COVID-19 Update from Dr. Smith: 3/20/20

Each day during the COVID-19 crisis, Dr. Craig Smith, Chair of the Department of Surgery, sends an update to faculty and staff about pandemic response and priorities. Stay up to date with us.

Dear Colleagues,

This has been a very active day, during which the hard data has become alarming.  I wish I could use a more comforting word. Today NYP has about 300 COVID-19 antigen-positive inpatients, with about 200 awaiting test results.  This approaches a 50% increase in one day. CUIMC inpatient COVID-19 positive patients have increased from 37 to 59 overnight, ventilator patients from 10 to 12.  Projections presented at noon today estimate that we will reach peak COVID-19 volume within 22-32 days, at which point the NYP system will need 700-934 ICU beds. The lower estimate exceeds our ICU capacity, even with surge construction, HSS and DHK capacity added.  With that resource limitation in mind, we have reduced the urgent OR schedule even more dramatically. There is a sliver of a silver lining—it appears the alarm raised yesterday about our blood supply was overstated. 

PPE is an increasingly limited resource, most dramatically illustrated by masks.  N95 masks are already extremely scarce. NYP normally uses 4,000 non-N95 masks per day.  Currently NYP is consuming 40,000 such masks per day, which is estimated to reach 70,000 per day.  The downstate region uses about 3 million masks per week. The entire United States strategic reserve holds only 75 million masks.  With great effort Dr. Corwin has successfully pried 150,000 masks out of the reserve; a two-day supply at peak. We’re told that manufacturing is beginning to accelerate, but that relief is weeks away at best.  These figures might make it hard for readers to understand today's decision to provide one non-N95 mask to each NYP, CUIMC, and WC employee, but it is a potentially important concession to their emotional needs.  In theory, the mask is to be used only if the person becomes symptomatic. Employees will be responsible for keeping their one mask clean and available.  

Nothing would give me greater pleasure than to apologize profusely in a few weeks for having overestimated the threat.  That would mean we never exceeded capacity, and that mortalities and morbidities rarely seen in non-pandemic circumstances were avoided.  The next month or two is a horror to imagine if we're underestimating the threat. So what can we do? Load the sled, check the traces, feed Balto, and mush on.  Our cargo must reach Nome. Remember that our families, friends, and neighbors are scared, idle, out of work, and feel impotent. Anyone working in health care still enjoys the rapture of action.  It’s a privilege! We mush on.

Craig R. Smith, MD
Chair, Department of Surgery
Surgeon-in-Chief, NYP/CUIMC


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