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Coronavirus in N.Y.: ‘Deluge’ of Cases Begins Hitting Hospitals Coronavirus in N.Y.: ‘Deluge’ of Cases Begins Hitting Hospitals
(about 5 hours later)
New York State’s long-feared surge of coronavirus cases has begun, thrusting the medical system toward a crisis point.New York State’s long-feared surge of coronavirus cases has begun, thrusting the medical system toward a crisis point.
In a startlingly quick ascent, officials reported on Friday that the state was closing in on 8,000 positive tests, about half the cases in the country. The number was 10 times higher than what was reported earlier in the week.In a startlingly quick ascent, officials reported on Friday that the state was closing in on 8,000 positive tests, about half the cases in the country. The number was 10 times higher than what was reported earlier in the week.
In the Bronx, doctors at Lincoln Medical and Mental Health Center say they have only a few remaining ventilators for patients who need them to breathe. In Brooklyn, doctors at Kings County Hospital Center say they are so low on supplies that they are reusing masks for up to a week, slathering them with hand sanitizer between shifts.In the Bronx, doctors at Lincoln Medical and Mental Health Center say they have only a few remaining ventilators for patients who need them to breathe. In Brooklyn, doctors at Kings County Hospital Center say they are so low on supplies that they are reusing masks for up to a week, slathering them with hand sanitizer between shifts.
Some of the jump in New York’s cases can be traced to significantly increased testing, which the state began this week. But the escalation, and the response, could offer other states a glimpse of what might be in store if the virus continues to spread. Gov. Andrew M. Cuomo on Friday urged residents to stay indoors and ordered nonessential businesses to keep workers home.Some of the jump in New York’s cases can be traced to significantly increased testing, which the state began this week. But the escalation, and the response, could offer other states a glimpse of what might be in store if the virus continues to spread. Gov. Andrew M. Cuomo on Friday urged residents to stay indoors and ordered nonessential businesses to keep workers home.
State officials have projected that the number of coronavirus cases in New York will peak in early May. Both the governor and Mayor Bill de Blasio have used wartime metaphors and analogies to paint a grim picture of what to expect. Officials have said the state would need to double its available hospital beds to 100,000 and could be short as many as 25,000 ventilators.State officials have projected that the number of coronavirus cases in New York will peak in early May. Both the governor and Mayor Bill de Blasio have used wartime metaphors and analogies to paint a grim picture of what to expect. Officials have said the state would need to double its available hospital beds to 100,000 and could be short as many as 25,000 ventilators.
As it prepares for the worst-case projections, the state is asking retired health care workers to volunteer to help. The city is considering trying to turn the Jacob K. Javits Convention Center in Manhattan into a makeshift hospital.As it prepares for the worst-case projections, the state is asking retired health care workers to volunteer to help. The city is considering trying to turn the Jacob K. Javits Convention Center in Manhattan into a makeshift hospital.
“The most striking part is the speed with which it has ramped up,” said Ben McVane, an emergency room doctor at Elmhurst Hospital Center in Queens. “It went from a small trickle of patients to a deluge of patients in our departments.”“The most striking part is the speed with which it has ramped up,” said Ben McVane, an emergency room doctor at Elmhurst Hospital Center in Queens. “It went from a small trickle of patients to a deluge of patients in our departments.”
At Elmhurst, a 545-bed public hospital that serves a large population of undocumented immigrants and low-income residents, coronavirus patients have begun to crowd out others. Protective gear is running low. Doctors are worried there will be a shortage of ventilators.At Elmhurst, a 545-bed public hospital that serves a large population of undocumented immigrants and low-income residents, coronavirus patients have begun to crowd out others. Protective gear is running low. Doctors are worried there will be a shortage of ventilators.
Outside the facility, at a tent housing a new mobile-testing site, a line snaked around the building on Friday, a sign of the demand on testing and how much worse the influx could become.Outside the facility, at a tent housing a new mobile-testing site, a line snaked around the building on Friday, a sign of the demand on testing and how much worse the influx could become.
Demetre Daskalakis, deputy commissioner of the city’s Department of Health, estimated that hundreds of thousands, or even millions, of city residents would be infected in the outbreak. Officials, however, have said that most people will have mild to moderate symptoms, or none at all.Demetre Daskalakis, deputy commissioner of the city’s Department of Health, estimated that hundreds of thousands, or even millions, of city residents would be infected in the outbreak. Officials, however, have said that most people will have mild to moderate symptoms, or none at all.
