“It’s something I’ve never witnessed in 40 years of medicine,” said Dr. Steven Corwin, the chief executive of NewYork-Presbyterian.
Dr. Steven Corwin was a doctor during the AIDS crisis. He was the chief medical officer at NewYork-Presbyterian on Sept. 11, 2001. He has never seen anything like this.
Dr. Corwin, now chief executive of NewYork-Presbyterian, says the coronavirus pandemic has stretched his institution to the brink. It has taken a devastating toll on its patients, its doctors, its nurses, and even the hospital group’s balance sheet.
NewYork-Presbyterian’s facilities have been at the center of the crisis. The first confirmed case in the New York area was in one of the group’s hospitals, and over the past two months, its emergency rooms and intensive care units have been overwhelmed with patients suffering from Covid-19, the disease caused by the virus.
Dr. Corwin believes the worst is over, at least for now. Yet he remains concerned about a resurgence of the virus as social distancing measures are relaxed around the country, and is particularly troubled by the emotional effects the crisis is having on doctors and nurses.
This conversation, which was condensed and edited for clarity, was part of a series of new live Corner Office calls discussing the crisis. Visit timesevents.nytimes.com to join upcoming calls.
DAVID GELLES: When did you and your team first become aware of this novel coronavirus coming out of Wuhan, and what steps did you start to take to potentially prepare for its arrival in New York?
Dr. Steven Corwin: Any time you see a viral infection like that in any part of the world, it raises your antennae. And when we saw what was happening in Wuhan, we were concerned about the possibility that it would come to the U.S. We started asking our infectious-disease people at that time: “What is this virus? How does it behave? What’s the mortality associated with it?” We were concerned enough to start preparing for a pandemic.
GELLES: How did you ramp up your testing, modeling, and preparations?
Dr. Steven Corwin: We were hampered in February by the faulty Centers for Disease Control test, as well as the insistence that the C.D.C. do any potential testing where we thought somebody might be positive. That really held us back, and quite frankly, I think during that period of time we missed the idea of community spread. When we saw Italy and we started to model out what that looked like, we became extremely concerned and started really ramping up our preparations.
GELLES: Part of those preparations were, of course, assessing how much personal protective equipment you had, how many ventilators, and I.C.U. beds you had. What did NewYork-Presbyterian do when you realized just what kind of actual resources were going to be needed to combat this virus?
Dr. Steven Corwin: Our assumptions around pandemic preparation were flawed. The first was that you could do quick and universal testing and contact tracing quite easily. That was Strike 1 because that didn’t happen.
The second was that our stockpiles of personal protective equipment could weather the first surge of the pandemic. That turned out to be completely false. We went from using 4,000 masks a day to 40,000 masks a day during the initial part of the crisis, to 90,000 masks a day at the peak of the crisis, and we did not have the stockpiles to make up for that.
The third was that with a modest surge in intensive care unit beds we would be OK, and that was a gross underestimate. We had 450 I.C.U. beds. We got to 900 I.C.U. beds by the peak of this.
Our preparation around the pandemic was insufficient, and the state and the national level was also insufficient in terms of stockpiling. We were on a hunt for P.P.E. right from the beginning. There was a free-for-all. We were able to secure some supplies from China. We didn’t have to buy things off the back of trucks, but we were very careful about how many masks we were using.
GELLES: When did you get your first case?
Dr. Steven Corwin: On March 1, in our Lawrence Hospital facility in southern Westchester, we had the first case of community spread of the virus with a 52-year-old male lawyer. That was the first time that we had seen somebody who did not have a travel history come down with the infection. We had admitted him to the institution on a Friday with pneumonia. We assumed it was a bacterial pneumonia. When he didn’t get better by Sunday, we did send a coronavirus test out, and he was positive. That’s when we knew we had community spread in New York State. And that’s when we knew that once you have community spread like that, that the outbreak was going to look pretty similar to Wuhan and Italy, and that’s when we really understood that this was going to be a crisis.
GELLES: Take us inside the E.R.s and the I.C.U.s over the past month or so. What’s it been like for your doctors and nurses on the ground?
