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Concern is growing around the country over how frontline health care workers will deal with a potential surge of patients. Doctors, nurses and other medical professionals are also worried about their own health and that of their families. William Brangham talks to Dr. Billy Goldberg, an ER doctor at NYU Langone Health, and Dr. Anish Mahajan, chief medical officer at Harbor-UCLA Medical Center.
As you know, there's growing concern around the country about how health care workers will deal with a potential surge of patients and the fears that doctors, nurses and others have for their own safety, as well as for their families.
William Brangham and I are going to explore some of these questions this evening with several voices.
We're going to start with William and a focus on the biggest hot spot in the U.S.
We begin with a view from one emergency room in New York City. That's one of the cities hardest-hit by this outbreak so far.
And for that, I'm joined by Dr. Billy Goldberg. He's an emergency room physician at NYU Langone Health.
Dr. Goldberg, thank you very much for doing this.
Can you just give us a sense of what it's like in the hospital today?
It changes every day.
So you know, what it was like yesterday and what it is like today is a different story. Things are getting real here in New York. We're getting sicker and sicker patients. We are all concerned about what is going to happen in the days and weeks to come.
But we're hanging in there. This is what we are trained for, as emergency medicine doctors. And we are there for you.
One of the things that we have read a good deal about is this concern that there is simply not enough protective gear for masks, face shields, gowns for people like yourself.
Are you guys OK on equipment right now?
So, describe OK.
We're not exactly where we want to be. Both of our hospital systems, both NYU and Bellevue, are doing everything we can to get the gear we need. On a normal day, when we see a patient, like a patient with COVID — prior to COVID, that is — we would be free to put on the full protective equipment that we need.
When we leave the room, we change that equipment and we put on new equipment for the next patient. That is not the case now. We do have equipment for the short term, but we don't know what is going to happen.
And we are doing things like using a mask for the entire shift, until it visibly soiled. And those are things that are tricky for us on the front line.
So, normally, you would take one mask, one face shield per patient?
Yes, the whole concept is, is, you want to protect yourself, you want to take anything that may have gotten on that, carefully remove the mask, and discard it, and then you start fresh with the next patient.
So, sometimes, we have what we are calling super spreader events. And these are events, such as an intubation, which is when we have to put a breathing tube down somebody's trachea.
Now, these are super spreader events, because the virus is spread much more rapidly. It's because we are aerosolizing the virus. Mostly, we're concerned about droplet transmission. But in these cases, because of the proximity to the airway and the exposure to the virus, it's much more risky for those of us in the health care field.
So we're trying to really protect ourselves during those times. And we will have a shield that kind of protects the mask. So you're hoping that no splash gets on the mask.
But, again, when the virus is everywhere, it's inevitable that this these — you know, these precautions are not perfect.
So you're talking about the need to put someone on a ventilator. That's something else that we have heard that there is a great deal of concern about that, that we simply don't have enough ventilators for all the patients who might need them.
Are you guys equipped well enough now, or not?
So, again, now, yes, but tomorrow, we don't know.
We're seeing more and more patients like this. We have a shift report at the end of every day, and, occasionally, we will put one or two people to shift on a ventilator. Yesterday, I got a shift report that said 10 people in one 12-hour period.
And the numbers are just — just increasing. So we don't know where this is going. So we need more supplies.
So many of us, of course, were following what was going on with the medical staff at all of those hospitals in Italy and the sort of heart-wrenching struggles that they had to make about who to care for and who not, simply because they had run out of that capacity.
Were you following that? Were you reading those dispatches from doctors? And were you talking amongst your colleagues about this?
So it's a very active thing that a lot of us are doing, not only to follow the stories, the way everybody is, but also to learn about the disease process.
So we're learning things all the time through our physician chat groups, through some of these online discussions. And, yes, we're following it. And we think about patients. What's in their best interest? We try to discuss advanced directives with them.
It is going to become a much different situation with this, because, as we get closer to kind of running out of some of these supplies, we're going to have to make tough decisions about who has the highest likelihood of surviving.
And that may mean you're not providing this high level of care to patients who perhaps could have had a chance.
And how are you — I'm just curious how you're personally doing. I mean, this seems to be something that much of the nation is alarmed about and watching the news and scared and worried and hoping for the best.
But, as someone who is obviously directly on the front lines of all of this, how are you personally doing?
You know, we're hanging in there. This is what we're trained to do.
It's scary. We're still trying to protect our families and protect ourselves. There's a lot of people — people are paying a lot of attention to E.R. doctors now, which is great, but our colleagues in the ICU and on the medicine floors and all the people who work in the hospital are also dealing with it, the clerks, the people who clean the floors.
