Emergency Department

NY Doctors Share Advice to Other States Seeing Coronavirus Surges

Earlier this year, New York was the epicenter of the coronavirus pandemic. At the pandemic's peak in April, New York doctors saw 18,825 hospitalizations and 800 deaths from COVID-19 each day. Amid this historic crisis, doctors at at the Vagelos College of Physicians and Surgeons at Columbia University Irving Medical Center have demonstrated remarkable courage and leadership to save lives under circumstances never seen before. Our doctors want to share some advice for colleagues in other states who are now facing a sharp increase in COVID-19 cases.

 

Helen Ouyang

Assistant Professor of Emergency Medicine

Helen Ouyang
Helen Ouyang. Image: New York Times

You will experience a sense of helplessness that you’ve never felt before as a clinician. Because you will feel that way with not just one or two patients, but with almost every patient, every time you set foot in the hospital. You will have shifts where all you do is pronounce patients dead and tell families members their loved ones have died. Colleagues may shut down, they’ll fall apart around you, you’ll fall apart. You will then leave the hospital and see people walking around without masks, carrying on with their day as if nothing was wrong, and you will feel intense anger at these public failures. When you’re not at work, you will think about work constantly, scenes from the hospital will flash through your mind, you’ll feel a phantom N95 mask on your face. People won’t be able to grasp the loss you’ve witnessed and the despair you feel. 

But what helped me the most was speaking daily to the doctors in Italy, who were two weeks ahead of us in New York City. Not only was it useful clinically—watch out for blood clots, steroids may be helpful—but it was emotionally helpful to hear how things were improving there each day. They knew exactly how I felt at every moment because they had processed those same reactions and thoughts two weeks earlier. 

Talk to us doctors in New York. Look out for each other. This virus is wily, masquerading as every symptom, bringing seemingly young and healthy patients and older patients alike to their premature deaths. The virus has had a similar effect on us clinicians—it will catch you off guard, bring you to your knees, humble and devastate you in a way you’ve never imagined. Be aware that this is normal—that we all felt this in New York—and help one another. Know that this will eventually end, if strict public health measures are in place.

 

Tsion Firew

Assistant Professor of Emergency Medicine

Tsion Firew
Tsion Firew

Amid the COVID-19 pandemic, health care professionals across the globe are faced with extraordinary levels of pressure not so different from a war zone. The trauma of this crisis is creating a new generation of veterans of a war at home, each of whom is serving our country and needs our support. But with the current capacities of our institutions, and the cultural stigmatization of mental and emotional health issues, we as a country are not prepared to support them.

The unfortunate truth is that the United States has never adequately provided treatment for mental and emotional health challenges, such as PTSD, for brave citizens who put their country before themselves. As we begin to imagine a post-COVID-19 America, we must do better by all of our veterans, including the hundreds of thousands of health care workers who have borne the trauma of this pandemic. That starts by destigmatizing mental health issues and making it easier for physicians, nurses, and others to seek out the resources they need.

Excerpt from CNN Opinion

 

Steven McDonald

Assistant Professor of Emergency Medicine

Steven McDonald
Steven McDonald

It is difficult to advise physicians in areas where the virus is peaking. The people I want to advise are the governors and state officials—the policymakers—because ultimately it is their actions that determine the public health response needed to curb the spread of the virus. 

For physicians on the brink of experiencing what New York City faced, it is important to protect yourselves since the systems in place will not protect you. Demand appropriate PPE, demand every possible comfort you can take refuge in, demand that your friends and family support you and listen to you, demand breaks and time to decompress. You have to advocate for yourselves because no one else will.

 

Cynthia Gyamfi-Bannerman
Cynthia Gyamfi-Bannerman

Cynthia Gyamfi-Bannerman

Ellen Jacobson Levine and Eugene Jacobson Professor of Women's Health (in Obstetrics & Gynecology) 

There were many lessons learned from the COVID-19 pandemic. In our first paper, the first case series of COVID-positive pregnant mothers from the United States, we shared our experience with atypical presentations of COVID-19. We initially treated this virus as any other, with Ebola recently in our minds. We naively asked for travel history or exposures, having no idea that many COVID-positive women would present in an asymptomatic or presymptomatic state.  

We also learned early on about the importance of universal PPE and testing and took the approach that a “COVID unknown” was a “COVID-positive” patient until proven otherwise. We went on to describe risk factors and outcomes, including the built environment as a risk factor for SARS-CoV-2 infection.  

 

Craig Spencer

Assistant Professor of Emergency Medicine

Craig Spencer
Craig Spencer

It’s incredibly disheartening to hear my colleagues all across the country, and especially in the latest COVID-19 epicenters, struggle with the exact same challenges that we faced at our peak in March and April. So much of what they report—the overwhelmed ERs, the exhausted front-line providers, and the incessant challenges of trying to provide high-quality clinical care as the system buckles under the weight of so many COVID-19 patients—is exactly what we all went through and are still recovering from. 

Some of the most important lessons are relatively simple—have a PPE ‘buddy’ who is constantly checking to make sure you are safe and protected, check in with your colleagues to make sure they are resting and have a space to be vulnerable. 

I think the larger lessons need to be directed at our communities and leaders, especially those who are reluctant to take this virus seriously. SARS-CoV-2 will continue to roll around this country, infecting blue states and red states, and literally anyone it comes in contact with for the foreseeable future. 

Most disturbing is that we know what it takes to get this under control. Albeit belatedly, we did it here in NYC. It’s maddening to see that instead of learning from the pain and struggle we went through so many places right now are attempting to tackle their own outbreaks with half-hearted measures. 


Angela Mills

Chair, Department of Emergency Medicine

Angela Mills
Angela Mills

As an emergency physician for over 20 years, I experienced a new first as I witnessed the heightened level of uncertainty and anxiety which surrounds this illness, much of it due to the many early unknowns of COVID‐19 in its presentation and disease progression. 

We spent countless hours in discussion and preparation regarding staffing, resources, alternate care areas, and wellness, while guidelines and recommendations concerning PPE, testing, and disease management were changing daily, even hourly. The numbers of severely ill patients rose dramatically over a few weeks to our peak of COVID‐19, with over 20 patients being intubated daily at our university site and more end‐of‐life discussions and emergency department deaths than some may see in a career span.

Reflecting on some of the key leadership skills I have valued during this crisis, I find they are similar to the ones we rely upon during normal times.  We established frequent departmental virtual huddles for two‐way communication, providing information while also encouraging feedback and suggestions in a safe environment. We were proactive and willing to invent new solutions for our patients and staff. We learned that it is more effective to collaborate on everything rather than to compete for solutions in a crisis. 

And finally, the importance of wellness. All of us need to check in with those around us, both in our professional and personal lives. We owe it to each other to ask how our colleagues are coping and processing their own emotions and not become accustomed to our new physically separate world.

Excerpt from AEM Education and Training