Since the last issue of The Oppy, COVID-19 has been labeled a pandemic, New York has gone into a state of emergency, and sheltering has been implemented. Yet, the incidents of COVID-19 continue to rise, and it is estimated we are another few weeks from the peak of cases. Our nation’s healthcare system is in crisis mode, and the supply chain is being ramped to its max to produce personal protective equipment (PPE) and ventilators (respirators). New York City hospitals are making makeshift COVID units to expand capacity by at least 50%, as mandated by Governor Cuomo. Javits Center, U.S. Navy ship, Comfort, and other pop-up hospitals, such as the Good Samaritan tents in Central Park Meadows, are being utilized for the continuous overflow of patients needing urgent medical attention. Healthcare professionals such as nurses (RNs), physician-assistants (PAs), nurse practitioners (NPs), and physicians (MDs) are facing mandated redeployment into intensive care units, COVID units, and emergency departments to meet the overwhelming needs of NYC’s sickest. As an ICU NP, here are some of the most common questions I am being asked with answers. Keep in mind that this is an ever-evolving situation, so what holds true today, may not be the case a few days later.
How are they predicting that the apex of COVID in NYC is going to roughly be by the end of April?
This is an estimation done by epidemiologists, based on the new number of cases confirmed each day and how long the COVID disease process has been averaging. This takes into consideration that the growth rate continues as is AND we maintain sheltering. The rate of cases doubled and then tripled in the days following the rapid expansion of testing in mid-March. As of April 2, there have been more than 102,000 confirmed cases in New York State. Remember, this is only the number of confirmed cases, meaning there are many more people, who have/had COVID and are either asymptomatic, or sick and quarantining at home with a presumed positive. Realistically, the number of positive COVID cases could be around 200-300,000 in New York State alone. However, there is no way to know an exact number.
While the growth rate of newly confirmed cases may have slowed down the past few days, D-Day is yet to come. Studies from China, as published by the CDC, have shown that the median time for ICU admission for the most ill from COVID was 10-12 days from onset of symptoms, and the median length of hospitalization for those survivors was 10-13 days. Therefore, the prediction that the healthcare system will be the most burdened is one week to three weeks from the apex of confirmed diagnoses.
What are the direst needs of the healthcare system at this time?
Right now, our hospitals are reaching capacity. While the pop-up hospitals, the U.S. navy ship, Comfort, and temporary expansion of all N.Y. hospitals are mitigating the increase in demand for beds, there are still not enough ventilators for the expected demand in the coming weeks. Biotech companies are trying to meet this demand by rapidly producing ventilators – utilizing automakers’ and other industries’ factory production lines that have currently halted their own production. However, ventilator production is very detailed and this process is likely to be fraught with difficulties; there are bottlenecks in the supply chain and risks for defects brought on by producing a life-sustaining technology in an unprecedented timeframe. Then there is the shortage of PPE. The federal government is trying to solve this problem through the Defense Production Act, which forces manufacturers to upscale production to capacity, as well as shipping in millions of masks, face shields, gowns, and gloves from China. Finally, there is the lack of intensive care trained clinicians, whether they are nurses or providers. Hospitals are currently implementing mandated redeployment policies, where clinicians are being redeployed wherever they are needed in that institution. State restrictions have been lifted off licenses, so providers can practice in a higher capacity than normally allowed. For example: dermatologists can work in ICUs; pediatric nurse practitioners can take care of adults; surgeons, who no longer have scheduled surgeries, can be deployed to emergency departments; retirees are asked to come back to the workforce with expedited renewed licenses and working wherever they are needed. Everyone is trying to do their part but the stress and the fear is quite prevalent in the healthcare community.
Is social distancing effective?
Absolutely. By watching Netflix at home and partaking in virtual happy hour and classes, you are doing your part. The healthcare system is so overstrained right now; I cannot imagine how horrifying it would be if sheltering was not put into effect. COVID is still spreading, but we are flattening the curve. This graph is rudimentary but it gets its point across. The healthcare burden is still overwhelmingly high but it would be unmanageable if social distancing were not in place. If you’ve been feeling bored of Netflix, click here for more tips on how to avoid boredom while you’re stuck at home.
Is there a cure or vaccine in the making?
There are a lot of research and clinical trials currently in process. The World Health Organization (WHO) has a global treatment trial, called the Solidarity trial, testing four antivirals: Remdesivir, which had been used as treatment for Middle East Respiratory Syndrome (MERS-CoV) and severe acute respiratory syndrome (SARS), which are also caused by coronaviruses; Lopinavir/Ritonavir, which are licensed treatments for HIV; and Chloroquine/Hydroxychloroquine, which are used to treat malaria and rheumatology conditions, respectively. It is very early in clinical trials, however no astounding positive results have been noted as of yet.
Medical institutions and pharmaceutical companies are racing to find a vaccine. The most recent, promising news is from the University of Pittsburgh, which believes it may have found a vaccine based on their studies in mice. However, the next step is human clinical trials so that is not an immediate solution either, as it could take six to eighteen months to be proved effective and FDA approved.
Will COVID die down as spring comes in?
To summarize before I even begin: we don’t know. This strain of coronavirus is novel and to predict how a new virus will behave based on how others have is always speculative. We know the current trend of respiratory viruses is that they are less prevalent in the summer and they transmit more efficiently in the winter. However, there is no herd immunity for COVID. Herd immunity means that there is mass immunity in a community that decreases the rate of transmission – therefore,, most people do not get or transmit the disease. However, there is no herd immunity with COVID-19 because of its novelty, so all of us have the ability to contract and/or spread the virus. Only time will tell.
How many people are dying with COVID?
I am only going to give U.S. statistics, because there are many variables in the differences in mortality rates across the world. As of April 3, out of the 275,288 diagnosed and confirmed COVID cases, there have been 7,094 deaths. This is roughly a mortality rate around 2.6%, and is more specifically, a case fatality rate. I would like to reiterate that this is again out of the confirmed cases via testing. There are numerous presumed or unknown cases not taken into account, which would therefore decrease the mortality rate. The large majority of mortalities arise from old age and comorbidities, such as cardiovascular, respiratory, and obesity. This is not going to put us at ease, as we all know and love someone with one of those underlying conditions and do not want to transmit it to them. However, it is important to understand why we are sheltering and implementing other protective measures.
How is this going to end?
Medical experts, scientists and epidemiologists, cannot say for certain. Most agree that we are past the point of containment. It’s possible that this virus could continue to circulate among humans, such as influenza or common colds. It is unknown at this point if COVID will become seasonal, but it does appear that this situation is going to get worse before it gets better. Only time will tell if the situation improves through seasonality, herd immunity, vaccine, or treatment.
Stay safe and please talk to friends, family, or professionals about stress and fears. These are anxiety-inducing times and it is so important, now more than ever, to support each other.
Photo credit: https://www.wilx.com/content/news/Nation-prepares-for-coronavirus-568707221.html
