The Anonymous Story Of A NYC Resident At The Frontlines Of The COVID-19 Pandemic
The COVID-19 pandemic has significantly impacted all of our lives. NYC residents have been particularly hard stricken. As of April 10, the total number of confirmed cases is over 100,000, with almost seven thousand fatalities.
We had a rare chance to talk about the current situation to a anesthesiology resident in NYC. Sarah (name changed) is in her late twenties and a third year resident in a large hospital in NYC.
The daily struggle is pushing everyone to the limit
She spoke with us after yet another 14 hour shift and is making food before crashing in her small one-bed room apartment in the Upper East Side.
“As an anesthesiologist, you usually have two roles” Sarah starts, “you are an intensive care doctor, tending to the day to day work for your critical patients, as well as taking urgent calls for intubations”
Typically, a resident would do five intubations a day, maximum.. “That’s already a busy day. Now we’re doing an average of 20!”
Just like everybody in the hospital, intubation teams are being pushed to their limits these days.
Because of the high patient numbers, hospitals have run out of space. “Normally, intubations are supposed to be done in a negative pressure rooms to minimize risks of infections. However, because it’s so busy, we’re doing it in a standard room with just a curtain around the patient’s bed. Next the patient is already the next one. No privacy, no containment.”
Patients are sometimes surprised to learn they are infected
Worsening matters, patients oftentimes don’t know they have the virus when the intubation team arrives. This means the team informs them as they start the intubation. Doctors who usually inform the patient beforehand are too busy attending to other patients.
“When patients realize what’s going on, they try to frantically call family to tell them about the situation,” says Sarah.
Higher mortality because hospitals are past their limits
“Approximately 20% of cases get hospitalized, and 20% of those need intubation,” points out Sarah. “50% of those who get intubated die”. Of course, numbers vary significantly across age group.
“In my opinion, the mortality rate is so high because we are past our limits and not capable to provide the level of care we normally would”, says Sarah.
Obviously patients in the ICU need a lot of care which is why one nurse typically only takes care of no more than two ICU patients. “They need to be turned every two hours to avoid pressure sores, labs need to be taken every six hours, and a host of vital signs are constantly monitored to step in immediately if necessary.
Now, one nurse will take care of four patients on average. And we are still short on nurses. This means nurses with no or limited experience with critical care are being coached in the moment”.
“Nobody is getting turned every two hours. Nobody is doing PT. And keep in mind, the average intubation period is three weeks for those patients”, elaborates Sarah.
In the worst cases, patients might wake up after intubation due to limited attention from nurses. Those patients oftentimes get agitated and self-extubate, which only worsens their situation.
Last Tuesday, the Emergency Department had 16 patients on ventilators. “There was simply no space in the ICU. The ratio of patient to nurse was 13:1”, Sarah continues.
“This is a good hospital with a large critical care team. Despite that, we still might have to give a crash course to an orthopedic surgeon who never managed a ventilator before.”
Medical staff are holding up but long-term effects are unclear
We asked Sarah how she and hospital staff are impacted by the situation. “I’m used to seeing patients with terminal illnesses. The hard part is knowing it’s impossible to provide them with the best care.”
“However, we are not used to seeing young patients with no medical history in those situations.” Normally, patients who get intubated already have multiple illnesses. “But in the current situation, you see patients who are 41, no medical history, non-smokers, fighting for their lives”.
This is what hits especially young doctors the hardest. Sarah argues that the immediate impact on her mental health is very manageable. “My hospital is providing me with excellent support.” Mental health and wellness initiatives are available for doctors and hospital staff at no cost.
“However, it’s impossible to predict what the long-term impact will be on all of us.”
Supply chain of equipment is still intact
One very comforting observation is a never-ending supply of donations to hospitals. The hospital has enough personal protective equipment (PPE) and donations keep coming in. “I know not every hospital accepts direct donations. “Donations that can’t be accepted, we can keep for personal use”.
On top of PPE donations, the hospital has been receiving donations of food and other daily necessities. “We had really, really good steak, salads, and pizza donated last week. Some even drop off wine to support us when we’re out of the hospital”, she says with a laugh.
Additionally, hospitals are making sure that staff stay as safe as possible. “The reason for the cold trucks outside of hospitals is not that there’s no space in our morgues. But the morgues don’t accept patients infected with COVID-19 to avoid spread of the disease.”, she elaborates.
The bodies are then taken to be cremated. This, however, sometimes results in pushback from the families. “But cremation is essential to prevent the spread”, she explains.
Number of new cases are easing up in NYC
Looking ahead, the hope is that “this and last week are the peak in NYC. We are already seeing admissions slowing down.” However, it remains critically important to do everything possible to flatten the curve and slow down the spread.
One worry is a resurgence of cases once the lockdown is lifted. ”Realistically, we won’t get in the safe zone until we get a vaccine out – hopefully by September or October”, Sarah explains. “Some people are saying it might be seasonal. That would mean that even if we get a vaccine out, we might get it back in a few months”.
Message to the people
At the end, we ask Sarah if she has a message for us at home. Her response speaks volumes the spirit of New Yorkers (which we can 100% attest to after having lived there for a long time ourselves).
“I’m really thankful for the generosity the people have shown. We get donations en masse. Every day we get personal equipment, food, and other supplies”, Sarah responds. “Restaurants are delivering food for free. Those restaurants point out that they themselves received donations and instructions to prepare food for the hospitals around them.”
“We are all in this together, and I’m confident we’ll get through this stronger than before”.Posted on: 12 Apr 2020