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

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,

Inpatient census for the NYP system has fallen to the level of 13 days ago.  At CUIMC it has fallen to the level of 10 days ago, but the number of patients in ICUs on ventilators remains stubbornly stuck at the peak.  This cold reality won’t prevent us from turning to the future, but it attaches a governor to our accelerator, with implications for personnel and infrastructure that should be obvious to everyone by now.  Keep that in mind when hearing from international voices, caught up in excitement over opening up, who question whether this has been a fake crisis, or perhaps an exaggerated crisis.  They point to California, which appears to be peaking prematurely, at much lower incidence than predicted.  As mentioned yesterday, that may have something to do with inaccuracy in the denominator, but it is still unambiguously wonderful news for California.  It is not, however, the reality we are living.  I invite anyone who thinks the COVID pandemic is fake or exaggerated to take a walk through any New York City hospital.  It can appear exaggerated only after the curve has flattened.  Even then, whatever the percentage of critical illness in a population turns out to be, that represents a very large number of inpatients when the population at risk is very large.

Our situation serves as a cautionary reality-check on logistic obstacles to restarting normal healthcare, and for reopening the economy.  Caution and relentlessness can coexist.  We will continue driving towards reopening without riding the brakes or swerving for squirrels.  I will take this excuse to exorcise some nonsense from our vocabulary, specifically the term “COVID-free.”  In the parochial world of health-care institutional marketing, it will be tempting to contrast “COVID-free” environments, or sub-environments based on the ring-fence principle, with the terrors of “COVID hospitals.”  In the larger world of our overall economy “COVID-free” can be a similar puff floating on claims of comprehensive testing and PPE.  I probably don’t need to elaborate on the imperfections of testing and PPE, or reiterate that every hospital is a COVID hospital.  This is a pandemic, and the world is not “COVID-free.”  Parsing us into fanciful microcosms of perfect safety feeds localisms, regionalisms, and nationalisms that are divisive and falsely reassuring.  There is only relative safety.  We should talk about “COVID-safe,” “COVID-secure,” “COVID-mitigated,” or some more artful term that anyone is welcome to coin.  At the very least we must be COVID-honest. 

Over the past two days, three more residents working in the ORICUs were relieved of duty to shelter at home with COVID disease.  No serious symptoms, at least at this point.  They were quickly replaced—they never hesitate.  We keep putting gunners and drivers in tanks.  We will worry about each one of them until this is over.

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

Get Dr. Smith's COVID-19 updates in your inbox.