Dr. John Marshall, the chair of emergency medicine at Maimonides Medical Center in Brooklyn, has seen a lot. He served as a doctor for the air force in Afghanistan and was working in a trauma center in Denver the day of Columbine. But nothing like this.
“This is an order of magnitude different,” he said. “This is stuff that we’re all learning to adjust to, but stuff that none of us have ever seen....We’re learning to care for these patients as we go.”
Maimonides Medical Center, like all hospitals in our region, is rapidly moving to scale up from around 560 beds to 1400; from 54 intensive care beds for the sickest patients, to around 300. As of Sunday, across New York state, more than 8,500 patients are hospitalized with COVID-19 and more than 2,000 are in intensive care. That’s more than 1,000 new patients in a day.
At Maimonides, they’re converting all kinds of spaces into COVID-19 wards — a laboratory, an outpatient clinic, a rehabilitation gym — throughout the hospital and in nearby outposts. Like many other hospitals, they’ve set up a tent on a blocked-off sidestreet that’s being fitted with climate control and electricity, if things get really dire and patients must be housed there. A refrigerated truck parked beside the hospital will serve as overflow space if the hospital’s morgue fills up.
Inside an intensive care unit, nurses and doctors in protective gowns, face shields and surgical masks rush between rooms. Patients in individual rooms are separated behind sliding glass doors. As much equipment as possible is set up outside of the ICU rooms so staff have to enter as little as possible.
Most of the critically ill are sleeping or sedated, and though many of the hospital’s patients have been older, a significant number admitted to intensive care have been between the ages of 25 to 50, Dr. Marshall said.
“Sometimes [they need] 10 days, even two weeks on the ventilator before they recover. You know, they're frequently requiring three full weeks in the hospital. That's a lot longer than our normal hospital stay,” Dr. Marshall said, adding that the longer stays are another reason why hospital capacity is maxing out all over the region.
And of course, ventilators are scarce. Dr. Marshall and other hospital officials refused to provide specifics.
“Right now, we have as many patients on ventilators as we had ventilators before this, so every one of the ventilators we had a month ago is in use now,” he said. Fifty more were donated to the hospital, and another 50 are on the way. But at Maimonides, they’re trying to avoid the use of ventilators whenever possible, using other types of treatments, such as a high-flow oxygen machine or other lung therapies.
One of the patients, who was only partially visible through the glass sliding doors, called out to the director of the ICU, Dr. Cameron Kyle-Sidell. It’s the first time in days he’s been able to breathe on his own, the doctor said.
“He’s completely off oxygen,” Dr. Cameron Kyle-Sidell said, beaming from behind his surgical mask.
“He looks great,” Dr. Marshall said.
Dr. Cameron Kyle-Sidell and Dr. John Marshall look into a room in which a patient is recovering from COVID-19.
There are about a dozen patients in this small ICU. It’s relatively calm, but there are many of these wards throughout the hospital and dozens more patients in the emergency room waiting to be admitted. Hospital officials refused to say how many patients they currently have admitted to the hospital, how many were in intensive care or how many patients had died, but said they had treated hundreds of patients over the course of the outbreak so far.
A spokeswoman said that 80 percent of emergency patients are sick with COVID-19 and of them, a third are hospitalized. A third of those who are hospitalized need intensive care, and about half of intensive care patients need ventilators.
Down a stairwell and through a maze of corridors, Dr. Marshall passes into it.
“This side of the Emergency Department is normally our critical care zone. It became our hot zone last week for the COVID patients,” Dr. Marshall said. “Although as the week has progressed, pretty much everything has become the hot zone.”
There are dozens of patients of all ages in rows of beds, all wearing hospital gowns and masks, one woman sitting in a chair. A woman behind a thin fabric partition is gasping for air; others cough. Many will need beds inside the hospital.
Listen to reporter Gwynne Hogan's radio story for WNYC:
Henry Halpert runs Hatzolah of Borough Park, the volunteer EMS service that caters to the neighborhood’s Orthodox Jewish community, and he rushed up to Dr. Marshall for a handshake. Dr Marshall collegially swats him away and tells him to keep his social distance.
“It's been a war zone,” Halpert said, describing the last week of ambulance trips around Borough Park and Midwood.
And it’s just the beginning.
The anticipated peak of New York’s outbreak is several weeks away, in mid-April according to projections from New York Governor Andrew Cuomo. The question on everyone's mind, Dr. Marshall said, is will there be enough protective gear, equipment, physical space and healthy staff to care for everyone who needs it, as best as they can.
“Am I gonna be able to do what I've spent my whole life training to do when it matters the most?” he said, before darting off to care for his patients. “And this is, in my 30 years of my medical career, the time it’s mattered the most.”
