Tales of COVID-19 on the front line in NYC

In the early COVID-19 hospitalization peak in New York City, it was all hands on deck. From dermatologists and orthopedists to dentistry students and anesthesiologists, “the collaboration that occurred was incredible,” said Doreen J. Addrizzo-Harris, MD, FCCP, who was in charge of staffing at several of NYU Langone Health’s hospitals in New York City.

“We recruited people from other departments to become full-time critical care people,” said Dr. Addrizzo-Harris. “Some of the fellows got promoted to attendings. We recruited GI fellows and cardiology fellows—people who were already pretty good at medicine and procedures. They went through a 4-hour training simulation course and then became part of the team.”

Dr. Addrizzo-Harris and her team at NYU Langone Health saw their first COVID-19 case on March 8. As the cases grew, they transitioned the hospital to house 13 medical ICUs with 17 patients each. By the second week of April, there were 10 times as many cases with the ICUs full and the majority of patients intubated. That persisted until the downward trend started to happen in May.

“Of course, we didn’t know what hit us at first,” Dr. Addrizzo-Harris said. “A lot of the information coming from China was inaccurate, so we were really not prepared for any of the pathologic findings with this disease. I don’t think we realized how infectious it was initially. We were just overwhelmed with all these people coming in at the same time and not knowing how to care for them because we didn’t know so much about the disease.”

Once they were able to see autopsies and understand what was going on from a thromboembolic level, the anticoagulation protocols were rolled out, in addition to the mechanical ventilation and bronchoscopy protocols, which led to designated teams for each of these. They were better able to care for these patients once they understood more of the pathophysiology.

In the beginning when the hospitals were overwhelmed, the hospitals not only called on fellows and medical teams from other departments but volunteers from across the nation. Dr. Addrizzo-Harris’ team sent out a call for help for volunteers to come to NYU and other NYC hospitals—with more than 100 physicians and health-care workers volunteering. She did this with the help of CHEST, who put out a call through its social media and internet channels. They divvied up the volunteers between hospitals, depending on their specialty and expertise. CHEST ended up expanding the volunteer program and using its analytics platform to reach out to other cities that needed help. To learn more about the Clinician Matching Network, go to chestnet.org/clinician-matching or email [email protected].

“Some of the volunteers came back more than once. Some of them were here for several weeks. It was quite remarkable how amazing, how generous, and how fearless they were.”

“Some of the volunteers came back more than once,” Dr. Addrizzo-Harris said. “Some of them were here for several weeks. It was quite remarkable how amazing, how generous, and how fearless they were. Some were older than 60 and traveling across the country by plane. … It was also unbelievably helpful because when those physicians came in, it was a chance for us to give our doctors a few days off. Many of them hadn’t had vacation prior to this for many months and a lot of them had separated from their children and families.”

NYU and local hotels provided housing to the physicians who wanted to either separate from their families because they didn’t want to infect them or because they lived 1 or 2 hours away.

“It was difficult for many reasons,” she said. “The severity of disease, the mortality rate was extremely high at first, and patients were totally isolated. No family members were allowed to come in, so NYU, under the direction of Dr. Kathy Hochman, set up a Family Connect program. They would connect with a family each day to provide an update on their family member in the hospital.”

What was helpful throughout this trying time was that NYU was already equipped to do telehealth visits for all specialties, so the team at the hospital could focus on taking care of the critically ill COVID-19 patients, and others could work on research trials.

“I must say we had unbelievable vision and support from the leadership of all the hospitals, both the city hospital and NYU hospitals,” she said. “There was a lot of communication upfront and very frequently.”

Dr. Addrizzo-Harris said the team at her hospitals were very lucky to always have enough PPE. However, they didn’t realize at first that you could be an asymptomatic carrier. That’s when everyone started wearing masks and no longer eating together. The whole city started doing the same.

“Once we started implementing an all-mask policy for everyone and social distancing, the numbers started going down. Everyone is wearing a mask here [in Manhattan] even if they’re jogging or biking. You can’t enter apartment buildings without a mask and parks were closed until recently. I think all of that really helped with the downturn.”

With frequent COVID-19 debriefs, her hospitals are already prepping for a resurgence if one comes by allocating different staffing models.

One thing Dr. Addrizzo-Harris won’t forget is the 7:00 pm clap during shift change that lasted for 2 months. Each night, the local fire departments, EMS, and health-care workers would go outside and be welcomed with applause, fire engine sirens, and car horns beeping.

“It kept people going even as people were starting to get tired,” she said. “We all just really looked forward to that.”