Dr. Steven Corwin: I took care of many patients through the AIDS epidemic, another horrific story, but I’ve never seen anything like this. The sheer numbers of patients. The fact that all of them were really quite ill. The number of patients that needed to be put immediately on a ventilator. The number of patients that came into the emergency room about ready to die. The same in our I.C.U.s.
It really was, even for somebody like myself, who has taken care of many patients through the years, really startling. The physical and emotional toll this has taken on everybody who works in our system is just enormous. It almost feels like the AIDS epidemic compressed into a six-week period of time. It’s something I’ve never witnessed in 40 years of medicine.
GELLES: At the peak of this surge, what was the single biggest challenge that your hospital system encountered?
Dr. Steven Corwin: The biggest challenge we faced was being able to create enough I.C.U. beds to withstand the high tide. We had to create I.C.U.s out of operating rooms, I.C.U.s out of procedure suites, I.C.U.s out of conference areas. That meant construction. It meant creating negative pressure rooms. It meant piping in oxygen.
Then we had to come up with a completely novel way of staffing the I.C.U.s to be able to deliver the excellent care that people expect. Then we weren’t sure whether we had enough ventilators, and thanks to the ingenuity of our respiratory therapists, we were able to create ventilators out of anesthesia machines. We were able to split ventilators to be able to ventilate two patients simultaneously.
GELLES: Where are we now, and what are your concerns as you look forward in the months ahead?
Dr. Steven Corwin: First, just as a citizen having lived through this, it’s really important for people in other parts of the country to really understand how horrific this can be if an outbreak happens. I worry about opening up too early and having a significant resurgence of this. In the absence of substantially increased testing, you’re not going to know. I’m not convinced that the relaxation is going to be beneficial to the economy if we do it too quickly. We know we can’t do it too quickly.
Our view of it is we have to keep a fair amount of our excess I.C.U. capacity. We have to stockpile the P.P.E. We’re going to be living with masks and protective gear for quite a while. It’s going to change the way we live as a country. It’s certainly going to change the way that my institution operates, and we’re looking at every aspect of that: from going into a doctor’s examining room and how to clean it, to how many virtual visits are we going to do, to making sure that we space hours so that we don’t congregate patients, to making sure that we don’t have more than four or five people in an elevator at any one point in time.
The idea of 40 people in a waiting room? Not going to happen. The idea of people congregating in a cafeteria? Not going to happen. All of those things we’re trying to rethink now.
GELLES: How is NewYork-Presbyterian going to weather these staggering deficits under which it’s currently operating?
Dr. Steven Corwin: We think that over the course of this pandemic, we anticipate that we’ll lose probably, by year’s end, close to $1 billion, if not more than that. Thankfully, we have the balance sheet to be able to withstand that.
I’m very fearful of the notion that we’re going to lay off people. I will resist that as long as I possibly can, and I’m hoping to avoid that, period, for a very simple reason. Morally speaking, all of the people that work for us have run through walls to get us through this crisis. You can’t turn around and say, “The finances aren’t great, so we’re going to furlough people.” So we’re going to do everything we can to have everybody who has a job keep a job, everybody who has a salary to be able to continue to maintain their living for their family. I think that’s what we owe to the workers who work for us.
GELLES: Given that, as you said, many of your assumptions were flawed, how do you change the way you prepare, going forward from this point?
Dr. Steven Corwin: We, as a country, have to think about the supply chain differently. All the manufacturing of the gowns, masks, etc., were, for all intents and purposes, in China or, ironically, in Italy. And so we were cut off from the supply chain, and we did not have enough of a stockpile to deal with it. The same goes for ventilator supply.
The same thing goes for I.C.U. bed capacity. We’re not going to go back to the capacity we had. We’re going to have a fairly large reserve, larger than what we previously had. Flexibility, both on the space side and the staffing side, I think, is something that we were not prepared for.
I also think that we get super specialized in medicine. But in this crisis, we redeployed a lot of physicians who had not done intensive care medicine in quite a while. They did a remarkable job, but we have to be much more structured about giving people those experiences so that we can turn it on and turn it off as need be.
Originally published on Nytimes.com