New York healthcare workers say they've never faced a medical emergency of this scale before

New York's battle with COVID-19 has brought the region's hospital system to its knees.

The state is asking hospitals to double their bed counts and is desperately trying to find 10 times as many ventilators as they currently have. Convention centers and college dorms have been enlisted to make room for an anticipated surge of patients. Doctors and nurses have turned to social media to beg for the protective gear that will keep them from becoming patients themselves.

Modern Healthcare's sister publication, Crain's New York Business spoke with frontline healthcare workers and hospital leaders around the region to learn how they're coping with this generation's greatest medical challenge, one that could get worse before it gets better. Gov. Andrew Cuomo has said the virus might not peak for at least another two weeks.

"I've been doing this for a long time. Through the course of my career I have worked through the 1993 World Trade Center bombing and 9/11 and been in Los Angeles for an earthquake," said Dr. Billy Goldberg, an emergency-room physician at NYU Langone and the emergency department's vice chairman for business operations and strategic planning. "This is on a larger scale and very different from anything I've experienced."

Goldberg said doctors and nurses in the emergency room are getting one N95 mask per shift to conserve supplies, as opposed to changing masks with each new patient they see.

"The shifts are physically and emotionally exhausting," Goldberg said. "There's that anxiety of bringing things home to your family, and then I'm the doctor for my friends, family and neighbors. It's like you're always on."

As of Sunday night, New York state had confirmed nearly 60,000 cases of COVID-19, with about 34,000 people sick in New York City. In the city there were 6,600 people hospitalized, about 1,500 of whom were in intensive care. Queens and Brooklyn had the highest number of cases, and 776 city residents had died from complications with the respiratory illness.

Cuomo has instructed hospitals that they must increase the number of beds in their facilities by at least 50%, with some hospitals tasked with doubling their capacity. The state anticipates needing 140,000 beds at the outbreak's peak.

Some of the city's largest gathering spaces are candidates to house patients. A 1,000-bed medical facility was built at the Javits Convention Center, and Cuomo said last week he is considering creating more facilities at Aqueduct Racetrack in Queens, the Brooklyn Cruise Terminal, CUNY's Staten Island campus and the NY Expo Center in the Bronx.

Hospitals have been setting up tents outside their doors to triage patients. Refrigerated trucks have been stationed outside the city medical examiner's office in Manhattan as a potential temporary morgue.

Efforts to close schools and businesses have all been aimed at delaying the apex of the outbreak, so the hospital system might have more time to ramp up its capabilities and acquire ventilators.

It is the ventilators that have truly vexed the Cuomo administration, which anticipates needing 40,000 when the largest number of patients are hospitalized. The state estimated it had 3,200 a few weeks ago. It now says it has about 12,000 and is exploring converting anesthesia machines and splitting the breathing machines using tubes to treat several patients at a time.

The problem was particularly pronounced at the city-run Elmhurst Hospital Center in Queens, where 13 patients died from COVID-19 during one 24-hour period, The New York Times reported.

"So many people are saying it's going to be OK, everything's fine, we have what we need," Dr. Colleen Smith, who works in Elmhurst's emergency department, said in a video shared with the Times. "And if this goes on for a month or two, or three or five like it did in China, and we're already this strained, we don't have what we need."

Dr. Eric Wei, an emergency medicine physician and chief quality officer at NYC Health and Hospitals, said the public hospital system has diverted more resources to Elmhurst Hospital as well as Lincoln Hospital in the Bronx and Bellevue Hospital in Manhattan, which have been treating the largest numbers of patients, he said.

Wei said the system hasn't determined the origin of the cluster of cases in Elmhurst. Certain factors, such as the density of the population there, might have been responsible, he said.

"I'm very proud of how we handled this as a system," Wei said. "We've never come close to running out of PPE or ventilators."

He said workers' concerns about inadequate supplies are understandable but said the system has procured 100 more ventilators. A city spokeswoman said Friday it was sending thousands of pieces of safety gear and dispatching 105 nurses to Elmhurst Hospital.

