COVID-19 Update from Dr. Smith: 3/18/20
Each day during the COVID-19 crisis, Dr. Craig Smith, Chair of the Department of Surgery, sends an update to faculty and staff about pandemic response and priorities. Stay up to date with us.
Our hospitals and our region are still in the terrifying, accelerating phase of new COVID-19 cases. The shortage of PPE continues to be critical. The PPE shortage may improve in the next few weeks, but not anytime soon. The ED is under serious pressure. Five Department of Surgery faculty have volunteered to be re-deployed to the front lines in the ED. Details are being worked out as I write this. We should all be proud of their altruism.
The OR schedule is functioning reasonably well at about 25% of capacity, focusing exclusively on cases classified as urgent and emergent. This has helped preserve PPE, improved ICU-bed availability, and made staff more available for other uses. Whether this level of function is sustainable, or improvable, will be determined by resource availability (bed capacity, staffing, and PPE).
Yesterday, within hours of a request from VP&S, Saleha Ahmed and Larry Beilis delivered a 343-row, 10-column roster spreadsheet that will be the basis for planning re-deployments. For the present, volunteerism (as above) is driving re-deployment. If demand exceeds the capacity of volunteerism, which is likely, more central decisions will be made jointly between the Department, NYP, and VP&S. Each of our Divisions has been working rapidly to re-deploy internally, principally by staggering schedules, which takes advantage of markedly reduced clinical activity to reduce the number of people exposed to infection at one time in one place. For example, it makes more sense for one person to see 10 patients, while 4 people are elsewhere than for 5 people to see two patients each, in the same time and space. Obviously, this leaves parts of employee-days unfilled with customary work. Re-deployment on a larger scale will probably be based on those remainders if that becomes necessary in the future. Sticking with my example, that might mean we have 3 people seeing 10 patients and 2 people re-deployed.
Please remember that hospital security cannot provide very effective front-door screening for patients at risk of carrying Coronavirus. Be certain that our staff does a careful evaluation of that probability when arranging any live visits.
Our research faculty have responded with remarkable speed to the command from CU and VP&S to scale back all research to bare essentials. This action may make some PPE more available, but it is a significant professional sacrifice for those directly involved. One more reason to hope for a timely resolution of this crisis.
Testing remains a complex and rapidly changing topic. Resource limitations (machines, reagents, swabs, sites) continue to retard rapid acceleration of testing. The PRA test performed on nasopharyngeal swabs for antigen will remain a limited option for some time. Serum tests for antibody are still relatively embryonic and have the defect mentioned yesterday (they miss the peak of viral shedding). Today I learned from Dr. Roth that only ~25% of the PRA antigen tests done so far have been positive, despite the fact that the tested population was very thoroughly screened, and would be expected to have a relatively high pre-test probability of being positive. Most of the remaining 75% have some other significant respiratory illness, but not COVID-19. This is stark proof of the specificity challenge faced by anyone attempting to assess new patients in the front lines.
Craig R. Smith, MD
Chair, Department of Surgery