COVID-19 Update from Dr. Smith: 4/13/20

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,

Recently I have been sharing more good news than bad, at least if we attach enough moral weight to data that it can presume to counterbalance personal tragedies. Good news persists in several forms beyond the overall flux of patients in and out of our health care system. Our PPE supply at present is very good, even for N95s. ELISA serum testing for antibody is finally NY State approved. Initial capacity is in the low hundreds per day, but should ramp up to a few thousand per day in the next week or so. Medical teams from UCSF start working here today, joining the team from Cayuga Hospital that started last week. I met a surgeon from University of Minnesota in the ICU huddle on Friday. Teams from Cleveland Clinic and Intermountain are expected later in the week. Such unselfish professionalism invigorates our front lines, and makes us all proud to share a higher calling. It will be good news for public health if our debt to these generous friends can’t be repaid in kind.

The bad news for today is that CUIMC is closer than ever to exhausting its ICU and ventilator capacity. Attentive readers already know that it will take at least a week or two for ICU discharges to create significant numbers of ICU bed vacancies. And that assumes stable flux—vacancies will only appear if admission rates continue to fall, and if vacancies are not filled with transfers from other institutions. Much of the core business of this Department of Surgery depends on procedures that require ICU beds. Revenue associated with those procedures is as critical to NYP and CU as it is to our Department. Our dilemma couldn’t be more simple and obvious. We can’t begin returning to normal until our ICUs have room for non-COVID patients.

Leadership at all political levels (CU, NYP, States, Federal) has seized on the recent spate of good news to legitimize turning attention towards recovery. This has a whiff of desperation which is shared by me, and by anyone following the economic impact of public health measures taken to combat COVID transmission. Desperate or not, if we are indeed standing on the summit of new-case numbers, this is the time to start thinking about how to find our way down. Yesterday I wrote superficially about some of the tactics involved. The concrete point for today should be obvious. We must create vacancies in our ICUs. Desperately ill ICU patients with a poor chance of survival necessarily preoccupy us, but they represent where the puck is now, not where the puck will be.

At the risk of mixing metaphors, and of overworking poor Balto, I’ll mention that only a spectacular lead dog can take his team through blizzard headwinds, in white-out so complete that the musher can’t see his dogs. There are other relevant parallels—the 674-mile serum run was accomplished not by one team, but by 20 mushers and 150 sled dogs. A storm in Alaska early in the relay subjected teams to temperatures ranging from -50F to -70F, killing some dogs, and freezing hands to sleds. While the dogsled teams mushed on to Nome, the same storm swept East to New York, delivered 27” of snow on Manhattan, and nearly froze the Hudson River. Don’t all momentous stories drop their curtain in New York City?

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

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