COVID-19 Update from Dr. Smith: 5/09/20

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,

Today is May 9.  35F, 20 mph winds, and snow flurries! "Rough winds do shake the darling buds of May.” Who approved this? Is this how Covid-19 herds us into a defile, setting us up for an enfilade on the road to “invincible summer?” I’m still pondering the Perfusion team video I circulated yesterday. It’s humbling to see so many people doubling-down on doing their jobs with such abandon, faintly reminiscent of landing craft on Omaha Beach. How many of us have earned the right to lead people like these?

I may not need to point out the contrast in the video between the ceaseless activity inside our walls, and the eerie silence of Times Square, Trevi Fountain, or Duomo di Milano. They can take a break. Not CUIMC. I credit restless hospital-like environments with curing the insomnia that plagued my earliest teens. Lying in the dark in a peaceful, quiet room became phobic. I surreptitiously used my mother’s makeup to cover up the dark circles under my eyes. I gradually learned to accommodate. Later in life, experiences like studying through most of the night in college, working night shifts in the steel mill, and working through the night in hospitals were revelatory. I discovered that being surrounded by ceaseless, purposeful activity authorized me to sleep any time those endeavors didn’t require me. My phobia disappeared. Someone else is always awake somewhere. Sleep is a precious resource worth hoarding, but only when possible. Eight hours of uninterrupted sleep is not the eleventh commandment. I suspect this pandemic is generating plenty of insomnia. Our brains are working overtime to find solutions to unprecedented problems that have no atlas. But who wants to sleep through this? Our sickest patients are, as they struggle to survive in the ICU; think how nice consciousness must feel to those who emerge. We have permission to sleep when we can and when we must, with or without first creating an algorithm for response to a second surge.

It’s worth staying awake to hear about some invigorating steps towards greater access to ORs. The 4th floor ORs are being recommissioned. The 3rd floor ORICUs are one-third empty. Early next week we should be able to book into virtual elective blocks. With OR capacity still restricted to 20-25% of capacity, our block time will also be restricted to ~25% of our pre-Covid blocks, probably for much of this month. The preop window for PCR nasopharyngeal swab testing has been extended to 48 hours, which simplifies our logistics considerably. The Governor’s prohibition of “elective” surgery excludes Tier 1a or 1b operations, and creates a requirement for some degree of review committee oversight of our booking process. As I’ve mentioned several times previously, the average complexity of procedures in this Department will keep us busy Tier 2 and 3 for quite awhile. The Governor is also asking hospitals to maintain PPE stockpiles adequate for 90 days at peak Covid-surge use. Taking simple surgical masks as an example, NYP used 4,000 per day pre-Covid, and 100,000 per day at peak. The sheer volume of a 25-fold stockpile, and the impact of scarcity on price, make the Governor’s goal rather aspirational, but we must do our best. Anxiety over a second surge is epidemic. PPE supplies are at risk when businesses and medical offices reopen, with or without a second surge. Those unknowns make it hard to guess when the Governor will be confident enough to issue new Directives. These are just a few of the predictable unpredictables in an unprecedented situation.

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

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