Notes from COVID19 Frontlines

Nobody wants to have a kid go to war, but sometimes it happens.

My brother got sent off to Vietnam, and while our family opposed that war, his choice was a Hobbesian choice, which is to say, not much of a choice.

With respect to NYC right now, doctors who are employed by any of the major hospital health care systems  are more or less conscripted, but they have more choices to avoid service, if they wish.

As the email below mentions, if you are employed as a physician by a hospital system, you can choose not to report for duty--you simply won't be paid. For those who had enough financial cushion, that is an option.

But unless I miss my guess, I am betting even doctors with a lot of cushion will not leave town.  I can think back to docs I knew in NYC and I can name those who have likely already decamped to their places in the Hamptons. Medical practice  for them was never about anything but the money, so hazardous duty makes no sense for them.

But for a lot of docs, like the 60 year old with two coronary stents, he will not fail to step up--he will not fade from the firing line, because if you are a doctor, you show up.

A check out clerk at Market Basket told me, "I did not sign up for this. If I didn't need the money, I wouldn't be here."  I can see that.  She felt that simply standing across the checkout counter was too big a risk. Some grocery stores are installing plexi glass panels to protect the cashiers now.

There are no plexi glass barriers for the doctors and nurses in NYC now.

But for many doctors, they just could not face their colleagues later on, if they were not visibly present now.

Nurses, too.  Nurses especially. Nurses are closer to the patients than doctors mostly.

And it's the innoculum, the number of virions, viral particles, that likely determines who gets the overwhelming infection. 
Also the host. 
The author of this email has underlying asthma. A respiratory infection for him is a far more dangerous thing than for his non asthmatic colleagues.

But there he is.

He is writing his uncle, who is a doctor at Duke, replying to his uncle's inquiry about how things are going in NYC.

On Fri, Mar 27, 2020 at 2:14 PM 

Hi,
How are things going for you in NYC? The evening news makes it look pretty bleak - but hopefully they are exaggerating a bit for effect.

So far Duke Hospital has no cases of COVID-19, although there are two hospitalized at Duke Raleigh Hospital. Only a matter of time before the virus makes its way to Durham.

Hey Unc, (added dad as well)

Things are pretty much at capacity in NYC with the smaller satellites starting to get overwhelmed. I think that trend will progress to our main hubs by next week. As an example, at Brooklyn Kings Highway (a sinai affiliate near cony island) 146 of 220 beds are currently occupied with covid patients, their ICU expanded into their ORs and PACUs. Our colleagues there paint a pretty grim picture, the morgues are only used to about 5 deaths a day, so there is a refrigerated truck taking bodies away.  We have many more covid  patients in Manhattan but obviously way more capacity. As of last count, there were about 50 open ICU beds system wide. 

Surgeons were first told we could volunteer for "platoons" consisting of 2 surgeons and 4 mid levels/ trainees. These platoons would be sent to hot spots to help out in ICUs and ERs system wide. We will be functioning as whatever they need, ICU attending? ER? whatever. We were then told today that these platoons were only voluntary in the sense that we can also choose not to get paid. My immediate boss is in his mid 60s and has multiple coronary stents, and he will go to the front lines with the rest of us. 

A bright spot is it sounds like there is a decent amount of PPE to go around in manhattan, and have not heard stories like they are sensationalizing on the news. 

But yeah, all in all, we are in for a dark couple weeks. I plan on doing what I can on my platoon and being extremely paranoid with PPE. I also think it is quite possible [his wife] had and convalesced from it, so hopefully I already had an asymptomatic case. No way to know without serology (not available)