22 BARRON’S April 6, 2020
from emergency rooms are being re-
deployed to help respiratory patients,
while doctors from the clinics are go-
ing to work in the wards. Idle spaces
around the hospital are being swal-
lowed by the yawning need for
Covid-19 beds. “The second we need
more space, we take over an infusion
center, we take over the [postanesthe-
sia care unit],” Carr says.
The first North American city to
feel the full weight of a Covid-19 out-
break, New York has scrambled to
meet the challenge. Gov. Andrew
Cuomo of New York, who has called
the state’s experience a “microcosm”
of what awaits elsewhere in the
nation, expects the worst of the out-
break to hit by early May.
For cities outside of New York still
waiting their turn with the virus, epi-
demiologists and physicians at the
heart of the fight in New York have
clear advice: be aggressive about social
distancing. Have extra hospital beds,
tools, and supplies ready. Find places
to put patients when they get out of
the hospital. And start talking about
who gets help, and who doesn’t, when
resources run out.
“There’s no way to overprepare for
this,” says Dr. Neil Schluger, a profes-
sor of epidemiology, environmental
health sciences, and medicine at the
Columbia University Medical Center,
who has been treating Covid-19 pa-
tients for the past two weeks. “The
volume really is overwhelming.”
New York City’s own preparation
for the pandemic came in stutter-
steps. By the time Mayor Bill de Blasio
announced on March 15 that he would
close the city’s public schools, there
were already 329 confirmed cases and
five deaths attributed to the virus in
the five boroughs. The state had
banned large gatherings three days
earlier, effectively shutting down
museums and Broadway theaters.
The lockdown started in earnest on
March 16, when the state closed all
movie theaters, gyms, and restaurant
dining rooms. Restrictions ratcheted up
from there, until the governor shut all
nonessential businesses on March 22.
For New York City, it wasn’t
enough. De Blasio now says the city
will need 65,000 new hospital beds
by the end of the month. Cuomo said
on April 2 that the state would run out
of ventilators—machines needed to
keep desperately ill Covid-19 patients
alive—by April 8.
The brunt of the illness has, so far,
disproportionately fallen on the poor-
est New Yorkers. Confirmed cases
span the city, but are most dense in
neighborhoods outside Manhattan.
Residents in Brooklyn report constant
ambulance sirens.
In downtown Manhattan on Thurs-
day morning, at an hour when waves
of commuters should be emerging
from the subways, elbow to elbow,
clutching coffee cups and iPhones,
there were only delivery men on bikes
and a few pedestrians in masks. The
governor that afternoon said the virus
could kill 16,000 New Yorkers. So far,
2,935 have died statewide.
New York does have some advan-
tages in confronting the virus that
other cities won’t have, including a
dense concentration of sophisticated
hospitals and geographical attributes
that make it easy to bring aid.
“Places like Colorado can’t have a
Navy ship sail in to provide additional
beds,” says Charles Branas, a profes-
sor of epidemiology at Columbia’s
Mailman School of Public Health.
Still, New York’s successes and
failures in handling the virus should
help prepare cities across the country
and the world that have yet to see
large numbers of Covid-19 cases.
“Implement social distancing
measures rapidly—sooner rather than
later—and try to implement them in
large degrees, as opposed to incre-
mentally,” Branas says.
He pointed to the San Francisco
Bay Area, where six counties shut
down all at once on March 17, in
contrast to New York’s staggered
approach, and where the growth in
new cases appears to have moderated.
That message hasn’t made its way
across the entire country yet, but more
states are falling in line, with Florida
and Georgia ordering their own state-
wide lockdowns on April 1 and 2,
respectively. Still, more outbreaks are
coming, and doctors in New York say
that hospitals around the country
must get ready.
“Hospitals should be thinking
about how they can safely use as
much space as they possibly can in
their hospital,” says Columbia’s
Schluger. It is not just ventilator sup-
plies that will be stretched to their
absolute limit. Drugs used to sedate
intubated patients may run low. Many
Covid-19 patients go through renal
failure and need to be supported by a
type of specialized dialysis machine.
“How are you going to dialyze 10
times the number of patients, perhaps,
that you usually have to dialyze in a
single day?” Schluger says. “Medica-
tions people are using, that we use all
the time in the ICU, but because we
have maybe five times the number of
ICU patients as we normally have,
these medicines are going to be in
short supply.”
The particular nature of the dis-
ease, the unusual length of time it
takes to get really sick, is compound-
ing the problem of hospital shortages.
“There’s
no way to
overprepare
for this.
The volume
really
is over-
whelming.”
Dr. Neil SchlugerNew York Gov.
Andrew Cuomo
speaks to the media
at New York City’s
Javits Center, which
is being converted
into a hospital to
help treat patients
infected with the
coronavirus.Mount Sinai’s Carr says that patients
often look better than they actually
are, and then their condition suddenly
deteriorates. “You’ve got to watch
them longer than you think you’ve got
to watch them,” he says. The recovery
period, too, is long. That means that
people linger in the hospital, taking up
beds needed by fresh patients.
“Think about where you’re going to
put these people when they’re better-
ish, but not better,” Carr adds. “If you
continue to keep them in the hospital,
they’re going to box out the people
who are behind them.”
In New York, state officials ordered
nursing homes on March 25 to accept
Covid-19 patients released from hospi-
tals, according to a report in The Wall
Street Journal.
“They’re scared, and I understand
why they’re scared,” Carr says of the
nursing homes. But hospitals need
space for new patients.
Hospitals and public officials are
working to keep the Covid-19 wards
from running out of ventilators by
digging up unused units and figuring
out hacksto repurpose other devices.
But those efforts might be exhausted
soon.
And early data, largely from
overseas, show that many Covid-19
patients who are put on a ventilator do
not survive.
Carr says that families should talk
through end-of-life options: “The last
person who should be making this
decision is me, for a person I’ve never
met, late at night.”
As ventilator availability runs out,
hospitals and health officials need to
offer clarity about how rationing deci-
sions will be made. “If that comes to
pass, then it will be important for
public health officials and hospitals to
communicate very clearly with the
public about how that’s going to work,”
says Columbia’s Schluger. “Nobody
wants to be in that position at all.”
Amid all of the grim realities, there
is some hope. The doctors in New
York are learning a tremendous
amount about how to treat Covid-19,
both through clinical experience and
drug trials. A high volume of patients
means that trials can move forward
far quicker than under normal
circumstances.
“It’s hard to be optimistic,”
Schluger says. “I’m an optimist by
nature. I’m hopeful that in the next
several weeks, [from] all these clini-
cal trials, something will pop up
that’s positive.”B Eduardo Munoz Alvarez/Getty Images