NEW YORK - 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 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 Cuomo on Friday urged residents to stay indoors and ordered nonessential businesses to keep workers home.
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 immigrants living in the country without legal permission 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 Friday, a sign of the demand on testing and how much worse the influx could become.
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% of coronavirus patients require hospitalization, with about one-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 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 Friday to discuss its dwindling supply of ventilators, according to another employee.
Dr. Mitchell Katz, head of the Health and Hospitals Corp., which runs New York City's public hospitals, said there were 230 patients in the Elmhurst emergency room 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, Katz said. At the same time, 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 Friday in an interview with 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 the 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.
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, which are most effective at preventing the virus's 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 Corp., 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 ER."
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," Muller said.
This article originally appeared in The New York Times.
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