In New York, the main focus of the epidemic in the United States, caregivers have to contend with significant disparities in resources from one establishment to another.
New York City became the main focus of the Covid-19 pandemic in the United States last week, with nearly 40,000 people tested positive and nearly 1,000 dead. Many hospitals in the first American city are already overheating, and have to manage the influx of patients, with very uneven means from one hospital to another, as these testimonies show.
Trisha, nurse: “I paid masks, gowns, gloves from my pocket on Amazon”
Nurse for sixteen years in an intensive care unit of a nonprofit hospital in Brooklyn, the Brookdale University Hospital Medical Center, located in the disadvantaged district of Brownsville, Trisha (1) sees today her hospital, with a capacity of 300 patients, treat a hundred people who tested positive for coronavirus, but also nearly 80 who await their results. So far, at least 20 people have died from Covid-19 in the hospital.
“We have 18 cases in my intensive care unit alone. These are the most serious cases of the hospital: renal failure, respiratory failure, failures of several organs … The first death was a 49 year old man, but we also have patients 30 or 40 years old, with or without preexisting pathology . This disease does not discriminate on age, social status or skin color.
“The unit is full. We had to increase our capacity, by adding beds where we could, in the open spaces, which is problematic for patients who should be isolated. At first, patients who tested positive for Covid-19 were put in glass-enclosed boxes, but we can’t do that anymore because there are too many of them. The only thing you can do is draw the curtains between the beds.
“Healthcare workers are being hit hard by the lack of protective equipment, which is a problem across the country. In my hospital, the supply is very limited: you cannot have an N95 mask if you do not directly care for a patient with Covid. Like other nurses, I ordered, and paid out of my own pocket, materials on Amazon: masks, gowns, gloves. My mask, once I put it on, I don’t take it off all day.
“I have two sons at home. I stay in my room so as not to be in contact with them, we talk on each side of the door, I text them when I have to go out so that they are not in the living room. Today I am on leave, and I feel very guilty for not being with my colleagues, but I am exhausted. One of them just called me in tears. We try to support each other, but all this stress, all these patients, it shakes us a lot.
“Everyone is afraid to approach patients. We try to limit as much as possible the time we spend near them, but it is very difficult to work in these conditions. In my unit, a patient’s condition deteriorated very quickly. The doctor contacted his family, and when he told us that they had signed a DNR [a do not resuscitate order , editor’s note], the whole team was extremely relieved. It’s terrible to recognize it, but otherwise, we knew that it meant that by trying to resuscitate it, we were going to be very exposed to the virus: this patient coughed up blood. This may be the most traumatic moment of the past few days. ”
Nils Hennig, doctor: “We use all the available spaces: the cafeteria, the corridors”
Dr. Nils Hennig, Associate Professor in Pediatric Infectious Diseases, is director of the public health education program at Mount Sinai Hospital, a network of seven facilities in New York, treating a total of 1,250 patients with Covid-19 . The one in Brooklyn is already close to its limit, with 87% of the fans used.
“The number of Covid-19 patients doubled every other day, but now this doubling only occurs every six days, which is a very encouraging sign. We do not know if we can explain this positive development by the confinement of New Yorkers, but in any case we see it in our hospital.
“Right now we are using all the spaces available to accommodate patients; in the cafeteria, in the hallways. This is how we have been able to triple the number of intensive care beds since the start of the crisis. The Christian association of Pastor Franklin Graham has set up tents in Central Park to receive our newcomers and we are starting to install beds in Saint John the Divine Cathedral, near Mount Sinai. In terms of equipment, our hospitals are better off than other New York facilities because we generally have two days in advance. Members of the Mount Sinai Board of Directors have successfully used their business contacts, particularly in China, to secure supplies of respirators. But it is not enough to receive them:
“At the moment we expect to reach the peak of the disease in two to three weeks, followed by a plateau phase which could last three months. There is a chronic shortage of beds in American hospitals, which are close to saturation all the time. More generally, people are less likely to see their doctors here than in other countries due to medical coverage issues. We therefore receive many patients affected by preexisting diseases which increase their vulnerability to Covid-19.
“For now, we are holding out because we are better supplied than other hospitals and I must recognize the hard work of our staff. Everyone is requisitioned. All the researchers except those directly assigned to research on the virus, have stopped their work to care for the sick. All non-emergency surgeries are suspended and we all unfortunately have much less time to follow up with our other patients. We can hold out for now but I can’t get too far for the next few weeks. We are also very worried about other states that are less well equipped than us from the hospital point of view. ”