the end of April.

He also said they were looking to get reinforcements of doctors and nurses to the city.

“They need to see reinforcements come, they need to see some downtime,” de Blasio said. “They need a chance to get some downtime to finally recover.”

Thum realized there was a problem when she heard about the first case confirmed in New York, on March 1, that of a Manhattan woman who had recently traveled in Iran. The woman was not at her hospital, which had been designated to receive patients arriving from overseas with the virus — which meant that she had been in the community long enough to be spreading it to others.

A sign in the Emergency Department at St. Barnabas Hospital
The emergency department at St. Barnabas Hospital, Bronx, N.Y. (Misha Friedman/Getty Images)

Initially, early in March, there was a wave of “worried well” seeking to be tested at the hospital, but eventually word spread to stay away from hospitals unless you were seriously ill. That led to a period where there was space but no influx of patients that Thum described as “this anxiety, waiting for a storm to hit.”

Eventually, it did.

“[The week of March 8], we had three confirmed cases. By Monday, the number had tripled. By midweek, it was 50, by the end of the first full week there were already 100 and after that we stopped counting,” said Thum, adding, “The change in the hospital within two weeks is just unreal.”

Thum is frustrated by the spread of misinformation about coronavirus, such as the idea that social distancing is an overreaction. “The idea that it’s not really that contagious, that if you don’t have symptoms you’re fine. Everyone probably has the idea that they’re not going to get it, especially when they’re in a city that hasn’t been hit as hard.” She added that those who think they’re helping by limiting gatherings to small groups aren’t considering the ability of the virus to spread exponentially and advised them to “stick to your video chats.”

Thum said she and her colleagues are preparing for a fight that could take months, but the support from the community has been inspiring thus far.

“It takes a few cheerleaders here and there and a lot of encouragement, and I think being doctors, we have a lot of that responsibility and I try and go into work — it’s the same thing as any other ER shift in New York, it is long and exhausting and we focus on the patients, we support each other as a team, we try to protect each other,” said Thum. “People have been really generous, bringing coffee, free food, the appreciation for what we do has been overwhelming and that has kept me afloat for quite a bit.”

“We’re also just checking up on each other because we know what we’re going through; I know there’s going to be a lot of PTSD from this, I’m told, but so far spirits are high. We’re used to austere environments and hard work, so hopefully that kind of mindset and momentum will keep going to try and go in and save the world.”

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