COVID-19 Update from Dr. Smith: 3/22/20

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,

Before I write another word I must say that I am deeply flattered, and humbled, by the number of people who’ve taken time to tell me they appreciate my “Updates.”  You motivate me to keep groping for the right balance between frightening facts and sunny-day optimism. In that balance lies solace, but also resolve. I should also state something that I assumed was obvious:  the target audience for my Updates has always been the Department of Surgery family, and remains so. That people outside the family find value in some parts of the message is a welcome bonus, and perhaps a reminder that even Surgeons are human.  We struggle with many of the same issues that perplex the rest of the world.

There is nothing new to report on the sobering slope of the new-case rate.  Testing is still significantly limited by availability of swabs, reagents, machinery, and staffing.  One under-appreciated testing limitation crosses over with the still-critical limitations of PPE, in that someone wearing PPE is usually required to insert nasopharyngeal swabs.  Testing the worried well is very hard to support logistically at this point in time. Supermodels and the NBA have been criticized for this in the media, but they are also human, and it will be a wonderful thing for everyone when testing is widely enough available to sample a wider population.  Regarding PPE, as was emphasized on today’s NYP video update, massive efforts to mobilize new supplies are being pursued at the highest levels. A wide variety of mask offers are pouring in. All should be directed to the email address, which is being aggressively vetted.

The OR schedule has already been pared back for the coming week.  My Division Chiefs have been extraordinarily cooperative with the triage that this requires.  We have a spreadsheet for all of April, sorted into five levels of relative urgency, that will be the basis for daily scheduling.  Equally important, it will be a means for surgeons and their support staff to constantly reassess relative urgency and communicate with patients and referring physicians.  Our patients need honest information and genuine reassurance that we aren’t forgetting about them. These challenges might make us mourn for the predictability and safety of an elective world.  Elective, however, is a relative concept. Particularly in the specialities represented by our Department, truly “elective” is rare, gradations of urgency are the norm, risks are often high, resources are not always instantly available, and “safe” becomes an asymptotic goal.  “A ship in harbor is safe, but that is not what ships are built for.” (John G. Shedd). Surgery is not a harbor activity. Our tempest of the moment is resource limitation. We will sail through this together, in due time.

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


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