COVID-19 Update from Dr. Smith: 3/30/20

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,

I would love to say otherwise, but new-case rates compel NYP and the entire tri-state area to increase ICU capacity dramatically, as fast as possible.  For the NYP system alone this means increasing from a baseline of ~400 ICU beds to ~1100—almost a tripling in capacity.  These beds will be coming on line daily, in the largest possible aliquots, over the next few weeks.  All NYP construction resources are being directed at this with military focus and intensity.  Simultaneously, “field hospital” facilities are springing up here and across the region (Javits Center, USNS Comfort, possibly Riverview Terrace, and more).  Field hospitals are familiar elements of forward areas in armed conflicts and in natural disasters.  Yes, it is getting that serious.

Triage is a fundamental operating principle in field hospitals.  Triage determines who should be treated first, how they should be treated (surgery, fluid resuscitation, etc), and who should be kept comfortable.  Broadly construed, we will all be operating more and more on field hospital principles as we move through the next few weeks.  In the “how they should be treated” part of the spectrum, NYP is moving quickly to implement a form of triage that offers the promise of relieving pressure on inpatient beds.  Some carefully-selected COVID patients will be sent home with oxygen, an oxygen saturation monitor, and strict telehealth followup at 12-24 hour intervals.  Does this entail incompletely understood risk?  It certainly does, but triage is an essential part of the resource/utility-balancing situation in which we find ourselves.

Redeployment haunts my days.  To the redeployed I’ve emphasized that we’re not leaving you alone, that we will keep reinforcements flowing out.  Think about the impact of redeployment on the ranks left behind, who are steadily reduced to those inappropriate for duty.  They may be older, or medically compromised—or they may be your ensconced leaders, barricaded in the war room.  The entire group of remainders, I assure you, suffers from a thirst combined of guilt and FOMO that will never be slaked.  In contrast, those redeployed are thrown into rapidly evolving organizational structures made fluid by the fog of COVID.  On that side of the wire, new leaders must emerge, and fast.  It is a time for battlefield promotions.  Whether you’re a frustrated leader-in-waiting, or a reluctant leader who needs to be catalyzed by events, this is your time.  Dandelion seeds go nowhere without wind.  Our next generation of leaders will emerge in these few weeks.

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


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