Generally, about 20 percent of coronavirus patients require hospitalization, with about a quarter of those needing to be put on a mechanical ventilator machine to help them breathe. Statewide, more than 1,200 people have been hospitalized with the virus, according to Mr. Cuomo’s office. About 170 patients were in intensive care units in city hospitals, according to the city.Generally, about 20 percent of coronavirus patients require hospitalization, with about a quarter of those needing to be put on a mechanical ventilator machine to help them breathe. Statewide, more than 1,200 people have been hospitalized with the virus, according to Mr. Cuomo’s office. About 170 patients were in intensive care units in city hospitals, according to the city.
But even those initial cases were straining the health care system, a worrying sign.But even those initial cases were straining the health care system, a worrying sign.
“There’s no reference for this,” said Daniel Singer, who has been an emergency room doctor for 14 years and now works at Lincoln Medical and Mental Health Center. “It’s totally unprecedented.”“There’s no reference for this,” said Daniel Singer, who has been an emergency room doctor for 14 years and now works at Lincoln Medical and Mental Health Center. “It’s totally unprecedented.”
Lincoln administrators met on Friday to discuss its dwindling supply of ventilators, according to another employee.Lincoln administrators met on Friday to discuss its dwindling supply of ventilators, according to another employee.
Dr. Mitchell Katz, the head of the Health and Hospitals Corporation, which runs New York City’s public hospitals, said there were 230 patients in the Elmhurst emergency room on Thursday, about 50 more than any recent peak. Most were patients with the symptoms of Covid-19, the illness caused by the virus, he said.Dr. Mitchell Katz, the head of the Health and Hospitals Corporation, which runs New York City’s public hospitals, said there were 230 patients in the Elmhurst emergency room on Thursday, about 50 more than any recent peak. Most were patients with the symptoms of Covid-19, the illness caused by the virus, he said.
The system has received 100 more ventilators from its supplier and is expecting hundreds more, Dr. Katz said. At the same time, Mr. de Blasio has cast the equipment shortage in stark terms and has asked the federal government for help.The system has received 100 more ventilators from its supplier and is expecting hundreds more, Dr. Katz said. At the same time, Mr. de Blasio has cast the equipment shortage in stark terms and has asked the federal government for help.
“I don’t mean to be too dramatic here, it’s just a fact,” he said on Friday in an interview with the WNYC radio host Brian Lehrer. “It is a fact that a lot of people are going to die who don’t need to die if this doesn’t happen quickly.”“I don’t mean to be too dramatic here, it’s just a fact,” he said on Friday in an interview with the WNYC radio host Brian Lehrer. “It is a fact that a lot of people are going to die who don’t need to die if this doesn’t happen quickly.”
As of Friday, 35 people with coronavirus had died in New York State — the second highest number in the nation behind Washington State, where the virus appeared to hit first.As of Friday, 35 people with coronavirus had died in New York State — the second highest number in the nation behind Washington State, where the virus appeared to hit first.
In addition to converting the Javits Center, officials have considered turning a variety of other places into temporary medical facilities, including Madison Square Garden and the student dorms at New York University. A military hospital ship with 1,000 beds is coming, but it will not arrive until April. The state is planning to waive regulations in order to urge hospitals to increase capacity.In addition to converting the Javits Center, officials have considered turning a variety of other places into temporary medical facilities, including Madison Square Garden and the student dorms at New York University. A military hospital ship with 1,000 beds is coming, but it will not arrive until April. The state is planning to waive regulations in order to urge hospitals to increase capacity.
In the short term, hospital workers say their biggest worry is a severe shortage of the medical gear that protects them from sick patients.In the short term, hospital workers say their biggest worry is a severe shortage of the medical gear that protects them from sick patients.
The state has three stockpiles of medical supplies, including millions of masks and gloves, as well as more sophisticated equipment like ventilators. On Friday, the state health commissioner, Dr. Howard Zucker, said those supplies had been tapped to help backfill shortages at some hospitals.The state has three stockpiles of medical supplies, including millions of masks and gloves, as well as more sophisticated equipment like ventilators. On Friday, the state health commissioner, Dr. Howard Zucker, said those supplies had been tapped to help backfill shortages at some hospitals.
Hospitals have been trying to find more of the N95 masks that are most effective at preventing virus spread, as well as lighter surgical masks, goggles and gowns. But with suppliers running out across the world, hospital workers have improvised.Hospitals have been trying to find more of the N95 masks that are most effective at preventing virus spread, as well as lighter surgical masks, goggles and gowns. But with suppliers running out across the world, hospital workers have improvised.
Updated June 22, 2020 Updated June 24, 2020
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
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.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.
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.)
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.
