COVID-19 Update from Dr. Smith: 3/19/20

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.

Dear Colleagues,

Yesterday was the first day since the start of the epidemic that Wuhan did not have a single new case of COVID-19.  That glimmer of sunshine is worth fixing in mind as we enter the daily-doubling phase for new cases here at home. Since yesterday, COVID-positive infections more than doubled into the low thousands in NYC, and low hundreds in NYP.  Some of our patients are very seriously ill, but the system is still managing them. PPE supply is still critical but meta-stable. Urgent cases are still moving through the OR. The only new systems-alarm is from the blood bank. Mass cancellation of blood drives is producing an acute shortage of blood products that we will require some new approach to donations.  The implications for sustaining urgent surgery are obvious.

Four more Surgery employees have volunteered for redeployment in the ED or in fever clinics, joining our volunteer vanguard that is out in front of formal efforts to redeploy across our institutions.  “Courage is resistance to fear, mastery of fear, not absence of fear.” (Mark Twain)

Much anxiety has been generated by lay articles and news commentaries dramatizing evidence of aerosolization of COVID-19 presented in the New England Journal on March 17. Indeed, COVID-19 was present in experimentally-generated aerosols, and the virus survived for a few hours.  However, this was done by throwing virus into a Goldberg drum, which exists for the sole purpose of efficiently generating aerosols for experimentation.  Intubation, suctioning, and similar clinical maneuvers are not machines designed to generate aerosols for scientific study. The possibility of aerosol transmission has been acknowledged from the beginning of the epidemic.  That is why N95 respirators are recommended for procedures capable of some degree of aerosolization, and not for other clinical settings. The NEJM article would have been more newsworthy had it shown that aerosolization was impossible.

Craig R. Smith, MD
Chair, Department of Surgery
Surgeon-in-Chief, NYP/CUIMC


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