COVID-19 Update from Dr. Smith: 3/23/20

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,

COVID+ new-cases are still accelerating at a rate consistent with projections made by NYP and others.  This means the pressure on beds, on ICU and ventilator capacity, on our personnel, and on our PPE is still accelerating in parallel.  In Manhattan, the streets are empty, reminiscent of 9/11, and it’s hard not to feel under siege.

Today, however, the creativity of our colleagues is raising my spirits.  CU engineers have been working on 3D printing solutions to the scarcity of face shields.  A larger engineering group is working on a variety of methods for sterilizing used masks.  The relevance of that approach awaits clarity on a number of important technical details, simply summarized by the need to show that reused masks are substantially better than nothing, without quite demanding that they be as good as new.  Last week NY State requested a 50% increase in bed capacity in the NYP system, which seemed hopeless to me a week ago.  Yet there has been impressive progress towards that goal.  One small detail highly relevant to our Department is that blocks of 4th floor ORs at CUIMC are being converted to ICU pods.  Each room is capable of holding 2-3 patients.  In addition to ICU-level bed space, OR anesthesia machines add ventilator capacity.  Even more interesting, the CU anesthesiology and ICU teams have been working night and day to implement split-ventilation experiments that will allow one ventilator to support more than one patient.  The obvious challenge presented by patients with differences in airway resistance will initially require careful patient selection.

It would be nice to say that our split-ventilator experiment is first-in-man, but therein hangs an interesting story.  In pursuit of increased ventilator capacity during natural disasters, Neyman and Irvin (Acad Emerg Med 2006;13:1246-9) described successful in vitro ventilation of four simulated lungs with one ventilator.  11 years later, Kevin Menes MD was in charge of the ER at Sunrise Hospital in Las Vegas when 215 victims of the country music concert mass shooting poured in.  Dr. Menes thought of Dr. Neyman’s experiments because they had been residents together, and he applied the technique successfully to some of his GSW victims that night. [Read the article here.] Why do I mention this?  The history of health care shows that wars are times of rapid acceleration in the art and science of surgery.  Surgery takes the lead in many natural disasters.  But we depend on others to lead us through plagues and epidemics, when it’s our turn to fill whatever supportive roles are available, and cheer them on.  As one hand washes the other, today a technique forged in the crucible of mass trauma is helping our medical colleagues manage COVID-19.  Turn, turn, turn!  No one of us is smarter than all of us.

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


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