Philip S. Barie, MD, MBA, Master CCM, FIDSA, FACS
Professor of Surgery and Medicine (Public Health)
Weill Cornell medicine
New York, New York
I’m heading into work for an overnight shift-my first in a week after a lot of call in February and early March. It seems a good time to report what’s known, and how rapidly the situation is changing (for the worse…). Before all that, let me say a few things. First, I’ll try to report as often as possible, even daily, but you never know… Second, any “numbers” I provide will by necessity be estimates because of the fluidity of the situation. Third, only California and Washington state are now in comparable situations to NYC, so it is my hope that my observations and thoughts will provide you, dear reader, with a “window into the future,” because make no mistake, SARS-CoV-2 is coming to a hospital near you. It’s inevitable, as the virus has now been isolated in all 50 states; many areas may be only days to a few weeks behind what we are already experiencing.
Confirmed cases in New York State are increasing exponentially (50%-100% per day), only in part because of increased testing. As of today (March 20), confirmed New York State cases exceed 7,100, an increase of 2,950 since yesterday, with 22 deaths. Sixteen days ago, there were zero cases. New York City has 4,408 cases, with 1,939 new positives since yesterday. So far, 18% of patients diagnosed require hospitalization. About half who require hospitalization require intensive care. So that’s about 700 patients already in ICUs. There are about 5,000 ICU beds currently in New York State. The Borough of Queens has been hit especially hard. Also as of today, the state has ordered all “non-essential employees” to work from home, although it is emphasized that this is not a “shelter-in-place” order (yet) as was issued yesterday in California.
Across our network (10 clinical campuses), as of yesterday, there were more than 250 “virus patients” hospitalized. We have three (two on ventilators) already in our surgical ICU at the “mother ship.” Our planning assumes that the peak case load will occur sometime between April 1 and April 19, so the worst, it seems, is yet to come.
We stopped doing most elective surgery six days ago, before it was recommended by the American College of Surgeons and mandated (today) by New York State. That has allowed us to reduce the number of residents on duty to “weekend” levels. Several residents have been exposed and been under quarantine, but fortunately all have tested negative so far. Acute care surgery continues unabated, although trauma volumes are down.
ICUs are being redesignated to cohort patients insofar as possible. Plans exist to make more beds (PACU, use of operating rooms and anesthesia ventilators [about which, more soon]). Personal protective equipment is already in short supply. Ventilators will be soon. There is a dire shortage of blood for transfusion; people are staying away from collection centers in droves, more than 10,000 just yesterday in New York City alone.
If we become short-staffed (e.g., from exhaustion, or people out sick), the acute care surgeons will provide only ICU care, whereas our general surgery colleagues will do the acute care surgery. The possibility exists that any of us could be redeployed to any of the acute-care facilities in our network; the state has waived by executive order of the governor the formalities of credentialing, privileges, etc., during the crisis).
Finally, not having personally had the privilege of providing combat casualty care (thank you to those of you who have), tonight will be the first time in my career that I have provided care while in harm’s way. Hyperbolic, perhaps, but the statement reflects my personal level of discomfiture (and that of my family), and that I am “high risk” owing to age and infirmity. Several of you have already contacted me with well wishes. Thank you, it really matters.
9-11, Hurricane Sandy, and now this. Once more unto the breach.