Dr. Amy Plasencia, chief medical resident in internal medicine at Brookdale University Hospital Medical Center in Brooklyn, said she is concerned not everyone has had consistent access to protective gear. Resident physicians in the emergency department get one N95 mask per shift, she said, but those in lower-risk specialties have been asked to reuse the masks.

Plasencia spent the first three weeks of March working in the medical ICU, where her shift ran 6:30 p.m. to 6:30 a.m.

"We do what we can with what we have. If that means that we have to reuse masks, we'll reuse masks," Plasencia said. "We protect ourselves in the ways that we can, but we're not going to stop treating our patients because of suboptimal conditions."

Plasencia has been alarmed by patients who are in their 30s and 40s who become critically ill with COVID-19. Those patients typically were obese but didn't have other underlying medical conditions, she said.

"We've seen patients who come in one day, doing well enough, but we recommend to them admission. They say, 'No thank you.' They sign out against medical advice, and then they come back the next day in respiratory failure," Plasencia said. "We also have patients who, you know, they get admitted to the hospital and they do well and a week later they get discharged. It's completely variable, and it's very difficult to tell who's going to be the person to get very sick and who's not."

Plasencia is an executive vice president for the Committee of Interns and Residents SEIU, a national union, and has been advocating for a residents' bill of rights to protect the early-career physicians from unsafe working conditions. Those include limited access to protective equipment and working hours that can stretch beyond 80 hours per week.

That mission could become more important as hospitals tap into a volunteer medical reserve corps assembled by the state. About 76,000 people, including retired workers and clinicians with jobs outside of patient care, had signed up as of Sunday.

NYU's medical school told its students last week that those who had already met course requirements could graduate early if they agreed to work for the university's health system in internal medicine or emergency medicine.

"Those are individuals who are going to need more training and who may become more exposed because they haven't had the time to train to really prepare for this," Plasencia said.

Staffing concerns are top of mind for area health systems.

"The beds are the easy part," Northwell Health CEO Michael Dowling said. "It's the staff and supplies that become the management part."

Northwell has been having staff members take on additional shifts, and it tapped doctors and nurses working in nonclinical roles to get back into patient care. It has hired about 100 doctors and nurses from out of state and is calling retired clinicians to come back to work.

In one week, Northwell saw the number of COVID patients it was treating increase more than tenfold, from 90 to more than 1,250, across the system's 19 metropolitan area hospitals. Long Island Jewish Medical Center and LIJ Forest Hills have been two of its busiest campuses.

Dowling said he plans to deal with some of the surge by creating more beds in those places but also transferring patients to less inundated hospitals such as Southside Hospital in Bay Shore, Long Island.

"By doubling up and using nontraditional spaces such as lobbies and conference centers and moving things, we could create another 2,000-plus beds," Dowling said. "If I have a lot of patients in one place, I can move them to another place. It's not like I'm looking at each hospital separately. They're all part of a network."

As hospitals strain to assemble the necessary number of beds and acquire needed supplies, it raises the question of whether they were prepared to handle a pandemic of these proportions.

The Greater New York Hospital Association holds frequent emergency drills for situations as varied as mass shootings and chemical attacks. But COVID-19 is taxing the hospital system in a more widespread way that isn't limited to certain sections of the region, as was the case in response to 9/11 and Hurricane Sandy.

Northwell has been burning through about 6,000 N95 respirator masks each day.

"The lesson here for me is that we have to stockpile a lot more resources for the inevitability of something like this happening again," Dowling said. "We shouldn't be running around in a time like this looking for ventilators. We should be able to produce them quickly. We should not be totally reliant on overseas manufacturing."

Goldberg, in the emergency room at NYU Langone, is looking only at the next two weeks.

"I'm trying not to look too far ahead, because it's so unpredictable," he said. "We hope to see a decrease in the number of cases. Hopefully we will gradually catch up. I don't see this ending quickly."

This story first appeared in our sister publication, Crain's New York Business.