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COVID Crisis Post 9: Flattening the Curve.



New York City is the Wuhan of the United States.

Except it is already so much worse. Alert Kitty has pounced full-force.

The most updated info from Governor Cuomo today paints a grim picture in New York State, and especially here in this city I love so much.

New York City is the densest city per capita in America as most of us would likely have assumed. And because of this proximity, the attack rate (percentage of a population that gets the disease) is 1 in 650 (!!!) and the state 1 in 1000, more than FIVE TIMES higher than anywhere else in the US.

“We haven’t flattened the curve. And the curve is actually increasing. The apex is higher than we thought and the apex is sooner than we thought. That is a bad combination of facts.” - Governor Cuomo today

This is why social distancing and hygiene is so essential, especially here. But based on my observations and the hard numbers, we absolutely SUCK at it. And the city is massively suffering as a result.

New York State, as of this morning, has 25,665 confirmed cases and 210 deaths. New York City has 14,904 confirmed cases and is responsible for 130 of the deaths so far (this number is going to grow significantly). The current prediction is that the peak of the outbreak will occur in ~14-21 days. We have 53k hospital beds total in the state - the current estimate is we will need 140k beds with 40k of them needing to be ICU beds. We are estimated to need 30k vents, have only 4k, purchased 7k more, and were offered only 400 vents from FEMA though they supposedly have 20k vents stockpiled.

But wait, where do these numbers come from? Those numbers seem absurd. But not when the current data shows that the number of cases in NY State are doubling every 3 days.

Yes, every 3 days.

That means 3 days from now, the State predicts we'll have ~50k confirmed cases.

100k in 6 days. 200k in 9 days. 400k in 12 days. 800k in 15 days (early estimate of peak). 1.5+ million in 18 days. 3+ million in 21 days (late estimate of peak).

That is absolutely insane if that comes to fruition - the entire state's population is only 20 million! At first glance, those numbers seem absolutely PREPOSTEROUS. I just can't wrap my mind around it. But if the estimate that 5% of the COVID-19+ population will need to be hospitalized with ~20% of those patients requiring ICU level care with the majority on vents comes true, then well...

We're absolutely screwed.

The Javits Center is being converted to a 4 unit x 250 bed hospital (total 1000 beds) for NON-COVID patients. The US Navy ship Comfort will be docking in the next couple of weeks with an additional 1000 beds again for non-COVID patients. The purpose of both is to decompress the main hospitals so they can focus on COVID patients primarily. Hospitals are being asked to find ways to increase their bed capacity by at least 50%. The city is looking into the dorms at both SUNY and CUNY as temporary hospital beds, as well as hotels.

But what is so absolutely F*$KED about this is that these estimates focus on our needs for JUST COVID-19+ patients - but people are still getting sick with illnesses OTHER THAN COVID.

Even IF Javits and the navy ship are available, all the hospitals are able to increase capacity, and dorms and hotels can be converted to hospital beds to cover the estimated need (still a BIG if), who the heck is going to staff them all???

Governor Cuomo is asking retired healthcare personnel to come out of retirement to help out. But our retirees are in a high-risk category themselves! This has happened in Italy, and retirees make up a number of physicians who have died during the outbreak in Italy as a result.

IF the numbers get to where they are predicting, we can't just rely on retirees to come out of retirement to help us. We will need healthcare professionals from around the nation to serve as reinforcements.

I really hope these doom and gloom numbers are exaggerated and absurd and hyperbolic and an absolute MASSIVE overreaction.

But from what I am seeing personally and hearing from my colleagues around the city, there is a deeply unsettling feeling, the kind that churns away at your gut, it is true. We are in danger of reaching capacity much sooner than we had hoped.

And perhaps making decisions we hoped we never would have to make in our careers.

We are using everything at our disposal to treat the sickest of these patients, even unproven treatments, because we just don't have any time to waste. Hydroxychloroquine + Azithromycin for the sickest patients. Placing patients prone who have ARDS. And in a move that is understandable but so full of unknowns, the FDA approved plasma-injection trials in compassionate care situations, where the antibodies from a patient's plasma who recovered from COVID-19 are then injected into a severely-ill patient to help fight against the virus as a short-term treatment.

We have no idea how this will play out.

Hospitals around the city are mobilizing resources, including using anesthesia ventilators to fill in the ever-increasing ventilator needs. Healthcare workers are taking on new roles, including myself where I am the leader of the ICU assist team and soon will be a full-time attending in the ICU (believe it or not, I was deciding between pediatric anesthesia and adult ICU for fellowship, so not that much of a stretch).

And ultimately, we are doing everything we can to avoid the seemingly unavoidable conclusion to our lack of action, preparedness, and selflessness as human-beings:

Too little. Too late.

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