COVID-19 Update from Dr. Smith: 5/11/20

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,

New York City is the epitome of elevator culture. Hospitals share that with our fair city. Every hospital with at least two floors depends on elevators. Elevators are as essential for patients who are too disabled to climb stairs as they are for unconscious patients on ECMO. Countless pieces of essential equipment are impossible to carry up and down stairs. Elevators allow vertical orientation that centralizes important functions and minimizes long walks, benefitting disabled patients and the people who push their beds or wheelchairs. In this pandemic, elevators pose challenges to social distancing that all hospitals, office buildings, schools, parking garages, mass transit terminals, and any structure with an elevator must consider. Society’s approach to mitigation requires rational solutions to the unavoidable squeeze-points in life, of which elevators are only one easily-visualized example. Here in New York, at CUIMC, we must not consider ourselves structurally disadvantaged because of our dependence on elevators. Other healthcare environments may be less urban, and may have fewer elevators, but hospital elevators are all roughly the same size. Stairwells are not the answer. They are designed for use by employees and to meet requirements for emergency egress. As the Towers on 9/11 proved, they are also significantly rate-limiting. Even among the fit they prolong exposure per vertical foot in a confined space. Elevators make our highly sophisticated brand of healthcare possible.

Strict compliance with 6-foot spacing in elevators means an unrealistic 2-3 passengers per ride. Queue management is already complicated by the heretofore unusual requirement for low person-density (each person’s 6-foot circle = 28.3 sq ft). Countless images in various media show how that spacing looks in a variety of public spaces—quite a departure from business-as-usual. Expanding the area considered to be part of the elevator queue offers space for more circles, but less for those waiting to come down than for those waiting to go up. Extending hours will help reduce person-flow per hour, but at a substantial labor cost. Both strategies might be very quickly overwhelmed in any busy and successful enterprise, whether hospital or business, urban or suburban. I suggest we allow the space at either end of the squeeze to set the plan. Exposure time is much longer in the lobby or the floor waiting room than on an elevator. Let the elevators bear whatever traffic they must bear to maintain appropriate person-volumes above and below. Make sure everyone has a mask. Someone who is coughed on in the elevator, or is simply anxious about proximity, should do careful hand and face hygiene at the destination, and get a new mask. One of our hospitality tests is making all of that seamlessly available. As the world opens up, among the tactics for mitigation it will be hardest to sustain 100% compliance with social distancing. Exactly the same measures I just described are what we will be relying on in public—masks and hygiene.

Lately when discussing expanding our schedules we say “Open the aperture.” I get the metaphor, but in photography that creates a shallow depth-of-field. Apt for a specialty hospital that does lots of eyes, or joints. CUIMC is about breadth and depth. Clinical, cultural, socioeconomic, political, and geographic breadth and depth. For better, for worse, for richer, for poorer, in sickness and in health; it’s our bond. Opening the aperture speaks to volume. A software solution to a wide aperture is focus-stacking, or take advice from the Dalai Lama: “I find hope in the darkest of days, and focus in the brightest.” We’ve come a long way since March.

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

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