I am a 32-year-old doctor, currently practicing in the intensive therapy unit at a hospital in New York City.
On March 7, a colleague of mine had just finished receiving a report from an emergency room physician and was about to admit the first patient with COVID-19. He made orders for appropriate isolation, and was soon using all the PPE [personal protective equipment, i.e., N-95, face shield, and full-body gown]. This patient was in the emergency room for many hours without being subject to any isolation measures.
At that time, there was a strong misconception among health care officials about community spread. They believed that only those who traveled to “hot spots” were at risk. Eventually, it became clear that the coronavirus had spread.
Looking back, it is likely that it had been spreading unchecked in NYC since early February. However, since no one was tested, we had no idea what was really going on. Our mantra, “If you don’t take a temperature, you can’t find a fever,” taken from the 1978 satirical novel, The House of God, adequately summed up the situation we found ourselves in.
A week later, on March 14, after a 14-hour shift in the hospital, I had a sore throat, but I didn’t pay attention to it. On March 16, I felt worse, noticing muscle pain and shortness of breath. This was odd, considering that I live on the 12th floor and always take the steps without any problem. However, I was now noticing dyspnea on exertion [a sensation of breathlessness]. That convinced me to wear a mask at all times. Later in the day, I noticed the onset of dry cough, so I decided to take the coronavirus test. I was lucky enough to get tested the very same day. After the test, I went straight home. The next day, I was notified that I had tested positive. Patients with mild illness do not require admission to the hospital, so I quarantined at home. When I first heard my diagnosis, I called my parents, who live in Moscow. I used this opportunity to explain to them the importance of self-isolation as the epidemic was gaining momentum.
Interestingly, prior to March 16, I had not been taking care of any patients with confirmed COVID-19. Therefore, there are two ways in which I could have gotten it: through someone in the hospital (a healthcare worker or patient) who was carrying the virus but was not suspected, or through community spread (like walking in the park, going to bars or restaurants, or going grocery shopping).
I quarantined for eight days, and during the last three, all the symptoms went away, so on March 25 I returned to the hospital. The atmosphere had shifted from fairly relaxed to warlike. All outpatient procedures had been canceled, and physician assistants and nurses from other departments were transferred to medicine service or the emergency room. In the last week of March, we faced a shortage of PPE (mostly notably N95, followed by face shields and whole-body gowns), but New Yorkers were helping us out: they donated those supplies and supported restaurant-sponsored fundraisers for more PPE.
Everything seemed surreal. I could never have imagined that while living in the US and working in a large nationally-renowned healthcare system, I would have to save the N95, sterilize it for 30 minutes by heating to 158°F, and use it again.
Fortunately, those days are over. Thanks to donors and the hospital administration, we now have all the medical supplies we need. Coronavirus tests have also significantly improved: in the beginning of March, test results from our hospital were ready in seventy-two hours; now it takes eight to twelve hours.
We are so grateful for all displays of support, including the flash mobs and ovations. It’s so encouraging to see people clapping and whooping for us, which they do every day at 7pm. It truly helps to lift the mood.
As for ethical issues, I don’t know anyone who has refused to work with COVID-infected patients.
From early March to mid-April, more than 440 people died in our hospital. This is approximately the same number of fatalities that we saw in a 10-month period in 2019. I can’t find the words to describe this.
There is no proven treatment for the coronavirus, although data from a recent study in JAMA shows that we are doing our best to improve our patients’ chances of recovery. Unfortunately, COVID-19 not only affects the lungs; we are seeing high rates of renal failure requiring CVVHD [continuous veno-venous hemodialysis]. In addition, large numbers of patients are affected by hypercoagulability [excessive blood clotting] that can affect any organ in the body (causing heart attacks, strokes, etc). As you can imagine, these things can further complicate already complex health management.
It is clear that NYC passed the peak of hospital admission somewhere between April 8 and April 10. Since that time, we have seen a continuous decline in the number of admissions. I hope that this was the only peak and that we won’t see a second wave of infections after stay-at-home orders are lifted and businesses are reopened. Unfortunately, the recent repeat closure of Harbin, China and a strict quarantine in Singapore suggest otherwise.