"Beyond anything I've seen in my career": Doctors on the front lines describe surge in coronavirus patients
The surge of coronavirus patients is beginning to overwhelm hospitals in the world's new epicenter: New York City. Other hotspots are growing from coast to coast, but New York state has nearly half the known cases in the U.S. For more than 80% of patients, the symptoms of the disease, COVID-19, tend to be relatively mild. But the small fraction of seriously ill patients is forcing a national mobilization. In New York City alone, hundreds have died. The battle is being fought in the city's intensive care units by a frontline of critical care doctors and nurses.
Scott Pelley: Tell me about the battle you're fighting.
Dr. Gul Zaidi: It's hard. We're ICU doctors, we're used to pressure. We're used to seeing a lot of things that normal people don't see. But this is really beyond anything I've seen in my career.
Dr. Gul Zaidi has been a critical care specialist nine years at Long Island Jewish Medical Center in Queens.
Dr. Gul Zaidi: There's no time to sit, let alone eat or do simple things like take bathroom breaks. We just keep going. And it's essentially one room to the next.
Scott Pelley: When was the last time you slept?
Dr. Gul Zaidi: I don't know. I don't remember when was the last time. Probably before this exploded like this.
Dr. Mangala Narasimhan is chief of critical care at Long Island Jewish Medical Center, one of 23 hospitals in the Northwell Health System.
Dr. Mangala Narasimhan: I have 18 beds in one ICU full of people on ventilators, completely sedated unable to open their eyes or interact or talk to their families. And we are feeding them through tubes, and we are completely keeping them paralyzed so that we can properly ventilate them. It's our sickest patients, and they're in every single room of our ICU.
The pictures in our story were shot for us by hospital staff. By the end of this past week, New York City hospitals admitted more than 5,000 COVID-19 patients. At Northwell Health hospitals, about a third of COVID-19 patients go to intensive care, often suddenly.
Dr. Mangala Narasimhan: Very quickly, within hours. They walk into the hospital, talking, or into an urgent care. And 12 hours later they're on a ventilator, fighting for their life.
Scott Pelley: Is that unusual?
Dr. Mangala Narasimhan: Very unusual. Very unusual. We don't see that course in progression like this with any other disease that we deal with.
Scott Pelley: How long are they staying in the ICU?
Dr. Mangala Narasimhan: Much longer than our normal patients are. Normal patients, we have three or four days of ICU stay and they leave. These patients, and this is consistent with China and with what Italy is seeing, take about two weeks on a ventilator before they can come off, if they come off.
Before coronavirus, critically ill patients often had last visits with their family before being sedated and intubated, the insertion of a ventilator tube. But, now, because of contagion, families aren't allowed in the hospital. Dr. Eric Gottesman, of North Shore University Hospital on Long Island, helped a patient say goodbye remotely.
Dr. Eric Gottesman: I could tell that he was gonna need mechanical ventilation, be intubated. We-- I talked to his wife on FaceTime. We FaceTimed him all together. And then his wife sang goodbye to him. Very touching. And he-- he's still intubated, yeah. And there are lots of-- lots of stories like that. Lots of stories. FaceTiming and saying goodbye.
We watched as temporary morgues were set up in tents and 45 refrigerated trailers were made ready. Enough space, overall, for the potential of 3,500 bodies, about a thousand more than were lost at the World Trade Center on 9/11.
Scott Pelley: Have you had any patients leave the ICU yet?
Dr. Mangala Narasimhan: Yes, we have. We needed those wins to keep going, because we were getting very depressed by what we were seeing. But we've had some wins recently, and patients have come off ventilators and are doing well.
Scott Pelley: The youngest patient you've had on a vent so far is how old?
Dr. Mangala Narasimhan: Twenty-one.
Scott Pelley: How's that person doing?
Dr. Mangala Narasimhan: It's my one big win. Got off the ventilator and is doing really well, and is our hope.
Dr. Gul Zaidi: It's just the sheer magnitude of patients that are coming in, the influx not just into the hospital, but into our ICUs is beyond anything that we've seen before. We're doing our best, but it feels like wartime.
That war was joined by the military at the request of New York's governor.
Lt. General Todd Semonite: I flew up to see Governor Cuomo and he showed us the curves, when he thought it was gonna be a worst case...
Lt. General Todd Semonite commands the Army Corps of Engineers. He's leading a team building a 2,900-bed hospital in Manhattan's convention center. Across the city, the Corps is creating hospital space in hotels and vacant buildings.
Lt. General Todd Semonite: We don't have enough time to do this the normal way this is an unbelievably complicated situation, this is a catastrophe. We can't have a complicated solution. So, what we need is a very, very simplistic concept, what I call the 'good enough' design. But if we try to do any more than good enough, we're gonna miss the window. So, I'm tellin' my guys, "You don't have the time to do it exactly the way everybody wants it. You've gotta get it done by when that mayor or when that governor says, 'Here is my absolute critical peak. I've gotta have it done by then.'"
The convention center hospital opens this week. Patients who do not have COVID-19 will be transferred here to free up beds in regular hospitals that are becoming virus intensive care units. General Semonite has plans nationwide.
Lt. General Todd Semonite: We are concerned about New Jersey, we're very concerned about California, we're very concerned about Washington. Yesterday, I had one of my two-star generals in Illinois, worried about the Chicago area, we're worried about that, I talked to Governor Edwards the other day in Louisiana, so those are probably the big six but that doesn't mean that the other 44 aren't going to get the same level of treatment.
