Health International
Coronavirus patients start to overwhelm US hospitals
(CNN)" - We ended up getting our first positive patients -- and that's when all hell broke loose," said one New York City doctor.
The
doctor, who spoke to CNN on condition of anonymity out of concern for
his job, described a hospital that was woefully unprepared for an influx
of Covid-19 patients that started roughly two weeks ago -- which has
already stretched the hospital's resources thin and led to severely ill
patients outnumbering ventilators.
"We don't have the machines, we don't have the beds," the doctor said.
"To
think that we're in New York City and this is happening," he added.
"It's like a third-world country type of scenario. It's mind-blowing."
At
first, patients skewed toward the 70-plus age group, but in the past
week or so there have been a number of patients younger than 50.
"I don't think they understand the severity of this disease," the doctor said of the younger patients.
"Two weeks ago, life was completely different."
Increasing capacity
Public
health experts, including US Surgeon General Dr. Jerome Adams, have
warned the US could "become Italy," where doctors in hospitals filled
with Covid-19 patients have been forced to ration care and choose who
gets a ventilator.
But the US may already be seeing the beginnings of this in some areas, marking a new stage of the nation's outbreak.
"The
reality is that what we're seeing right now in our emergency rooms is
dire," said Dr. Craig Spencer, director of global health in emergency
medicine at NewYork-Presbyterian/Columbia University Medical Center in
New York City.
"Last week when I
went to work, we talked about the one or two patients amongst the dozens
of others that might have been a Covid or coronavirus patient," Spencer
told CNN's Anderson Cooper Tuesday. "In my shift yesterday, nearly
every single patient that I took care of was coronavirus, and many of
them extremely severe. Many were put on breathing tubes. Many
decompensated quite quickly.
"There is a very different air this week than there was last week."
Officials in New York state are pushing hospitals across the state to increase capacity. The state is home to more than 6% of the world's confirmed cases so far -- and roughly half of all US cases.
In
New York City, plans are also underway to build emergency hospitals and
backfill other hospitals with 1,000 beds in the Javits Center,
according to New York Gov. Andrew Cuomo. In addition, thousands of
doctors and nurses, who are either retired or no longer see patients,
have signed up as a "surge health care force," Cuomo said Wednesday.
There
are simultaneous effort to procure ventilators for the most severe
patients. According to Cuomo, New York has procured 7,000 ventilators in
addition to 4,000 already on hand, and the White House said Tuesday
that the state would receive two shipments of 2,000 machines this week
from the national stockpile. But the state needs 30,000, Cuomo said.
The
Strategic National Stockpile said Wednesday that it held approximately
16,660 ventilators before the coronavirus response, and ventilators have
been deployed over the past few days.
"An
outbreak, a pandemic like this could overwhelm any system in the
world," warned Dr. Anthony Fauci, the United States' top infectious
disease expert. Without enough ventilators, "that's when you're going to
have to make some very tough decisions."
Cuomo
also described the extreme measures hospitals are planning to take to
increase their capacity for patients who need intensive care.
"We're
going so far as to trying an experimental procedure where we split the
ventilator," Cuomo said Tuesday. "We use one ventilator for two
patients. It's difficult to perform, it's experimental, but at this
point we have no alternative."
'Exceptionally chaotic'
It's not just New York that's feeling the pressure. Hospitals across the country are seeing a surge of patients, a shortage of personal protective equipment such as masks and gowns, and health care workers who feel that they, their families and their patients are being put at risk.
Several nurses around the country also spoke to CNN on condition of anonymity, also fearing they could lose their jobs.
One
ER nurse in Virginia described her hospital as "exceptionally chaotic,"
with an emergency department where potential Covid-19 patients were
sitting next to patients with other health conditions.
"You
have an elderly couple that is having chest pain sitting right next to
someone who has a cough and flu," she said. "I think that's extremely
reckless."
She said she hadn't hugged her daughter since the outbreak started, for fear she may pass anything on to her.
Another
nurse in Georgia said she was repeatedly denied testing, even as her
own symptoms worsened over the course of a week. The nurse, who had
cared for several patients who died of pneumonia but were never tested
for Covid-19, was finally tested Tuesday -- the same day she was
admitted to the hospital and put in isolation.
"It
was not until this morning that I could finally be tested," she said as
she gasped for breath between heavy coughs. "It is insane. And it's
infuriating. You feel you have to scream to even be heard."
Judy
Sheridan-Gonzalez, an ER nurse at Montefiore Medical Center and
president of the New York State Nurses Association, said that "everybody
is terrified" about becoming infected because many lack the proper
protective gear, and many are being told to reuse the same mask between
multiple patients.
Sheridan-Gonzalez
said she fears not having enough ventilators or staff to take care of
everyone, but it hasn't "hit that level yet" at her hospital.
Similarly,
one New York City private hospital executive, who requested anonymity,
told CNN that "many hospitals believe they are covered on ventilators.
That doesn't mean some are not."
Still, the shortage of personal protective equipment continues to impact his and other hospitals.
For Sheridan-Gonzalez, the risk of becoming infected amid a shortage of masks and gowns is all too real.
"We
feel an obligation to take care of our patients. Everybody does. But we
don't want to become sick and we also don't want to become carriers,"
she said. "In my own hospital -- and I don't think it's unique -- we
have a nurse who is on a ventilator right now who contracted the virus."
If
the virus takes out health care workers, "it's game over. It's lights
out," Dr. Peter Hotez, professor and dean of the National School of
Tropical Medicine at Baylor College of Medicine, previously told CNN.
"If
we have multiple frontline health care workers, ER physicians, nurses
go down in this epidemic -- a situation where you have colleagues taking
care of colleagues in the intensive care unit -- there's nothing more
destabilizing for the United States."
Flattening the curve
The
capacity of US health systems is at the core of the effort to "flatten
the curve" -- to spread out the number of infections over time through
measures such as social distancing.
The goal: to prevent hospitals from seeing a massive spike of patients arriving around the same time.
On
Tuesday, President Donald Trump said he wanted the nation "opened up
and just raring to go by Easter," which is April 12 -- a date that few health experts believe will be sufficient to contain the spread of coronavirus.
Earlier
this month, Fauci said "it probably would be several weeks or maybe
longer before we know whether we had an effect" on flattening the curve,
and on Tuesday he emphasized the need to be "flexible" in the timeline
Trump laid out.
"Obviously, no one is going to want to tone down things when you see things going on like in New York City," Fauci said Tuesday.
Some in New York don't foresee the outbreak abating anytime soon.
On Wednesday, Cuomo said he expects to see peak numbers of patients in approximately 21 days, based on current projections.
"We're
really at the beginning of this outbreak," said NewYork-Presbyterian's
Spencer. "And you can feel that. You can sense that. It's palpable on
the front lines in the emergency department."
In a series of tweets
early Tuesday, Spencer urged people to practice social distancing in
order to save lives: "We were too late to stop this virus. Full stop.
But we can slow it's spread.
"Hospitals are nearing capacity. We are running out of ventilators," he said. "Ambulance sirens don't stop."
