New Year's Eve COVID-19 Update from Dr. Smith: 12/31/20

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

Dear Colleagues,

2020 is not going down without a fight. The strain on our inpatient capacity during the Covid resurgence is now visible even through my rose-colored glasses. The medical ICUs are all Covid, and Covid patients are spilling into surgical units. Nursing, already stressed, is using “pyramid” coverage in ICUs as necessary. Floor beds are being expanded in a variety of creative ways, with critical staffing help from nursing students. Proning teams are in limited use again, though our SWAT teams are not yet necessary. Double occupancy of some ICU beds has resumed, preventing visitors, so the family liaison teams will be reactivated to handle communication.

More importantly for our Department, we were asked to reduce by 50% the volume of operations that require inpatient stays for the week beginning Monday, January 4. This was deeply unwelcome news. Nonetheless, once again our Division leadership responded immediately. After some give-and-take, a realistic schedule has been set for next week. For the immediate future, we will retain the privilege of deciding how any future reductions are accomplished. Prioritization forces uncomfortable choices, but we’ve been through this before, and I know we will be fair and equitable, both to our patients and our surgeons. I will be surprised if this adjustment is necessary for more than a few weeks, but I’ve been wrong before in this 100-year event. It will be as important as it was in March to keep in touch with the patients who are postponed.

There are some important differences between this resurgence and the original surge in the spring. Covid occupancy in our ICUs has been increasing by 0.7 patients/day for the past month. In the month that followed March 21 that rate was 7.7 patients/day—ten times faster. Length-of-stay has been about one-third of what it was in the spring. It’s premature to measure mortality but it appears to be markedly lower, which has been true around the world. Credit is given variously to younger, healthier patients and better treatments. If you’re looking for one thing to be grateful for at midnight, be grateful for the fact that this pandemic has largely spared our children, unlike polio, smallpox, and many others. Maybe throw in some gratitude for vaccines. NYP has vaccinated over 22,000 people in about two weeks. 2021 may be the beginning of the end for Covid-19.

2021 comes in as anxiously desired, and freighted with hope, as any first-born. It is also a serial-pair year (20,21); each century is allotted one—does that help? The most recent one, 1920, was notable for the last “yes” vote (from holdout Tennessee) that ratified women’s suffrage. However, 1920 was also marked by the largest terrorist act in US history, when a horse-drawn carriage filled with explosives exploded on Wall Street, killing 38 people. Since a Covid resurgence clouds this New Year, gravely testing our resilience and stamina, I’d rather go back to 1415, to the Battle of Agincourt, when Henry V defeated a vastly superior French force through ingenuity, archery, and inspiration. Agincourt also inspired Shakespeare’s Henry V, which might seem like the perfect set-up to show off over-used quotes like “Once more into the breach, dear friends!” or the Crispin’s day speech (“We few, we happy few, we band of brothers”). I prefer “All things be ready, if the mind be so.” 2021, give us your best shot.

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

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