It's — we're all together in this. It's a scary time. I think our reserve is a little low, so small little things will tip us off. But we're trying to do the best we can to seek solace in the people who are doing the same things and just keep pushing along.
OK, Dr. Billy Goldberg from NYU Langone Health, thank you so much, and best of luck to you out there.
And now we turn to get a broader perspective, how an entire health system is preparing for this outbreak.
For that, I am joined by Dr. Anish Mahajan. He's the chief medical officer for Harbor UCLA Medical Center, which is operated by the Los Angeles County Health Department.
Dr. Mahajan, thank you very much for being with us.
Could you just give us a sense of how your hospital system is doing? How are preparations going?
Well, we are working very hard to be prepared for a larger number of patients that we anticipate as we get into the curve.
Here in Southern California. we are maybe a few days behind New York City and other places, certainly around the world. And so we are working very hard to increase our capacity through ICU level care and other types of care.
Approximately how many COVID patients do you have right now?
Well, I will speak for the public hospital system here in L.A. County.
We have about 10, or maybe a few more than that, that are confirmed positive. But, as you know, there's very little testing available. And we know that, in the community in L.A. County, there are likely to be many more confirmed cases of COVID. We just don't have the ability to test them.
So, is that your sense, that, absent good testing, we really just don't understand how widespread the virus is right now?
We have proxies without testing, such as patients that we are seeing presenting with flu-like type illness. So that gives us a sense, but we know already that there is community transmission occurring here in Southern California and many other places in the nation — community transmission, of course, being patients acquiring the infection, but not really knowing that they had contact with someone who was positive.
You mentioned that, systemwide, you're going through a lot of preparation.
What does that preparation look like? What are you guys actually doing?
Well, a number of things.
One of the first things we're doing are making sure that we have sufficient protective gear on hand, and using that protective gear wisely and when it's absolutely needed to protect staff from getting the infection.
The second thing we're doing is making sure that we're protecting patients from each other, ensuring that patients that have symptoms that suggest flu-like, or in this case coronavirus, are separated from other patients that we're seeing.
A third thing we have done is, of course, cancel all nonessential care, such as nonessential clinic visits, operations and surgeries. We're doing that, one, so that people can stay out of the hospital and clinics, so that they can be safe.
And are you confident that you have that capacity? I mean, do you have enough protective gear, do you have enough ventilator, do you have enough beds to do all of those things if the spike is, as we — as many people fear, the worst could be?
Well, we are working very hard to shore up our resources on all of those things.
You know — you have heard and all of us know that there's global shortages of protective gear. As it relates to ventilators, same thing. All jurisdictions at all levels of government are helping us find those ventilators.
But perhaps the most significant problem is that we need staffing for these critical care beds. And so we are asking nurses who used to practice critical care who may be in administrative roles to reacquaint themselves with how it is to take care of patients, because this is really going to be an all-hands-on-deck approach, if we don't flatten the curve.
What is the general sense amongst the staff?
I mean, for those of us who are reading reports, say, out of Italy, there seems to be a great deal of concern amongst medical staff about the difficult road that lies ahead. How are staff telling you, how are they doing, how are they coping with all of this?
Well, I think Americans know that people who come to work in hospitals and clinics are compassionate.
And these are not just the doctors and nurses, also the clerks, the people who clean the rooms and make sure they're safe and turn over the rooms. These people are very compassionate and mission-driven.
But what we are seeing now is, they're showing courage, because, in a public health crisis like this, where the infection can be transmitted so easily, naturally, our staff want to continue to help their patients and the community, but they also have to protect themselves.
And so, yes, we are seeing a lot of anxiety among all levels of staff about whether they may bring the infection home to their kids or to their parents. How do they protect themselves when we have shortages of protective gear?
We know your governor, Gavin Newsom, issued basically a stay-at-home order for the entire state.
Is it your sense that people thus far have been heeding that? Have you noticed more people seeming to stay away, to stay at home, to isolate themselves?
Well, certainly, we have probably all seen the reports of the fact that L.A. freeways are no longer choked. We can get around easily. Pollution is down in major cities that have stay-at-home orders.
One small silver lining to this crisis, I take it.
Right, and a proxy that people are generally staying home.
That said, there are groups of patient — people who maybe don't yet understand the message, and particularly young people. Young people in general feel they're invincible. So, it's extraordinarily important that everybody heed the stay-at-home orders, so that they protect the entire community and protect the — protect us from the infection spreading very rapidly, because, as you know, if the infection spreads rapidly, we will quickly be overwhelmed in being able to take care of the patients that need the help.
All right, Dr. Anish Mahajan, chief medical officer of Harbor UCLA Medical Center, thank you very much.
And from all of us, best of luck to you out there.
Thank you very much.
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