COVID-19 Update from Dr. Smith: 4/12/20

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,

This Easter Sunday is cold but was briefly sun-drenched in the hours after dawn. ICU patients and those on ventilators reached new peaks at CUIMC overnight. Chilly news, but unsurprising, given what we know about the pace of COVID disease. We are still working our way through the burden of illness that passed through our front door a week or two ago. There is abundant sunshine in other elements of this morning’s data snapshot. 10-day trends across all NYC hospitals (April 1-10) show that hospitalizations, ICU admissions, and intubations have dramatically decreased, and discharges have increased ~50%. Sadly, deaths have almost doubled. That is another predictable reminder of the burden of disease that will take some time to reach resolution, even though the overall flux is favorable.

For the Department of Surgery, and for our institutions, it is time to begin cautiously straightening up from a defensive crouch. Myriad details related to that process will be talked about at increasing length in the days ahead. Today I’ll confine myself to a few broad generalizations. Return to normal will not be a step function, like throwing the transfer switch from generator to grid. Even so, I think much of it will happen in unison as a rewind of how we got where we are today. We will deactivate pop-up ICUs as they depopulate, gradually increase OR capacity aimed at progressively less urgent cases, gradually increase outpatient office activity, and redeploy the redeployed in parallel.

The greatest single challenge facing everyone in the world is restoration of confidence. For us, that means our staff and our patients must feel safe entering, working in, and being cared for in all of our facilities. This requires gradual relaxation in social distancing. I suspect one of the earliest signs for us will be thoughtful liberalization of our visitor policies. That is a logical place for our patients and their families to test-drive the risk-benefit balancing (COVID fear versus visiting loved ones) that will inform our pace back to normal. In that respect we are identical to any other people-facing business, even though the specifics of the balance will vary. Theaters, restaurants, and sports venues will start to fill when COVID fear feels smaller than the pleasure of the occasion. Widespread testing will help enormously in this process. To keep superstition at bay we must educate people on how to assess risk-benefit balance in varying situations.

Speaking of superstition, a complex issue that will receive much attention is whether there are “COVID hospitals” and “Non-COVID hospitals.” For today, suffice it to say that both terms are redundant. The only “non-COVID hospital” in the five boroughs is the Renwick Smallpox Hospital ruins on Roosevelt island. Hospitals vary in numbers of COVID patients treated. As the inpatient surge passes, the primary COVID exposure risk will reside in the community of which we are all part.

Those who’ve been following along already know that Dante emerged from the underworld just before dawn, 700 years ago today, feeling renewed and hopeful. In the interest of balance, I will acknowledge that “hope” has its detractors, as exemplified by the popular Business School buzz-phrase “Hope is not a strategy.” Point taken, so remove “hope” from the tool kit in your wheelhouse when preparing for deep dives. I think I will hang onto mine. It pushes me out the door.

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

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