(CNN) – “We ended up having our first positive patients, and that’s when all hell broke loose,” said a New York City doctor.
The doctor, who spoke to CNN on condition of anonymity concerned about his employment, described a hospital that unfortunately was unprepared for an influx of covid-19 patients that started about two weeks ago, which has already exhausted the hospital’s resources and led to the number of seriously ill patients exceeding that of available ventilators.
“We don’t have the machines, we don’t have the beds,” said the doctor.
Rows outside a hospital in New York City for a coronavirus test. (Photo by Eduardo Munoz Alvarez / Getty Images)
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“To think that we are in New York City and that this is happening,” he added. “It is like the setting of a third world country. It’s amazing. “
Initially, the patients were in the age group over 70, but in the last week or so there have been a number of patients under the age of 50.
“I don’t think they understand the severity of this disease,” said the doctor of the younger patients.
“Two weeks ago, life was completely different.”
Increased capacity
Public health experts, including the US Surgeon General. USA Dr. Jerome Adams warned that the country could “become Italy,” where doctors in hospitals full of covid-19 patients were forced to ration care and choose who gets a respirator.
But the United States may already be seeing the beginning of this in some areas, marking a new stage of the outbreak in the nation.
“The reality is that what we are seeing right now in our emergency rooms is serious,” said Dr. Craig Spencer, director of global health in emergency medicine at New York University-Presbyterian / Columbia Medical Center. in New York City.
“Last week when I went to work, we were talking about one or two patients among the dozens of others who may have been covid or coronavirus patients,” Spencer told CNN’s Anderson Cooper Tuesday. “On my shift yesterday, almost all of the patients I attended were coronavirus, and many of them extremely severe. Many were put into breathing tubes. Many decompensated fairly quickly.
“There is a very different climate this week than it was last week.”
Officials in New York State are pressing hospitals across the state to increase their capacity. The state is home to more than 6% of the world’s confirmed cases so far, and about half of all cases in the United States.
Plans are also underway in New York City to build emergency hospitals and support other hospitals with 1,000 beds installed at the Javits Center, a convention site, according to New York Governor Andrew Cuomo. In addition, thousands of doctors and nurses who are retired or no longer serve patients signed up as an “emergency health care force,” Cuomo said Wednesday.
There are simultaneous efforts to acquire ventilators for the most severe patients. According to Cuomo, New York has acquired 7,000 fans in addition to 4,000 already in operation, and the White House said Tuesday that the state would receive two shipments of 2,000 machines this week from the national reserve. But the state needs 30,000, Cuomo said.
The Strategic National Reserve said Wednesday it had approximately 16,660 fans before the coronavirus response, and fans have been deployed in recent days.
“An outbreak, a pandemic like this could overwhelm any system in the world,” said Dr. Anthony Fauci, America’s leading infectious disease expert. Without enough fans, “this is when very difficult decisions will have to be made.”
Cuomo also described the extreme measures hospitals plan to take to increase their capacity for patients who need intensive care.
“We are going so far as to try an experimental procedure where we split the fan,” Cuomo said Tuesday. “We use a ventilator for two patients. It is difficult to perform, it is experimental, but at the moment we have no alternative. “
‘Exceptionally chaotic’
Not only is New York 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 healthcare workers who feel that they, their families, and their patients are at risk.
Several nurses across the country also spoke to CNN on condition of anonymity, also fearing they might lose their jobs.
An emergency 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 old couple who have chest pain next to someone who has a cough and the flu,” he said. “I think it is extremely reckless.”
She said she had not hugged her daughter since the outbreak began, for fear that something might happen to her.
Another nurse in Georgia said she was repeatedly denied the tests, even when her own symptoms worsened over the course of a week. The nurse, who had cared for several patients who died of pneumonia but never underwent the covid-19 test, was finally tested on Tuesday, the same day she was admitted to the hospital and isolated.
“It wasn’t until this morning that I was finally able to get tested,” he said as he gasped for breath with a heavy cough. “It’s crazy. And it is irritating. You feel like you have to scream to be heard. ”
Judy Sheridan-Gonzalez, an emergency nurse at Montefiore Medical Center and president of the New York State Nurses Association, said that “everyone is terrified” at the idea of a possible contagion because many lack equipment of adequate protection and many are told to reuse the same mask between multiple patients.
Sheridan-González said she fears she doesn’t have enough fans or staff to serve everyone, but that she has not yet “reached that level” at her hospital.
Similarly, an executive at a private New York City hospital, who requested anonymity, told CNN that “many hospitals believe they are covered with ventilators. That does not mean that some are not. ”
Still, the shortage of personal protective equipment continues to affect his and other hospitals.
For Sheridan-Gonzalez, the risk of catching it amid a shortage of masks and gowns is too real.
“We feel an obligation to care for our patients. Everybody does. But we don’t want to get sick and we don’t want to become carriers, either, ”he said. “In my own hospital, and I don’t think it’s something unique, we have a nurse who is on a respirator right now after contracting the virus.”
If the virus kills healthcare workers, “the game is over. The light goes out, ”Dr. Peter Hotez, professor and dean of the National School of Tropical Medicine at Baylor College of Medicine, previously told CNN.
“If there are multiple front-line health care workers, emergency physicians, and nurses falling into this epidemic, a situation where there are colleagues dealing with colleagues in the intensive care unit, there will be nothing more destabilizing for States United”.
Flatten the curve
The capacity of the US health systems. USA it is at the center of the effort to “flatten the curve”, to spread the number of infections over time through measures such as social distancing.
The goal: to prevent hospitals from seeing a massive increase in patients arriving at the same time.
On Tuesday, President Donald Trump said he wanted the nation “to open for Easter,” which is April 12, a date that few health experts believe will be enough to stem the spread of the coronavirus.
Earlier this month, Fauci said that “it would probably be several weeks or maybe more before we know if we had an effect” on the flattening of the curve, and on Tuesday he emphasized the need to be “flexible” on the timeline. established by Trump.
“Obviously, no one will want to tone things down when you see situations like in New York City,” Fauci said Tuesday.
Some in New York do not expect the outbreak to diminish anytime soon.
Cuomo on Wednesday said he expects to see a maximum number of patients in about 21 days, according to current projections.
“We are really at the beginning of this outbreak,” said Spencer of NewYork-Presbyterian. “And you can feel that. You can feel it. It is palpable on the front lines in the emergency department. ”
In a series of tweets early Tuesday, Spencer urged people to practice social distancing to save lives: “We are too late to stop this virus. Stop it completely. But we can delay its spread.
“Hospitals are reaching full capacity. We are running out of fans, ”he said. “The ambulance sirens don’t stop.”
Scott Bronstein, Nelli Black, Ellie Kaufman, Kevin Liptak, Maegan Vázquez, Nick Valencia, Jim Acosta, Arman Azad, Kristen Holmes and Ben Tinker contributed to this report.
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