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With Virus Surge, Dermatologists and Orthopedists Are Drafted for the E.R. With Virus Surge, Dermatologists and Orthopedists Are Drafted for the E.R.
(7 days later)
One of the largest hospital networks in New York has given its doctors an ultimatum: either help deal with the coronavirus crush, or stay home without pay.One of the largest hospital networks in New York has given its doctors an ultimatum: either help deal with the coronavirus crush, or stay home without pay.
At other hospitals, too, all hands are being called to deck. Neurosurgeons and cardiologists, orthopedic, dermatology and plastic surgery residents — all have been pulled into emergency rooms and intensive care wards. Receptionists who normally deal with billing are also being told they will be reassigned, to emergency rooms to help screen Covid-19 patients.At other hospitals, too, all hands are being called to deck. Neurosurgeons and cardiologists, orthopedic, dermatology and plastic surgery residents — all have been pulled into emergency rooms and intensive care wards. Receptionists who normally deal with billing are also being told they will be reassigned, to emergency rooms to help screen Covid-19 patients.
This is what the redeployment scramble looks like as hospitals, girding for a surge of coronavirus cases in the next two weeks, face an acute shortage of doctors and nurses trained in intensive care settings.This is what the redeployment scramble looks like as hospitals, girding for a surge of coronavirus cases in the next two weeks, face an acute shortage of doctors and nurses trained in intensive care settings.
From cream-of-the-crop surgical specialists to nurses, physician assistants and administrative staff, health care workers who have not done a critical care shift in many years are having to retool themselves overnight — and not always voluntarily. There is pressure from co-workers, guilt about not helping, and fear about the risks to themselves and their families.From cream-of-the-crop surgical specialists to nurses, physician assistants and administrative staff, health care workers who have not done a critical care shift in many years are having to retool themselves overnight — and not always voluntarily. There is pressure from co-workers, guilt about not helping, and fear about the risks to themselves and their families.
“I feel like I’d be pretty clueless in these units actually,” said an orthopedic physician assistant at a Long Island hospital who usually works on elective surgeries. The assistant, who said she had “zero critical care experience,” declined to be identified because she feared she would be fired for speaking publicly.“I feel like I’d be pretty clueless in these units actually,” said an orthopedic physician assistant at a Long Island hospital who usually works on elective surgeries. The assistant, who said she had “zero critical care experience,” declined to be identified because she feared she would be fired for speaking publicly.
She and other physician assistants had received an email from their supervisor, who reminded them that another hospital in the area had made the assignments mandatory. “I did not want to go that route but everyone needs to pitch in,” the email said.She and other physician assistants had received an email from their supervisor, who reminded them that another hospital in the area had made the assignments mandatory. “I did not want to go that route but everyone needs to pitch in,” the email said.
Northwell Health, the network that has told its medical staff to redeploy, has 2,900 Covid-19 patients in its 17 hospitals, which include Long Island Jewish Medical Center, Lenox Hill in Manhattan and Staten Island University.Northwell Health, the network that has told its medical staff to redeploy, has 2,900 Covid-19 patients in its 17 hospitals, which include Long Island Jewish Medical Center, Lenox Hill in Manhattan and Staten Island University.
“If you’re employed by us, it is expected you can be reassigned to an area of need,” David Battinelli, Northwell’s chief medical officer, said in an interview. Those who do not agree will be furloughed without pay, he said.“If you’re employed by us, it is expected you can be reassigned to an area of need,” David Battinelli, Northwell’s chief medical officer, said in an interview. Those who do not agree will be furloughed without pay, he said.
Dr. Battinelli said clinical staff would be reassigned based on their skills and comfort level. All elective surgeries have been canceled across the Northwell network, and only 20 percent of its patients, he estimated, were coming in for non-coronavirus emergencies like heart attacks, strokes and injuries.Dr. Battinelli said clinical staff would be reassigned based on their skills and comfort level. All elective surgeries have been canceled across the Northwell network, and only 20 percent of its patients, he estimated, were coming in for non-coronavirus emergencies like heart attacks, strokes and injuries.
Conference rooms, lobbies and some cafeterias were being converted to intensive care units; the network plans to expand its bed capacity by 60 percent.Conference rooms, lobbies and some cafeterias were being converted to intensive care units; the network plans to expand its bed capacity by 60 percent.
“Obviously that puts pressure on trying to find staff to support those patients,” said Terry Lynam, a Northwell spokesman. “That’s the biggest concern — to try to get additional staffing.”“Obviously that puts pressure on trying to find staff to support those patients,” said Terry Lynam, a Northwell spokesman. “That’s the biggest concern — to try to get additional staffing.”
