COVID-19 Update from Dr. Smith: 3/21/20

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,

One week ago I was optimistic that our health care systems could avoid being overwhelmed, even as we began eliminating elective surgery.  Yesterday I realized that only planning, cooperation, execution, personal sacrifice, and maybe a little luck will allow us to avoid being overwhelmed within a few weeks.  In my update yesterday I overshared data to help make this point to you--and to myself--as I grappled with decimating the urgent surgery schedule. We are past requiring late-breaking fine-detail data to show you which way the wind is blowing.  The NYP Infonet and Columbia University can be your primary data sources going forward.  In broad strokes, we know New York is the national epicenter of COVID-19 infection, with a 10-fold increase in cases in just one week.  To think we could mimic Italy seemed risible a week ago. Not today. 

No one is standing still, wringing their hands.  In the past week the number of Department of Surgery volunteers for deployment to the front lines is well into double digits.  ICU’s, step-down units, and patient floors have been reorganized around COVID+ patients. Institutions not renowned for their fast reflexes have been remarkably nimble.  Case in point, 3 days ago Governor Cuomo signed an executive order allowing all NYP-credentialed practitioners (MDs, NPs, PAs) to work at any NYP facility if required. Today NYP issued a sweeping “updated recommendation” on use of PPE [read it here] that shows impressive practicality and flexibility.  I urge everyone using PPE to read it, and conform to it.  Compliance will be absolutely critical to preserving our dwindling supply of PPE. 

I predict the next few days will show that the reservoir of undetected COVID+ patients is much larger than we imagined.  Consequently COVID+ patients will be cropping up among patients with important primarily surgical problems that must be treated.  Our policies and procedures will need to adapt accordingly, and you should be alert for announcements that address these issues. In the past few days it has also become obvious that the virus has breached our Department walls, and we can expect to hear about increasing numbers of infected Department colleagues.  It should be no surprise if these infections appear in clusters associated with the care of infected patients. This underlines the importance of deploying providers strategically to minimize the chance of incapacitating all or most of one subspecialty because of illness and quarantine.   

101 years ago Lenin said “There are decades where nothing happens, and there are weeks where decades happen.”  This has been one of those weeks! A more modern revolutionary (John Wooden) said "Failing to plan is planning to fail.”  That will not be us.

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


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