Coronavirus in N.Y.: ‘Deluge’ of Cases Begins Hitting Hospitals

There are already critical shortages: A Bronx hospital is running out of ventilators. In Brooklyn, doctors are reusing masks.

People waited outside Elmhurst Hospital Center in Queens on Friday to be tested for the coronavirus.
Credit...Dave Sanders for The New York Times

New York State’s long-feared surge of coronavirus cases has begun, thrusting the medical system toward a crisis point.

In a startlingly quick ascent, officials reported on Friday that the state was closing in on 8,000 positive tests, about half the cases in the country. The number was 10 times higher than what was reported earlier in the week.

In the Bronx, doctors at Lincoln Medical and Mental Health Center say they have only a few remaining ventilators for patients who need them to breathe. In Brooklyn, doctors at Kings County Hospital Center say they are so low on supplies that they are reusing masks for up to a week, slathering them with hand sanitizer between shifts.

Some of the jump in New York’s cases can be traced to significantly increased testing, which the state began this week. But the escalation, and the response, could offer other states a glimpse of what might be in store if the virus continues to spread. Gov. Andrew M. Cuomo on Friday urged residents to stay indoors and ordered nonessential businesses to keep workers home.



‘Everything Is Uncharted’: New Yorkers Confront Life Amid a Coronavirus Shutdown

With restrictions tightened on businesses and daily activity, residents are grappling with uncertainty about resources, health care and their paychecks.

“We’re going to put out an executive order today. New York State on pause — only essential businesses will be functioning. 100% of the workforce must stay home. This is the most drastic action we can take.” “Everything is uncharted territory. Nobody knows what’s going to happen in the news any minute.” “I think I’ve been asking a lot of how we could have prevented this.” “Am I going to see another depression like my grandfather saw in the 1920s?” “Over the past few days, New York City has taken a lot of important measures. I’m just worried it came a little bit too late.” “I think I’m scared of having to see more death and from reading stories from abroad, having to make decisions about resources. And I’m worried people in my life are going to die from it. A few days ago, I had to watch a patient basically slowly die. I just felt helpless. This is the first time I’ve really seen people that I truly don’t know how to help. And they are coming in so sick that everything I’m used to doing to be able to treat them, I can’t really do.” “How was your day off, Mich?” “It was emotional, to say the least.” “Why?” “It’s just, like, the hospital has been insane. And every hour, like, things are changing. So it’s just, like, trying to keep up with that while trying to read about what I should be treating these people with, while people are rolling in the worst — I don’t know. They say in 18 days it’s supposed to get really bad. I guarantee you tomorrow we’re going to have like 1,000 more. The numbers are going to go up.” “That’s no problem at all. Thank you very much. That’s very nice. Thank you. Sounds good. See you then. Bye. Well, I have been working. A lot of people are not, which is hard. This place used to have 30 employees, and on Sunday we let go of 90% of the staff. We want to reopen so we can rehire people, you know? It was really hard to let everyone go. These are people that are at the level, they’re not wealthy, you know? This is a very harsh reality. And actually what the job is, is smiling through stress. And this is hard to smile through.” [Rain falling] “It’s go time here at the community kitchen. This is the time where we have to ramp up our services to be very sensitive to how people are feeling. People are coming to us feeling vulnerable. They maybe work in the restaurant industry. People who work in Broadway and in a lot of the behind-the-scenes, they’re coming here saying, well, I don’t have work. So those industries are the folks that are the first ones that we’re seeing come through. But we’re preparing to see more people come through in need.” “All programming at the senior center is suspended for the next two weeks. Stay safe and have a good day.” “So this is not business as usual. We don’t know what’s coming up if people have to stay in their homes for a longer period of time. And we want to make sure people are getting food, especially since a lot of industries are out of work. We are expecting a lot of new people, and we are going to be ready to receive them. This is all very new for them, and some of them are feeling guilt or shame coming to an emergency food program. So we have to remember that we do this all the time, but for them, it’s something new and something that they feel anxious about doing. We’re just getting them registered. They’re getting food. That’s our main priority is people are getting food.” [Sighing with exasperation] “I’m not supposed to touch my face. Hold on a second.” “I have prepared myself already, mentally, multiple times, to go back to Oregon and leave this entire beautiful dream behind me. So many people, including many of my friends, are working at bars, at restaurants, which are now closed. And now we’re all at home, wondering, Can we make it another month? Can our families afford to pay their mortgages at home? Do we just need to go back and start working, just so we can help our own families, the people that we love the most, stay in the homes that we grew up in? It’s hard to think that my mom or my dad are never going to see retirement. The best things that we can do right now as a community is just to give ourselves over to something that brings us true happiness. Because right now, it feels like it’s about to get very desperate.” “This is only something that we can get through if we’re working together. There will be so much suffering, unnecessary suffering, if we’re not really looking out for each other and if we only think about ourselves and our well-being. We have to be thinking about each other.” [Birds chirping]

Video player loading
With restrictions tightened on businesses and daily activity, residents are grappling with uncertainty about resources, health care and their paychecks.CreditCredit...Yousur Al-Hlou/The New York Times

State officials have projected that the number of coronavirus cases in New York will peak in early May. Both the governor and Mayor Bill de Blasio have used wartime metaphors and analogies to paint a grim picture of what to expect. Officials have said the state would need to double its available hospital beds to 100,000 and could be short as many as 25,000 ventilators.

As it prepares for the worst-case projections, the state is asking retired health care workers to volunteer to help. The city is considering trying to turn the Jacob K. Javits Convention Center in Manhattan into a makeshift hospital.

