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NY Times, March 25, 2020
13 Deaths in a Day: An ‘Apocalyptic’ Coronavirus Surge at an N.Y.C. Hospital
Hospitals in the city are facing the kind of harrowing increases in
cases that overwhelmed health care systems in China and Italy.
By Michael Rothfeld, Somini Sengupta, Joseph Goldstein and Brian M.
In several hours on Tuesday, Dr. Ashley Bray performed chest
compressions at Elmhurst Hospital Center on a woman in her 80s, a man in
his 60s and a 38-year-old who reminded the doctor of her fiancé. All had
tested positive for the coronavirus and had gone into cardiac arrest.
All eventually died.
Elmhurst, a 545-bed public hospital in Queens, has begun transferring
patients not suffering from coronavirus to other facilities as it moves
toward becoming one dedicated entirely to the outbreak. Doctors and
nurses have struggled to make do with a few dozen ventilators. Calls
over a loudspeaker of “Team 700,” the code for when a patient is on the
verge of death, come several times a shift. Some have died inside the
emergency room while waiting for a bed.
A refrigerated truck has been stationed outside to hold the bodies of
the dead. Over the past 24 hours, New York City’s public hospital system
said in a statement, 13 people at Elmhurst had died.
“It’s apocalyptic,” said Dr. Bray, a general medicine resident at the
Across the city, which has become the epicenter of the coronavirus
outbreak in the United States, hospitals are beginning to confront the
kind of harrowing surge in cases that has overwhelmed health care
systems in China, Italy and other countries. On Wednesday morning, New
York City reported 16,788 confirmed cases and 199 deaths.
More than 2,800 coronavirus patients have been hospitalized in the city.
Gov. Andrew M. Cuomo on Wednesday offered a glimmer of hope that
social-distancing measures were starting to slow the growth in
hospitalizations. Still, hospitals are preparing for a major influx.
Working with state and federal officials, hospitals have repeatedly
expanded the portions of their facilities equipped to handle patients
who had stayed home until worsening fevers and difficulty breathing
forced them into emergency rooms.
Dr. Mitchell Katz, the head of the Health and Hospitals Corporation,
which operates New York City’s public hospitals, said plans were
underway to transform many areas of the Elmhurst hospital into intensive
care units for extremely sick patients.
But New York’s hospitals may be about to lose their leeway for
creativity in finding spaces.
All of the more than 1,800 intensive care units in New York City are
expected to be full by Friday, according to a Federal Emergency
Management Agency leadership briefing obtained by The New York Times.
Patients could stay for weeks, limiting space for newly sickened
residents. Mr. Cuomo said on Wednesday that he had not seen the
briefing; he said officials could quickly add intensive care beds if the
state dipped into its growing supply of ventilators, the machines that
help the most sick coronavirus patients breathe.
The federal government is sending a 1,000-bed hospital ship to New York,
although it is not scheduled to arrive until mid-April. Officials have
begun erecting four 250-bed hospitals at the Jacob K. Javits Convention
Center in Midtown Manhattan, which could be ready in a week. President
Trump said on Wednesday on Twitter that construction was ahead of schedule.
Officials have also discussed converting hotels and arenas into
temporary medical facilities.
At least two city hospitals have filled up their morgues, and city
officials anticipated that the rest would reach capacity by the end of
this week, according to the leadership briefing. The city requested 85
refrigerated trailers from FEMA for mortuary services, along with staff,
the briefing said.
“That is inaccurate,” said a spokeswoman for the city’s office of the
chief medical examiner. “We have significant morgue capacity in our five
citywide sites, and the ability to expand.”
In interviews, doctors and nurses at hospitals across the city gave
accounts of how they were being stretched toward a breaking point.
Workers at several hospitals, including the Jacobi Medical Center in the
Bronx, said employees such as obstetrician-gynecologists and
radiologists have been called to work in emergency wards.
