At NYC hospital treating coronavirus, doctors 'use their MD license like they haven't had to before'

Ryan W. Miller, USA TODAY

The head of urology is working nights in the emergency room.

The chairman of orthopedics is picking up shifts in the intensive care unit.

For some, it's the type of work in a hospital that they haven't done in decades. And it's necessary, said Dr. Steven Corwin, as the new coronavirus devastates communities and stretches hospitals and staffs to their limits in New York.

"This has fundamentally altered the way we care for patients in the hospital," Corwin, the president and CEO of NewYork-Presbyterian, told USA TODAY.

In his 40 years of medicine, Corwin said he's never seen this sort of response to a disease. Not during the AIDS pandemic. Not during H1N1.

In New York, 2,373 people have died from complications due to COVID-19, the disease caused by the new coronavirus, Gov. Andrew Cuomo said Thursday. New York City alone has seen 1,562 deaths and 49,707 known cases leading to an estimated 10,590 hospitalizations, as of Thursday evening, according to its data

"We're asking people to go above and beyond and to use their M.D. license like they haven't had to before," Corwin said of his staff. "You're asking people to do things they've never done." 

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At NewYork-Presbyterian, one of the largest and top-ranked hospital systems in the U.S., 58% of beds are being occupied by COVID-19 patients as of Thursday morning, Corwin said. Five hundred patients in its ICUs are on ventilators. The 10 hospitals in the system normally have more than 4,000 beds.

To address patients' needs, there is a pyramid structure for medical staff. Doctors and nurses who are in ICUs every day are at the top, those who have some intensive care experience below and so on, including medical staff who are in entirely different specialties.

The urology chair is  "there because he feels it's important for morale and important for the actual work getting done," Corwin said. Physicians who have stopped elective surgeries have been redeployed.  

But it's going to get worse, Corwin said.

Ventilator shortage, ICU overhauls add stress

NewYork-Presbyterian estimates the peak of cases in the area will come about April 15. About a quarter of its patients admitted need ventilators, meaning at the peak, about 1,000 ventilators will be needed.

At a press conference Thursday, Cuomo said the state was facing a dwindling supply of ventilators. An additional 400 ventilators were sent to the city Thursday, but the state could run out in six days, he said. This comes after receiving 4,400 ventilators from the federal government in addition to New York's stockpile.

Still, Cuomo stressed that New York was doing everything it could to procure as many new machines as possible. Among the measures: Ending all elective surgeries in the state where a ventilator might be needed, using anesthesia machine ventilators and splitting ventilator tubes so two patients can be on one machine.

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Cuomo was hopeful, though, as the number of patients discharged from New York hospitals rose sharply Wednesday. The governor said while bed capacity was still an issue, he was more worried about medical supplies and staff.

Adding to the timeline is room overhaul: An ICU bed for treating COVID-19 patients requires physical changes to the hospital, and it's not as easy as just putting more monitors in the room, Corwin said.

Construction is necessary to convert a room to negative pressure, which allows for air to flow into the room but not out, so possibly infected respiratory droplets don't spread. A range of technical equipment is needed in addition to an adequate power supply, Corwin said.

An operating room core also has to be a sterile environment surrounded by the negative pressure rooms. The whole process takes "the better part of a week" for turning operating rooms into ICU beds, Corwin said. NewYork-Presbyterian hospitals have been doing so since mid-February because Corwin said it was clear that their normal ICU bed capacity would not be enough. 

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He expects needing 1,100 ICU beds just for COVID-19 patients. They have 650 now. Normal ICU capacity is 450, he said.

Fever clinics have also been set up outside emergency rooms. The tents are used to see patients with coughs, colds and fevers and screen them for the coronavirus.

"It's really an extraordinary scene," Corwin said.

'It is heart-wrenching'

The psychological effect of seeing such a severe disease has been "traumatic" for staff, and some of what they've had to see is "gruesome," adding to the pressure those in the medical field are facing in combating the pandemic.

"This is not a flu or flu on steroids. This is an entirely new disease where people are really sick and their lungs are really sick," Corwin said.

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While many people in the U.S. may have expected the elderly and those with underlying conditions to be severely affected, that's not the reality on the ground, Corwin added.

"It is heart-wrenching to see an otherwise healthy 40-year-old require ventilatory support because of this virus. It is heart-wrenching to see a child get it. It is heart-wrenching to see somebody taken out of the prime of their life and die from this," Corwin said.

Corwin, a cardiologist and internist, never thought he'd see such a wide-reaching disease. "You always worry about it. You think about it. But to this extent, no."

In making estimates and projections for a pandemic, one underlying assumption is that there will be early and extensive testing for the disease.

"I think the CDC was behind the curve," he said. "We did not recognize community spread early enough."

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Corwin praised President Donald Trump's early actions to limit travel from high-risk areas, including China and Europe, but said more was needed in the way of testing.

"The travel ban bought time, and we didn’t use that time wisely," he added.

Still, Corwin is hopeful. He gets encouraging emails and texts every day from doctors, nurses and other staff who aren't deterred.

"It takes extraordinary effort, and if it's up to us, we're going to make sure that we keep swinging as long as we possibly can," he said.

Contributing: Joseph Spector in Albany, New York

Follow USA TODAY's Ryan Miller on Twitter @RyanW_Miller

This article originally appeared on USA TODAY: Coronavirus: Inside NewYork-Presbyterian's battle against COVID-19