Scott Pelley: And you are anticipating retrofitting not just hotels, but sports arenas.
Lt. General Todd Semonite: We are. One of the ones we are doing is Seattle. The concept right now is going into Seahawks stadium and we're basically going to go in there – not out there where the football field is, but, you know, all the space down underneath where all the concessions are. A lot of great space.
Army medical teams have arrived at the convention center. A Navy hospital ship will dock soon.
Mayor Bill de Blasio: April will be worse than March. May will likely be worse than April.
Democratic Mayor Bill de Blasio told us that he spoke to the president three times last week about military reinforcements to help relieve the city's frontline doctors and nurses.
Mayor Bill de Blasio: And they are not gonna be able to sustain this pace. And we need to bring in a whole new group to substitute for them and give them a break and keep building out our capacity. If we don't get a lot more medical personnel quickly, even if we have the equipment, it won't be enough.
Scott Pelley: Where do you get them?
Mayor Bill de Blasio: We gotta take every person who works in medicine, regardless of what they do, private practice, any kind of medicine, we need to mobilize them we're gonna have to be very strong using all the legal powers of the state and city to mandate it. Because it's getting desperate.
In Manhattan, message boards beg on the street for, "recently retired health professionals to help treat patients." Thousands of retirees have responded. Mike Dowling, the CEO of Northwell Health System, is also counting on those at the beginning of their medical careers.
Mike Dowling: the medical schools' graduations were to be happening in two months. They will happen quickly so we'll assign those medical students that were graduating to the hospitals as well.
Scott Pelley: You're accelerating this class of medical school graduates?
Mike Dowling: Yes. And they're going to get an experience that will be wonderful for their continuing education.
Dowling is preparing for equipment shortages. Masks are being reused, and ventilators, known as 'vents,' may be pushed beyond their design.
Mike Dowling: You can, under certain circumstances, take a vent and put two patients on a vent. That helps. But we need more vents because you can turn any bed into an ICU bed if you have the ventilators.
The need for ventilators is acute because of the surprising nature of the disease.
Dr. Mangala Narasimhan: We have lots of people in their 20s, 30s, and 40s that are sick and are on ventilators and don't have a lot of medical problems. So, while the older people definitely fare worse, the younger people are also not spared.
Scott Pelley: Have you found a common denominator for why some patients crash so precipitously?
Dr. Mangala Narasimhan: We do think that there's some trends towards obesity, that patients who are obese seem to do-- worse and men definitely more than women. Men seem to have about a 60% chance of doing worse, of those people who do worse. So, there are some trends, but not enough for us to pick those patients out.
Scott Pelley: In Italy and other places, we have seen rationing of care.
Dr. Mangala Narasimhan: Yes.
Scott Pelley: And physicians such as yourself having to make a decision who gets a vent and who doesn't. Are we approaching that?
Dr. Mangala Narasimhan: We are preparing for that in case we do approach it. I hope that we don't approach it. I think we have to think about things like that because of the numbers of people that are coming in.
Scott Pelley: And what are the answers?
Dr. Mangala Narasimhan: They're difficult. They are gonna be based on; probability of survival, how much is the ventilator gonna help this person?
At least one New York City nurse has died of COVID-19 infection. There have been spot shortages of protective gear, but Dr. Zaidi says there's enough at her hospital for now.
Dr. Gul Zaidi: We're all scared. I'm scared. But I have to lock those fears away in a box, because once I set foot into the hospital, it's all about the patient. So, we try to be cautious. We try to use the protective equipment. But it's not perfect. We all know that. But this is what I do. It's my job. So, I do what I have to do to help these people.
Elyse Isopo, a critical care nurse practitioner at North Shore University Hospital on Long Island, may have said it best.
Elyse Isopo: It's very scary and very real, but the camaraderie that I've seen I've never seen before. And when I'm home, I want to be there. And it's a feeling that I've never had before. It's like, okay, when you can't wait to get out of work 'cause it's a busy day, and everybody's sick, and you just want to go home. But now when you're home, you just want to be at work
Dr. Sameer Khanijo, of Long Island Jewish Medical Center in Queens, told us family is a source of strength and worry.
Dr. Sameer Khanijo: I have a wife and a daughter. We have a whole elaborate decontamination process when I get home.
Scott Pelley: What's your decontamination process at home?
Dr. Sameer Khanijo: I go straight home. I don't pick up my daughter from her daycare. I get home, I go straight into the shower clothes go into a bag. Take a shower. Everything that was with me gets either Lysoled or Cloroxed. And then I go and I clean my car.
Scott Pelley: To those who question whether businesses should be closed, whether entire cities or states should be locked down, you say what?
Dr. Gul Zaidi: You have to keep it locked down. The influx already is so much that if this continues, there's no resources in the world that'll be enough to deal with this and contain this. And we have to keep it locked down. Anything else would be irresponsible.
That's taken seriously in america's most densely crowded city. More than 8 million people appear to have nearly vanished, imprisoned in apartments by the shutdown of schools and businesses. Police have orders to break up gatherings, but judging from Fifth Avenue, the cops could stand some company.
Still, the extreme social distancing measures have not yet slowed the spread. New York's hospitals may be a preview of what's to come as more cities join the battle.
Mike Dowling: I would like to say to the public, the health care system is resilient. We will handle this. And it's important for people to understand this. You don't quit. You don't retreat. You don't put up the white flag. You are going to win.
Produced by Maria Gavrilovic and Alex Ortiz. Broadcast associate, Ian Flickinger. Edited by Daniel J. Glucksman.
