COVID-19 Update from Dr. Smith: 3/24/20

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,

Admissions of new COVID+ cases to our system have continued to increase ~10% per day.  ~20% are in ICUs, and ~80% of ICU patients require ventilators.  Consult a compound-interest calculator to get a sense how quickly we are approaching infrastructure capacity limits.  We are scheduling very urgent cases in 3 ORs each day, with 2 rooms for true emergencies.  Operating at 10% of capacity has an economic impact on a Department of Surgery that should be obvious to all readers.  You probably realize that hospitals depend disproportionately on revenue related to procedures, and revenue related to COVID care won’t begin to compensate.  That must be as that must be, until the pandemic ebbs.  Your Department is doing what it can to preserve cash flow.  Our goal is carry everyone through to the ebb, but exactly how we will achieve that remains to be seen.

Enforced inactivity can feel like prison, and surgeons addicted to hyperactivity tolerate idleness perhaps less well than better-adjusted members of society.  In that sense, it may be a good thing that redeployment is suddenly accelerating today.  I’ve boasted in several previous Updates about how many Department members have volunteered.  We already have double-digit MD redeployments to the ER and ICUs.  Today a rapid-response team of surgical residents is being formed to carry out a variety of minor procedures across CUIMC.  This will allow MDs usually responsible for those procedures to focus on care in the ER and ICUs. Today we are also responding to the first distress call directed to us through the alert system that reviews staffing across all of the NYP hospitals each evening.  Four Department of Surgery NPs promptly volunteered to provide ICU and floor care to COVID patients in another system hospital.  One of the volunteers is my NP; since I’m unable to do much heart surgery these days, I will get by.

I am well aware that there is a yin and yang of redeployment.  A new and unfamiliar assignment may be hard to embrace when it replaces relatively safe and undemanding time in an idle office, or at home.  Time at home may be anything but undemanding for employees suddenly responsible for children who are out of school, or who carry other extended-family burdens related to economic dislocation.  There will be situations in which redeployment is impossible, for those and other reasons.  For MDs, NPs, and PAs redeployment may involve caring for COVID+ patients, as in today’s example.  Leaving home or office to care for COVID+ patients undeniably carries increased risk of infection.  Redeployment is service, it is sacrifice, it is something to do, it is scary, and it meets the mission.

This all boils down to the fact that health care is the most people-intensive enterprise of humankind.  Health care workers are the limiting reagent for everything we do.  Even if supply-chain victories suddenly leave us luxuriating in technology like respirators and ECMO, none of that is even remotely automated.  A forest of bamboo bends to the ground in a typhoon but rarely breaks.  We are that forest and we must not break.  By the people, for the people.

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


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