‘This Is Our Chernobyl’: New York City’s Nurses Are Terrified


 
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By Katie MacBride

With the deadly coronavirus quickly spreading through New York City, the city’s doctors and nurses are panicking that a lack of tests, beds, ventilators, and protective equipment have set them up for failure in one of the most critical fights in the city’s history.

“This is our Chernobyl,” said one New York hospital doctor, who like other health care professionals interviewed for this article, requested not to include his name or place of work. “The people in charge are not listening to the people on the ground. Everything is getting caught up in bureaucracy.”

This week, New York Gov. Andrew Cuomo warned that the virus could peak in a month and a half. But as of Thursday, New York City already had confirmed 3,600 cases of coronavirus—up from 2,000 cases just the night before—and New York State had 5,200 confirmed cases, the most of any state in the country. Cuomo has asked President Donald Trump to mobilize the Army Corps of Engineers and build temporary medical facilities in New York. “It’s only a matter of time before our state's ICU beds fill up,” Cuomo tweeted Monday. “The federal gov't must act.” According to New York hospital staff, the extra beds are already necessary. The growing number of cases have left hospital staff feeling overwhelmed by the flood of COVID-19 patients—a situation made worse by conflicting messaging and loosened safety standards that staff fear could increase their and their patients’ chance of exposure to the virus.

A firm COVID-19 fatality rate has been difficult to lock down. The New York Times recently reported that many "scientists and public health officials who have studied the data so far say they expect a fatality rate for Covid-19 of around 1 percent." But a separate New York hospital doctor said that New York’s fatality rate could inch closer to Italy’s seemingly much higher one if the state doesn’t take action to improve its infrastructure and facilities soon. “The 1 percent mortality rate is based on perfect ICU care,” the doctor said.“We need infrastructure to be built and to be protected."

To successfully fight coronavirus, New York hospitals will require fast and reliable tests; quarantine and isolation facilities; ICU beds and respirators, personal protective gear for staff, and enough staff to have dedicated teams for COVID-19 and non-COVID-19 patients. Right now, New York doesn’t have enough of those things, sources said.

“The isolation beds are constantly full,” said one nurse practitioner. “They’ve resorted to putting up tents in the halls of the emergency department to isolate people. Our hospital system just isn’t equipped for something like this.”

Without drastic action, the nurse practitioner said the city will soon not be able to house everyone who is in need of help. “It’s very obvious we don’t have enough space for these patients,” the nurse practitioner said. The overflow could cause issues for not only those with coronavirus, but people who need traditional medical care. “People don’t just stop having strokes and heart attacks because there’s a pandemic.”

In order to create more hospital beds, another doctor said he and others are pushing for hospitals to learn from China and create separate facilities to isolate people who have tested positive for coronavirus and keep hospital staff and other patients safe. So far, talks have not led to any concrete action. “We can do this. We have these colleges all around us that are now empty. I don’t understand. We’re not a third-world country. We’re able to mobilize when it’s needed, but everything is mired in this bureaucracy,” he said. “I feel like I’m living in bizarro world.”

Amid a public-health crisis, workers have found themselves frustrated by hospitals' continued concern with their bottom line. On Sunday, Mayor Bill de Blasio ordered city hospitals to cancel elective procedures that can wait, like tonsillectomies. But hospital staff said administrators haven’t complied since then. One health care worker said that they knew of roughly a dozen gastric bypass surgeries that happened at the hospital he works at since de Blasio’s order.

“It’s hard to justify,” the hospital staffer said. “But they’re making money off of those surgeries. If you shut down the whole [operating room], you’re shutting down a huge revenue source for the hospital.”

The situation has been made worse by the general public’s frantic desire to purchase or otherwise obtain personal protective equipment normally reserved for health care professionals, causing shortages at hospitals around the country.

Of particular concern is a lack of N95 masks. The masks—designed to fit snugly on the face—are critical for health care providers and other people working directly with infected patients, but have become an object of desire among coronavirus-related panic. One New York doctor said that boxes of N95 masks had even been stolen from the hospital emergency department.