At Kings County Hospital Center and the Long Island Jewish Medical Center in Queens, administrators have given doctors one N95 mask to last all week, according to employees at the facilities. At Kings County, emergency room doctors wipe down the masks with hand sanitizer between shifts and put the masks in brown paper bags labeled with their names, a doctor there said.At Kings County Hospital Center and the Long Island Jewish Medical Center in Queens, administrators have given doctors one N95 mask to last all week, according to employees at the facilities. At Kings County, emergency room doctors wipe down the masks with hand sanitizer between shifts and put the masks in brown paper bags labeled with their names, a doctor there said.
The Health and Hospitals Corporation, which runs Kings County, denied that workers were being told to reuse masks. A representative of Northwell Health, which includes Long Island Jewish, acknowledged that administrators were trying to preserve masks because the supply was limited.The Health and Hospitals Corporation, which runs Kings County, denied that workers were being told to reuse masks. A representative of Northwell Health, which includes Long Island Jewish, acknowledged that administrators were trying to preserve masks because the supply was limited.
The federal Centers for Disease Control and Prevention has said that N95 masks should be discarded after each interaction with an infected patient and should not be used for more than eight hours.The federal Centers for Disease Control and Prevention has said that N95 masks should be discarded after each interaction with an infected patient and should not be used for more than eight hours.
At other hospitals across the city and beyond, workers have turned to social media to plead for masks.At other hospitals across the city and beyond, workers have turned to social media to plead for masks.
In a hospital affiliated with Montefiore Medical Center in the Bronx, administrators stowed their masks in a locked room after a fistfight broke out among workers and visitors over access to the dwindling stockpile. Several hospitals have sent emails warning workers that they can be fired for the “unauthorized use” of masks.In a hospital affiliated with Montefiore Medical Center in the Bronx, administrators stowed their masks in a locked room after a fistfight broke out among workers and visitors over access to the dwindling stockpile. Several hospitals have sent emails warning workers that they can be fired for the “unauthorized use” of masks.
Medical workers exposed to the coronavirus had been self-quarantining, but this week state and city health officials issued new guidance recommending that hospital workers stay on the job until they show symptoms of the virus. People with symptoms of the virus spread it most easily, but research has also indicated that asymptomatic transmission is possible.Medical workers exposed to the coronavirus had been self-quarantining, but this week state and city health officials issued new guidance recommending that hospital workers stay on the job until they show symptoms of the virus. People with symptoms of the virus spread it most easily, but research has also indicated that asymptomatic transmission is possible.
“I’m worried because if we get it, everybody is going to get it,” said Aretha Morgan, a pediatric emergency room nurse at Columbia University Medical Center in Manhattan. “I might actually be exposing children in the E.R.”“I’m worried because if we get it, everybody is going to get it,” said Aretha Morgan, a pediatric emergency room nurse at Columbia University Medical Center in Manhattan. “I might actually be exposing children in the E.R.”
Dr. Katz, the head of New York City’s public hospitals, said he understood fears about having to keep working after being exposed. He defended the policy by saying the virus was already widespread, so workers exposed in a hospital setting were not any more exposed than anybody on the subway.Dr. Katz, the head of New York City’s public hospitals, said he understood fears about having to keep working after being exposed. He defended the policy by saying the virus was already widespread, so workers exposed in a hospital setting were not any more exposed than anybody on the subway.
He also said that while more supplies were needed, workers at public hospitals had enough protective gear to last through the end of the month.He also said that while more supplies were needed, workers at public hospitals had enough protective gear to last through the end of the month.
The city’s other efforts included reserving 1,500 hotel rooms to potentially use for people with mild coronavirus symptoms or other illnesses, said Deanne Criswell, the city’s commissioner of emergency management.The city’s other efforts included reserving 1,500 hotel rooms to potentially use for people with mild coronavirus symptoms or other illnesses, said Deanne Criswell, the city’s commissioner of emergency management.
Some medical students have also volunteered to help respond to the crisis. For now, students are working in support roles, such as taking notes and managing materials, said David Muller, dean for medical education at the Icahn School of Medicine at the Mount Sinai Health System.Some medical students have also volunteered to help respond to the crisis. For now, students are working in support roles, such as taking notes and managing materials, said David Muller, dean for medical education at the Icahn School of Medicine at the Mount Sinai Health System.
But if the number of cases continues to rise, it is possible that graduating students could start seeing patients — though not necessarily ones with the virus — even before their residencies are scheduled to begin in July.But if the number of cases continues to rise, it is possible that graduating students could start seeing patients — though not necessarily ones with the virus — even before their residencies are scheduled to begin in July.
“It could be not even a week or two before we have to sweep away some of those restrictions,” Dr. Muller said.“It could be not even a week or two before we have to sweep away some of those restrictions,” Dr. Muller said.
Luis Ferré-Sadurní, Jesse McKinley and Andrea Salcedo contributed reporting.Luis Ferré-Sadurní, Jesse McKinley and Andrea Salcedo contributed reporting.