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Across a city on edge, doctors, nurses and lab technicians working the coronavirus front lines are embracing improvisation as a means of survival — finding new ways to make shrinking resources work against an enemy that claims more casualties by the day.
Under trying circumstances from Bellevue in Manhattan to New York Presbyterian in Queens to Montefiore Medical Center in The Bronx, medical staffers are devising protocols on the fly to protect themselves and aid their ailing patients.
At the same time, the hospitals are creeping closer to the line where their resources — including intensive care unit (ICU) beds and ventilators for patients, and N95 masks and other protective gear for medical workers — begin to get outstripped by crushing need.
“The apex could be here in as little as 14 to 21 days, and you’re talking about a very significant logistical operational movement to increase that number of hospital beds and do everything that you need to do related to the increased hospital beds,” Gov. Andrew Cuomo said Tuesday during a press briefing at a soon-to-be makeshift hospital at the Javits Center in Manhattan.
New York has 53,000 hospital beds, but could need as many as 140,000 at the peak of the crisis — and an additional 37,000 ICU beds on top of the 3,000 statewide, the governor said.
Mayor Bill de Blasio has said the city will need 15,000 ventilators — far more than the roughly 6,000 it will have after the latest commitment from a federal stockpile announced Tuesday.
As the number of hospitalizations in the city from COVID-19 hit at least 2,850 Tuesday night — including 660 or more patients in intensive care — here’s a look inside some of the busiest hospitals in New York City:
‘We’re Drowning Here’
NewYork-Presbyterian Queens, Flushing
Hospital Beds: 535
ICU Beds: 29
An impromptu conversation among four frazzled doctors in a hospital hallway earlier this week led to an unusual work-around to address a pending shortage of ventilators: Use anesthesia machines instead.
“Right now, we’ve got maybe 20 to spare. They deliver gases and they’ve got monitors, so they’ll work,” said high-ranking medical staffer at NewYork-Presbyterian Queens.
“This is a chronic mass-casualty situation,” the source added. “Our plan from a week ago is out the window. We need help.”
As of Monday, 214 of the 438 people admitted through the hospital’s emergency room were designated as COVID-19 patients “under investigation.”
COVID-19 patients have essentially taken over the hospital’s seventh floor. All medical and surgical ICU patients have been relocated to a cardiac recovery unit on the second floor. The internal rejiggering has opened 16 beds, the staffer said.
“We’re drowning here and it’s getting worse by the day,” the source said. “We’re at 50% capacity already and we’ve got 30 patients on ventilators who are not going to get better. Within a week, we’ll be a 100% COVID-19 facility.”
Like at other medical facilities throughout the city, the hospital is facing “real shortages” of protective equipment, including N95 face masks. But the obstacles haven’t slowed the “all-hands-on-deck” response.
“Everyone here is really hyped up, and my colleagues have really been so tremendous about stepping up and doing what’s needed,” the source said.
New Battle Garb
Bellevue Hospital, Manhattan
Hospital Beds: 912
ICU Beds: 40
At Bellevue and all 11 city Health and Hospitals Corporation public hospitals, coronavirus patients who don’t require intensive care are discharged to make room for more serious COVID-19 cases.
Bellevue — with dozens of coronavirus patients spread across multiple units — now has a limited number of available ventilators.
On entry, all staff are supposed to be checked for fever — but not all are getting their temperature taken, according to a source at Bellevue who described the scene on condition of anonymity.
Emergency alerts are also being handled differently than before — with responding teams of 12 or more now limited to seven to reduce staff exposure.
Like at all city hospitals, Bellevue medical workers must reuse N95 face masks, even after the masks have been exposed to the virus. They’re allotted one mask per employee and must stash the equipment after every shift in a paper bag.
The new battle garb of a frontline nurse assigned to COVID-19 patients, according to the source: a surgical mask over the N95, rubber gloves that go to the elbow and under gown sleeves — and a second pair of gloves over the first that snags the gown so it doesn’t pull up.
To take a swab of a suspected patient a nurse in full gear does the job in a sealed room, puts the swab in a sealed bag and wipes down the bag. The nurse brings the bagged specimen to the door of the patient’s room and drops it into another bag held by a second masked nurse. The specimen is then sent to the lab via an internal tube system.