The shortage of N95 masks had led to loosened safety standards and dangerous levels of rationing among health care progressional. “We were told today that select patient safety standards are no longer necessary,” the nurse practitioner said.

Some hospitals are now encouraging health care professionals to ignore typical best practices, like changing a mask after each patient. Now, at least three hospitals are encouraging workers to wear the same mask for 7 to 14 days, which means they have no choice but to reuse potentially contaminated masks around new patients, sources said.

Doctors in some cases are being encouraged by hospital administrators to only wear masks after a patient has tested positive for COVID-19, a suggestion that appalled them. With so few coronavirus tests available nationwide, and the length of time it takes to get results, doctors and nurses expect to come into contact with COVID-19 positive patients well before their tests have come back positive.

“If we don't have adequate [personal protective equipment], you're just asking for an even bigger disaster, because once you start knocking us out, and we have to be quarantined or we get infected, then we can’t work,” one of the doctors said.

NYU Langone Health—which operates two hospitals in Manhattan, one in Brooklyn, and one in Long Island—released an internal report on Wednesday that acknowledged some of the staff’s concerns. In the report, NYU Langone Health noted that it was “Hearing from staff about coronavirus-related anxiety” and “Working across the system to address staff concerns re: potential exposure.” Nevertheless, the hospital also informed staff that it would be “out of surgical masks with attached face shields” by the end of the week.

“Face shield burn rates are increasing,” the report stated, and “face shields should be reused unless broken—this needs to be message [sic].”

In response to nurses’ concerns, Pat Kane, the executive director of the New York State Nurses Association, issued a statement this week criticizing the lack of masks and other personal protective equipment for health care workers.

“If growing numbers of nurses are not able to be at the bedside because they were exposed to COVID-19 unnecessarily at work, everyone’s health is put in jeopardy. Steps we take now can save lives down the road,” Kane wrote.

The NYSNA has also said it believes that the virus is more transmittable by air than the CDC is currently claiming, and that N95 masks alone may not provide enough protection. A statement on the organization’s website argues that health care workers should wear full-body personal protective equipment, like the kind worn for Ebola and other airborne viruses, when treating confirmed or suspected cases of COVID-19 until it’s confirmed that health care workers are not at risk.

Staff additionally expressed concern that hospitals are moving nurse practitioners and other providers on and off of COVID-19 patients, rather than creating a dedicated team to combat the virus. “You’ve got people who could be infected going back to other patients and potentially shedding virus,” the nurse practitioner said.

Hospital administrators aren’t always informing the staff about which patients have tested positive for COVID-19 either. “They say it’s a matter of patient privacy, that telling us might be a HIPAA violation,” the nurse practitioner said. “It’s obscene. There are ways of saying ‘Hey, a staff member may have been exposed.’” Instead, he said, “We were told to assume that we’d been exposed.” Health care providers are acutely aware of the fact that they have a much higher risk of becoming infected than the general public. “I have an infant at home,” said one doctor. “Part of me wants to take my spouse and child, run away and never look back. I know I signed up for this and I have a duty to my community. But it’s hard. It’s really hard. I’m struggling.”

The doctor said he feels as if the public still hasn’t come to terms with how much damage the virus can do to people of all ages. “There’s still this idea that if you feel well you can’t spread it and if you’re under 60, it will be mild with no permanent damage.” Data from the C.D.C shows that nearly 40 percent of people sick enough to be hospitalized with coronavirus were between the ages of 20 and 54 years old.

Already, the doctor has witnessed young men experience cardiovascular complications from the virus, he said. “There are cases where the patient looks like they’re recovering from the lung part of the disease. They’re getting better and then suddenly they have severe heart failure. Within a day or two they go into cardiac arrest and die.” He said it’s possible this is the result of viral myocarditis—inflammation of the heart caused by a viral infection—but with such a new virus, it’s difficult to know for sure.

“I keep telling myself it’s a small number of cases,” he said. “But yes, I’m scared.”



 
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