April 7, 2020 Update
Dear All,
As we discussed in last week’s blog, I just completed a stretch covering a COVID medicine team at NYU Langone Health. Here are some initial observations from the front lines:
I knew things were different within a few minutes of stepping into the hospital. For starters, there was hardly anyone waiting to ride the elevators in the lobby at 8am on a Thursday morning. The common areas of the hospital such as the lobby and cafeteria were empty, while the patient care units were completely full and buzzing with activity. This was only the beginning of what would be an unusual few days in the hospital.
When I got up to the unit, it was still unclear to me if my patients were in fact COVID patients or if I was covering a non-COVID team taking care of general medicine patients. When I asked my resident whether our service was a COVID service, she laughed and said “Of course we’re a COVID service. Every medical team is a COVID team.”
And that’s when it hit me that almost our entire hospital was filled with COVID patients. We have a huge hospital here at NYU, and almost every bed had a patient admitted with COVID. There was no longer such a thing as COVID teams or non-COVID teams. It was a given that every patient on a service had COVID. Throughout my 4 days, the only patients I saw were COVID patients who were admitted for respiratory (breathing) issues related to COVID. Yes, they may have had other medical problems, but every patient was in the hospital with the same primary problem of COVID.
This meant that every doctor was a COVID doctor. I was paired with residents from various specialties throughout my 4 days from rehab medicine to psychiatry. Other teams had plastic surgeons, dermatologists and gastroenterologists working with a medicine attending on a team. Just as the hospital had become a COVID hospital, every doctor was now a COVID doctor, every nurse a COVID nurse, and it was all hands on deck to deal with the huge volume of patients with everyone chipping in to do their part.
My patients ranged in age from mid-30’s to upper 80’s with a preponderance of patients in their 50’s, 60’, and 70’s. As we’ve discussed in prior posts, this virus does not discriminate purely based on age. Once you’re sick enough to be in the hospital, age alone does not protect you. My patient in his mid-30’s required ICU level care before being transferred to me after recovering. Several patients in their 70’s were directly admitted to the floor, did very well, and were able to be discharged home, even some with underlying comorbidities such as asthma, rheumatoid arthritis, and diabetes. I was able to send a patient in their mid-80’s home as well. This should be reassuring to those of you reading that just because you may be older than 65 does not mean there is no hope if you contract this and require a few days in the hospital.
Unfortunately, some did not do so well. Some patients deteriorated on the floor and required escalation to the ICU and some chose that they did not want to be put on a breathing machine if their lungs failed and preferred to be transitioned to hospice for whom we honored those wishes as well before they passed away.
Beyond the patient care, it was very different to have no family members at the bedside since no guests are currently allowed. My general practice was to call a family member when I got to the bedside so they could listen in on the clinical update when I would round on patients each day. This may have been more impactful for the patients and their families than the actual medical care itself. Given how few treatments we have to give patients, time at the bedside and calling family members may be the most important treatment of all. This was especially true for those on the verge of deteriorating and those who entered hospice care.
Despite the unusual circumstances described above, there were many positives from my initial stint in the hospital. The most striking was the sense of unity and duty among all the healthcare workers I worked with.
Because I’ve already contracted COVID and recovered, I can enter patient rooms knowing that I have some level of immunity against the virus if I happen to be exposed again. Many of my colleagues cannot say the same. Yet, there they are going room to room doing their job without the comfort of knowing they’ll be ok if exposed.
When I say colleagues, this goes well beyond physicians and includes our nurses, pharmacists, respiratory therapists, building services professionals, and so on. Strong nursing is the backbone of caring for COVID patients and we’re fortunate at NYU to have outstanding nurses who I can’t say enough good things about.
From my limited vantage point, NYU was well prepared in terms of having enough personal protective equipment for all staff and no shortage of medications, ICU beds, or any other patient care needs. Given the unusually high number of patients, it’s possible the scene looks different in our emergency departments and ICUs where there’s a higher level of acuity, but anecdotally I was told by anesthesiologists and intensivists that supplies and resources were adequate there as well. I’m sure that every hospital in New York may look a bit different, especially those in parts of Queens and Brooklyn where the outbreak seems to be hitting hardest, but this was my experience the past few days.
Tomorrow I will dive into what hospitals outside New York City should be thinking about as they prepare to see increasing numbers of COVID patients and later this week I’ll review some common questions on where we are in the pandemic. I will go ahead and note that New York City has had multiple days in a row of decreasing new admissions which is encouraging, but will address these trends in greater detail later in the week.
Lastly, I’ll be putting out a separate blog specific to clinicians on the more technical details of what I saw in treating COVID patients later this week as well.
Thanks to everyone for your support and well wishes.
Be safe,
Harry
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