And when the shift is over, taking this get-up off requires choreography: staying in the patient’s room, the wearer washes the outer gloves, cleans off equipment with anti-bacterial wipes and washes the gloves again.
The gown is removed by grasping it behind the neck and pulling over the head, keeping arms inside to avoid touching the outside of the gown, then balling it up with the inside out and tossing it in a bin.
Next step: The outer gloves are washed again, then peeled off and discarded. The inner gloves are washed and the surgical mask and N95 are removed, leaning forward so they don’t fall on your body. The surgical mask is discarded, the N95 placed in a paper bag. The inner gloves are washed again, removed and discarded.
Equipment is removed from the room. Then the hands are washed again.
‘Like a War Zone’
Montefiore Medical Center, The Bronx
Hospital Beds: 816
ICU Beds: 48
Stretcher beds full of patients wearing masks are lined up in rows in the emergency department at Montefiore Medical Center. There are no curtains or other dividers separating them, according to a doctor who spoke on the condition of anonymity.
Patients with the most severe symptoms are given a quick-turnaround test for COVID-19 that takes just hours to produce a result. But patients whose symptoms aren’t as severe are given a test that can take days to return with an answer, the doctor said.
“There are some people that have been there for anywhere from one to three days — just in the emergency department, which is kind of insane. Because if they came in without COVID, by that time they’re getting COVID,” the source said.
The hospital also has run out of single rooms in which to house coronavirus patients for treatment, so now they’re being doubled up with another patient with COVID-19.
Medical staffers are given a packet for their shifts that has one N95 mask, a yellow gown and a face shield. Gloves, surgical masks and hand sanitizer are available for the taking. The N95 masks are supposed to last the entire shift — even when staffers come in contact with multiple patients with COVID-19.
“Tensions are running high, but then there’s this ‘We’re all in this together’ feeling,” said the doctor. “Like a war zone.”
‘We’re Out of Fentanyl’
Lenox Hill Hospital, Manhattan
Hospital Beds: 632
ICU Beds: 15
On top of the normal shortage concerns at hospitals across the city, Lenox Hill is facing secondary shortages related to the operation of ventilators for the sickest coronavirus patients, according to a nurse who works there.
Lenox Hill’s ICU unit is filled entirely with COVID-19 patients, and they comprise about half the patients in the hospital’s intermediate care unit, the nurse said.
“We just found out that we’re out of fentanyl and running very low on all of the meds we use for intubation and sedation,” said the nurse, who spoke on condition of anonymity.
The fentanyl is used as a painkiller, and is typically standard for someone who’s breathing with the aid of a ventilator, the nurse said.
There’s a substitute for the two medications commonly used for sedation — propofol and precedex — but its side effects are intolerable for many patients. And it’s not ideal for long periods of sedation, the nurse said.
Meanwhile, rationing of N95 masks has gotten more strict: They’re now designed to last for four shifts per employee, regardless of patient load. They’re kept in baggies between shifts, under the watch of management, and distributed from under lock and key.
“Nurses are still anxious,” the source said, “but a bit more so than last week.”
‘Worried I Will Die’
NewYork-Presbyterian / Columbia University Irving Medical Center, Washington Heights
Hospital Beds: 1,022
ICU Beds: 99
The head of surgery at Columbia University Irving Medical Center has been sending out daily updates to staff — to inform them of the latest challenges they’re facing and to cheer them on.
The latest note from Dr. Craig Smith says that new COVID-19 cases are increasing across the NewYork-Presbyterian hospital system by about 10% per day.
“Consult a compound-interest calculator to get a sense how quickly we are approaching infrastructure capacity limits,” he wrote on Tuesday.
The city Department of Health has instructed medical staffers who had high-risk contact with a known COVID-19 case to keep working as long as they don’t have symptoms — and only to pull themselves from the rotation once they start showing signs of illness.
One doctor said not all the medical staffers are given the coveted N95 masks, with many getting ordinary surgical masks believed to be less effective at preventing transmission. So the doctor felt compelled to buy bandanas, just in case surgical masks run out.
“It doesn’t feel like my health or well-being is a priority,” said the doctor. “I am most worried I will get sick and die.”
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