“The most striking part is the speed with which it has ramped up,” said Ben McVane, an emergency room doctor at Elmhurst Hospital Center in Queens. “It went from a small trickle of patients to a deluge of patients in our departments.”

At Elmhurst, a 545-bed public hospital that serves a large population of undocumented immigrants and low-income residents, coronavirus patients have begun to crowd out others. Protective gear is running low. Doctors are worried there will be a shortage of ventilators.

Outside the facility, at a tent housing a new mobile-testing site, a line snaked around the building on Friday, a sign of the demand on testing and how much worse the influx could become.

Credit...Cindy Schultz for The New York Times

Demetre Daskalakis, deputy commissioner of the city’s Department of Health, estimated that hundreds of thousands, or even millions, of city residents would be infected in the outbreak. Officials, however, have said that most people will have mild to moderate symptoms, or none at all.

Generally, about 20 percent of coronavirus patients require hospitalization, with about a quarter of those needing to be put on a mechanical ventilator machine to help them breathe. Statewide, more than 1,200 people have been hospitalized with the virus, according to Mr. Cuomo’s office. About 170 patients were in intensive care units in city hospitals, according to the city.

But even those initial cases were straining the health care system, a worrying sign.

“There’s no reference for this,” said Daniel Singer, who has been an emergency room doctor for 14 years and now works at Lincoln Medical and Mental Health Center. “It’s totally unprecedented.”

Lincoln administrators met on Friday to discuss its dwindling supply of ventilators, according to another employee.

Dr. Mitchell Katz, the head of the Health and Hospitals Corporation, which runs New York City’s public hospitals, said there were 230 patients in the Elmhurst emergency room on Thursday, about 50 more than any recent peak. Most were patients with the symptoms of Covid-19, the illness caused by the virus, he said.

The system has received 100 more ventilators from its supplier and is expecting hundreds more, Dr. Katz said. At the same time, Mr. de Blasio has cast the equipment shortage in stark terms and has asked the federal government for help.

“I don’t mean to be too dramatic here, it’s just a fact,” he said on Friday in an interview with the WNYC radio host Brian Lehrer. “It is a fact that a lot of people are going to die who don’t need to die if this doesn’t happen quickly.”

As of Friday, 35 people with coronavirus had died in New York State — the second highest number in the nation behind Washington State, where the virus appeared to hit first.

In addition to converting the Javits Center, officials have considered turning a variety of other places into temporary medical facilities, including Madison Square Garden and the student dorms at New York University. A military hospital ship with 1,000 beds is coming, but it will not arrive until April. The state is planning to waive regulations in order to urge hospitals to increase capacity.

Credit...Dave Sanders for The New York Times

In the short term, hospital workers say their biggest worry is a severe shortage of the medical gear that protects them from sick patients.

The state has three stockpiles of medical supplies, including millions of masks and gloves, as well as more sophisticated equipment like ventilators. On Friday, the state health commissioner, Dr. Howard Zucker, said those supplies had been tapped to help backfill shortages at some hospitals.

Hospitals have been trying to find more of the N95 masks that are most effective at preventing virus spread, as well as lighter surgical masks, goggles and gowns. But with suppliers running out across the world, hospital workers have improvised.

At Kings County Hospital Center and the Long Island Jewish Medical Center in Queens, administrators have given doctors one N95 mask to last all week, according to employees at the facilities. At Kings County, emergency room doctors wipe down the masks with hand sanitizer between shifts and put the masks in brown paper bags labeled with their names, a doctor there said.

The Health and Hospitals Corporation, which runs Kings County, denied that workers were being told to reuse masks. A representative of Northwell Health, which includes Long Island Jewish, acknowledged that administrators were trying to preserve masks because the supply was limited.

The federal Centers for Disease Control and Prevention has said that N95 masks should be discarded after each interaction with an infected patient and should not be used for more than eight hours.

At other hospitals across the city and beyond, workers have turned to social media to plead for masks.

In a hospital affiliated with Montefiore Medical Center in the Bronx, administrators stowed their masks in a locked room after a fistfight broke out among workers and visitors over access to the dwindling stockpile. Several hospitals have sent emails warning workers that they can be fired for the “unauthorized use” of masks.

Medical workers exposed to the coronavirus had been self-quarantining, but this week state and city health officials issued new guidance recommending that hospital workers stay on the job until they show symptoms of the virus. People with symptoms of the virus spread it most easily, but research has also indicated that asymptomatic transmission is possible.

“I’m worried because if we get it, everybody is going to get it,” said Aretha Morgan, a pediatric emergency room nurse at Columbia University Medical Center in Manhattan. “I might actually be exposing children in the E.R.”

Dr. Katz, the head of New York City’s public hospitals, said he understood fears about having to keep working after being exposed. He defended the policy by saying the virus was already widespread, so workers exposed in a hospital setting were not any more exposed than anybody on the subway.

He also said that while more supplies were needed, workers at public hospitals had enough protective gear to last through the end of the month.

The city’s other efforts included reserving 1,500 hotel rooms to potentially use for people with mild coronavirus symptoms or other illnesses, said Deanne Criswell, the city’s commissioner of emergency management.

Some medical students have also volunteered to help respond to the crisis. For now, students are working in support roles, such as taking notes and managing materials, said David Muller, dean for medical education at the Icahn School of Medicine at the Mount Sinai Health System.

But if the number of cases continues to rise, it is possible that graduating students could start seeing patients — though not necessarily ones with the virus — even before their residencies are scheduled to begin in July.

“It could be not even a week or two before we have to sweep away some of those restrictions,” Dr. Muller said.

Luis Ferré-Sadurní, Jesse McKinley and Andrea Salcedo contributed reporting.