COVID-19 Update from Dr. Smith: 3/25/20

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,

It may be obvious that writing these Updates is a daily struggle to balance terror with reassurance. Today the steady drumbeat of new cases continues, and it remains possible that our system will be overwhelmed.  Repeating the threats represented by a lack of PPE and testing can feel corrosive.  In sum, the accelerating pace of this contagion so easily overwhelms me that I risk becoming the Jaws of doomsurfing.  But this is a day I’m mostly astonished by the explosion of energy and creativity being applied to the battle.  “Not knowing when the dawn will come / I open every door” (Dickinson).  Doors are flinging open all over the place.

Less than 24 hours ago, I mentioned that a rapid response team of Surgery residents was “being formed.”  Overnight they went into action, as the self-designated “Surgical Workforce Access Team” (SWAT), doing arterial lines, central lines, Foleys, OGT/NGT insertions, and dealing with difficult peripheral access.  POCUS and more is on the near horizon.  Anesthesiology donated two anesthesia carts and an ultrasound to the effort.  Yesterday I also mentioned our redeployed NPs.  They start this morning in the ICU at the other system hospital.

In our larger environment, mask resterilization has progressed rapidly through theory to practice and appears poised to handle a remarkably large number of masks/day with a dry-heat method.  As I understand it, this includes N95 masks.  3D-manufactured face shields developed by CU engineers should be in use later today.  Clusters of our mothballed elective ORs have already been converted to ICU pods with 2 or 3 patients per room, including two patients being carefully managed on one ventilator.  We now have the machine capacity to do 1,000 PCR antigen tests per day, but can’t fully utilize that capacity because of severely limited swabs, transfer medium, and the PPE required for the person doing the swabbing.  Pathology is rapidly testing a variety of swab and transfer medium alternatives.  Related resources from our idle basic science labs are on offer immediately if they become relevant.  A serum test for anti-Coronavirus antibody is on the verge of clinical applicability, pending a few logistic hurdles.  The ability to detect antibody will help epidemiologically in scaling the denominator of infected patients and makes possible exciting efforts that are underway to study therapeutic uses of convalescent plasma (obtained from patients who are antigen-negative, antibody-positive). 

I’ve mentioned previously that VP&S research activities have been slashed to the barest essentials.  Even so, precious and often irreplaceable animal colonies are being meticulously cared for by Institute of Comparative Medicine staff, at a negligible absentee rate.  We are truly all hands on deck.  I’m proud to be part of it.

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


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