On Thursday, Mayor Bill de Blasio called for a national draft of doctors and medical workers to be sent to places where the virus has hit hardest, starting with New York. Some hospital systems had already been pleading for help from outside their networks. On Wednesday, NewYork-Presbyterian Hospital put out a call on Twitter for doctors and nurses, as it tries to expand intensive care units and emergency rooms in its hospitals.On Thursday, Mayor Bill de Blasio called for a national draft of doctors and medical workers to be sent to places where the virus has hit hardest, starting with New York. Some hospital systems had already been pleading for help from outside their networks. On Wednesday, NewYork-Presbyterian Hospital put out a call on Twitter for doctors and nurses, as it tries to expand intensive care units and emergency rooms in its hospitals.
Late last week came an urgent call from Dr. Augustine M.K. Choi, the dean of Weill Cornell Medicine in Manhattan, whose faculty work in several New York City hospitals.Late last week came an urgent call from Dr. Augustine M.K. Choi, the dean of Weill Cornell Medicine in Manhattan, whose faculty work in several New York City hospitals.
“We are running out of ICU trained doctors,” he wrote in bold type in an email to a national medical association, asking for intensive care physicians from other states and promising to cover the cost of travel, housing and meals.“We are running out of ICU trained doctors,” he wrote in bold type in an email to a national medical association, asking for intensive care physicians from other states and promising to cover the cost of travel, housing and meals.
Even before the United States had confirmed cases of the coronavirus, it was facing a growing physician shortage because of its increasing and aging population. A recent study projected a shortfall of between 46,900 and 121,900 physicians by 2032.Even before the United States had confirmed cases of the coronavirus, it was facing a growing physician shortage because of its increasing and aging population. A recent study projected a shortfall of between 46,900 and 121,900 physicians by 2032.
Last month, the medical association of critical care physicians warned that Covid-19 would strain the country’s roughly 29,000 intensive-care-trained physicians. “Having an adequate supply of beds and equipment is not enough,” the association, the Society of Critical Care Medicine, wrote in a blog post, adding that “the intensivist deficit will be strongly felt.”Last month, the medical association of critical care physicians warned that Covid-19 would strain the country’s roughly 29,000 intensive-care-trained physicians. “Having an adequate supply of beds and equipment is not enough,” the association, the Society of Critical Care Medicine, wrote in a blog post, adding that “the intensivist deficit will be strongly felt.”
Updated June 16, 2020 Updated June 22, 2020
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
In New York State, the exponential growth of virus patients, with nearly 15,000 hospitalized, has stretched medical workers to their limits, both numerically and psychologically.In New York State, the exponential growth of virus patients, with nearly 15,000 hospitalized, has stretched medical workers to their limits, both numerically and psychologically.
Stefan Flores, an emergency room doctor at NewYork-Presbyterian/Columbia University Medical Center, had an orthopedic resident by his side recently, and said specialist doctors were helping monitor patient vitals and doing bedside rounds. On a 12-hour shift, he has had to do as many as six intubations.Stefan Flores, an emergency room doctor at NewYork-Presbyterian/Columbia University Medical Center, had an orthopedic resident by his side recently, and said specialist doctors were helping monitor patient vitals and doing bedside rounds. On a 12-hour shift, he has had to do as many as six intubations.
“I do think we need more doctors,” Dr. Flores said. “It’s unsafe to deal with the acuity and volume we are dealing with. I’ve been on shifts where I’ve never felt so overwhelmed.”“I do think we need more doctors,” Dr. Flores said. “It’s unsafe to deal with the acuity and volume we are dealing with. I’ve been on shifts where I’ve never felt so overwhelmed.”
The anxiety among the redeployed is pouring out on WhatsApp and in text messages. “Now doing ED shifts for the first time in 17 years,” one doctor said on a WhatsApp group chat, referring to the emergency department. “Our ICUs are full and vents are pretty much all being used.”The anxiety among the redeployed is pouring out on WhatsApp and in text messages. “Now doing ED shifts for the first time in 17 years,” one doctor said on a WhatsApp group chat, referring to the emergency department. “Our ICUs are full and vents are pretty much all being used.”
A neurosurgeon at a Manhattan hospital learned last weekend that he would have to work in an I.C.U. alongside an intensive care doctor. He said he worried that at some point, intensive care doctors would fall sick or be overwhelmed by patients and that non-I.C.U. doctors would be managing ventilated patients.A neurosurgeon at a Manhattan hospital learned last weekend that he would have to work in an I.C.U. alongside an intensive care doctor. He said he worried that at some point, intensive care doctors would fall sick or be overwhelmed by patients and that non-I.C.U. doctors would be managing ventilated patients.
On his first shift, the neurosurgeon, who declined to be identified for fear of retribution, was assigned a N-95 mask and told to use it indefinitely. Several times an hour, code blue alerts were called out on the hospital loudspeaker, indicating a medical emergency. “Everybody is dug in for the long haul,” he said.On his first shift, the neurosurgeon, who declined to be identified for fear of retribution, was assigned a N-95 mask and told to use it indefinitely. Several times an hour, code blue alerts were called out on the hospital loudspeaker, indicating a medical emergency. “Everybody is dug in for the long haul,” he said.