With more than 3,200 COVID-19 patients in hospitals across New York and around 600 new patients in a 24 hour period between Monday and Tuesday, healthcare workers on the front lines describe increasingly dire conditions inside hospitals, with limited access to protective gear, life-saving measures prioritized for younger, healthier patients, and early signs the virus may be spreading within hospitals themselves.
Several doctors and nurses across the region spoke to Gothamist/WNYC reporters on the condition of anonymity as they were not given permission by their employers.
At one Manhattan hospital, a nurse practitioner assigned to a COVID-19 ward spoke while stealing a few minutes break from the hospital floor.
“One [patient] died and one went to the ICU in the last five minutes,” she said. “There’s more fear, a palpable fear among staff members. A lot of nurses have called out.”
At her hospital, she said they had a total of 20 intensive care beds, four of which were empty, as of Monday.
“It’s a very new thing for me not to be able to be with my patients,” the nurse practitioner said, describing how patients are isolated behind glass walls and nurses are instructed to enter as little as possible. One of her patients died alone in the isolation room recently. “That loneliness, that dying alone is something I don't think people had considered. My patient who just passed away, the family didn’t want to come see her. They were afraid.”
New York State is moving to rapidly increase the number of hospital beds from 53,000 to 140,000, according to new state projections released Tuesday. State and city officials are also scrambling to secure thousands more ventilators to provide oxygen for critically ill patients. As of Tuesday evening, New York City had 15,597 confirmed cases. At least 192 people have died.
Statewide, 3,234 patients are in hospitals; 756 of them are intensive care units.
At Montefiore Health System’s main Moses campus, one healthcare worker described how COVID-19 patients from the network’s fifteen other hospitals were being sent there, even though their emergency department was usually at capacity on a regular day. Patients were commingled in different wards, he said, including intensive care units where he worked. Three intensive care patients who arrived at the hospital with other issues, like liver failure or heart attacks, later developed COVID-19 symptoms under his watch, according to the worker.
“It’s like a cesspool...It’s now spreading throughout the hospital,” he said. “I am sure I am going to get infected. My concern is that we are both getting infected and spreading it to other patients.”
Healthcare workers aren’t being tested for the virus proactively, he said, and they were dissuaded against using face masks as a precaution for patients who don’t have COVID-19. A letter sent out to staff provided to Gothamist/WNYC threatened employees with termination if they used masks when not indicated by hospital policy, though the hospital has since walked that back and allowed staffers to use face masks throughout the facility. A spokesman for Montefiore Medical Center confirmed COVID-19 patients were being consolidated at Moses Campus but said they were separated from other hospital patients.
“Our team follows strict infection prevention protocols and has screening procedures in place to recognize, isolate and evaluate patients for various illnesses, including COVID-19,” said Laura Ruocco, a Montefiore spokeswoman. “Comprehensive plans have been in place to reduce risk of potential exposure to our patients, staff and community.”
Kristi Barnes, a spokeswoman for the New York State Nurses Association, said that a recent survey of nurses across the region found that “a high number of our members have already been exposed, very few of them have been tested and testing has been slow.”
Barnes pointed to a March 16th change in state guidance that allowed healthcare workers who’d been exposed to COVID-19 who were not showing symptoms to return to work, and even people who tested positive for the virus to work if they were asymptomatic, instead of isolating themselves.
“We’re not invincible, we’re human beings [who] can still spread a virus,” Barnes said. She pointed out states and cities all over the country had imposed “extreme measures” to cut down the spread of the virus like closing schools and non-essential businesses.
“But those same extreme measures are not being taken in our hospitals, which could become petri dishes for the spread of this virus.”
New York City officials said it didn’t have an estimate on how many nurses had tested positive for COVID-19. But several told us that they have developed symptoms in recent weeks. One nurse at a Brooklyn Hospital recently spoke to a reporter via phone from her sick bed.
“I feel like death. I’ve had fever for nine days straight. My kids are sick. My husband is sick,” she said. “This is really, really bad. There definitely wasn’t enough of an effort to keep anyone safe.”
The Centers for Disease Control and Prevention had also recently changed its guidelines allowing for the reuse of surgical masks and N95 masks and even suggesting healthcare workers could use bandanas or scarves “as a last resort” when caring for COVID-19 patients, which has also raised alarm bells for the nurses union, Barnes said.
“What they need to do is provide what was considered a safe standard a month ago and make sure their nurses get that today, get that yesterday,” she said.
Access to proper personal protective gear, including N95 respirators, surgical masks, gloves and gowns weighs heavily on the minds for many health care workers, and it will continue to determine how well they can care for patients. One described spending her spare time collecting respirators for her colleagues.
Another worker described having to reuse a disposable mask shift after shift, and somehow disinfect it between shifts.
Hospitals across the city and New York City government are also asking for supply donations.
“For now we are told even if someone’s heart stops, or if they get crazy and pull out their breathing tube, even with seconds to live - you must put on your protective gear fully,” one intensive care nurse at NYU Langone said. “The line right now in the sand is: protect yourself before helping others.”
The hospital now has at least three floors of COVID-19 patients in intensive care, the nurse said.
“What will happen when you can’t protect yourself? If I don’t have the gear, I’m not helping these patients and exposing myself to the virus. Am I allowed legally to refuse?”
The nurse added while the hospital was not yet restricting access to ventilator care it was reserving more invasive treatments, like using a process that bypasses a person's lungs when ventilator therapy is not working, for younger patients who are more likely to fully recover.
A nurse at a Queens hospital described the escalating situation like the “wild, wild west.”
“They’re bullying [people] to sign [do not resuscitate, do not intubate] orders,” she said, of older patients in her ward, “and if you walk into a room and find somebody not breathing, you do not call any response whatsoever, you let them go.”
Starting last week, she’d seen all kinds of patients given ventilators as needed, including a 91-year-old, but now younger patients were being prioritized, she said.
“They’re being choosy...Resources are dwindling,” she said. “In normal times they’re being given choices, here it’s wartime, making the decision based on the livability.”
With reporting from Jake Offenhartz and Christopher Robbins.