At a branch of the Montefiore Medical Center, also in the Bronx, there
have been one or two deaths a day, or more, said Judy Sheridan-Gonzalez,
a nurse. There are not always enough gurneys, so some patients sit in
chairs. One patient on Sunday had been without a bed for 36 hours, she said.
Confirmed coronavirus patients are sometimes paired with those who have
not yet received test results, added Ms. Sheridan-Gonzalez, the
president of the New York State Nurses Association.
At the Mount Sinai Health System, one of the most prestigious health
systems in the country, some hospital workers in Manhattan have posted
photos on social media showing nurses using trash bags as protective
gear. A system spokesman said she was not aware of nurses using trash bags.
Since ventilators are in short supply, both Mount Sinai and
NewYork-Presbyterian, two of the city’s largest systems, are exploring
using one machine to help multiple patients, an unusual move, according
to employees at both networks and to staff emails.
But officials have called Elmhurst among the hardest-hit hospitals in
“Definitely Elmhurst Hospital in Queens has had an extraordinary amount
of activity,” Mayor Bill de Blasio said in a radio interview earlier
this week. “It’s been very tough for Elmhurst.”
Elmhurst Hospital Center opened in 1832 and moved to its current Queens
location in 1957, making it one of the oldest hospitals in New York
City. In the neighborhood it serves, Elmhurst, more than two-thirds of
residents were born outside of the United States, the highest such rate
in the city. It is a safety-net hospital, serving mainly low-income
patients, including many who lack primary care doctors.
Medical workers said they saw the first signs of the virus in early
March — an increase in patients coming in with flulike symptoms before
the alarm had been fully raised in the city and the country. Tests
results were taking longer then, but they eventually confirmed that many
of these patients had coronavirus.
In the weeks after, the emergency room began filling up, with more than
200 people at times. Every chair in the waiting room was usually taken.
Patients came in faster than the hospital could add beds; earlier this
week, 60 coronavirus patients had been admitted but were still in the
emergency room. One man waited almost 60 hours for a bed last week, a
The patients coming in now are sicker than before because they were
advised to try to recover at home, doctors said.
“Elmhurst is at the center of this crisis, and it’s the number one
priority of our public hospital system right now,” the city’s public
hospital system’s statement said. “The front line staff are going above
and beyond in this crisis, and we continue surging supplies and
personnel to this critical facility to keep pace with the crisis.”
Mr. Cuomo said that on Sunday, the state’s projections showed
hospitalizations doubling every two days, while Tuesday’s estimates
showed them doubling every 4.7 days. “That is almost too good to be
true,” the governor said, “but the theory is, given the density that
we’re dealing with, it spreads very quickly. But if you reduce the
density, you can reduce the spread very quickly.”
But the crowds outside of Elmhurst have not thinned out.
The line of people waiting outside of Elmhurst to be tested forms as
early as 6 a.m., and some stay there until 5 p.m. Many are told to go
home without being tested.
Julio Jimenez, 35, spent six hours in the emergency room on Sunday night
after running a fever while at work in a New Jersey warehouse. He
returned on Monday morning to stand in the testing line in the pouring
rain. On Tuesday, still coughing, eyes puffy, he stood in line for
nearly seven hours and went home, untested, again.
“I don’t know if I have the virus,” Mr. Jimenez said. “It’s so hard.
It’s not just me. It’s for many people. It’s crazy.”
Rikki Lane, a doctor who has worked at Elmhurst for more than 20 years,
said the hospital had handled “the first wave of this tsunami.” She
compared the scene in the emergency department with an overcrowded
parking garage where physicians must move patients in and out of spots
to access other patients blocked by stretchers.
Family members are not permitted inside, she said.
Dr. Lane recalled recently treating a man in his 30s whose breathing
deteriorated quickly and had to be put on a ventilator. “He was in
distress and panicked, I could see the terror in his eyes,” she said.
“He was alone.”
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