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I’m an emergency physician at St. Barnabas Hospital in the Bronx. I have been in the ER every day these last few weeks, either supervising or providing direct care. I contracted a COVID-19 infection very early in the outbreak, as did two of my daughters, one of whom is a nurse. We are all well, thank God.
COVID-19 has been the worst health care disaster of my 30-year career, because of its intensity, duration and potential for lasting impact. The lasting impact is what worries me the most. And it’s why I now believe we should end the lockdown and rapidly get back to work.
From mid-March through mid-April, the ER staff at St. Barnabas huddled in groups of about 20 every morning. We asked ourselves what had happened over the previous shift. We generated a list of actionable tasks for the following 24 hours. At first, we addressed personal protective equipment and the management of patients with mild illness who were seeking COVID-19 tests.
Then came the wave of critically ill patients in numbers none of us had ever seen. This lasted for two weeks. The number of patients on ventilators accumulated in the ER and throughout the hospital. We witnessed an unprecedented number of deaths. The tone of the huddles became more somber. We became accustomed to the morbidity; we did our jobs.
It is precisely what I have witnessed that now tells me that it’s time to ease the lockdown. Here’s why:
First, the wave has crested. At 1 p.m. April 7, the COVID-19 arrivals slowed down. It was a discrete, noticeable event. Stretchers became available by 5 p.m., and the number of arriving COVID-19 patients dropped below the number discharged, transferred or deceased.
Testing is important work, but it should happen in parallel to the immediate resuscitation of the economy and getting people back to work.
This was striking, because the community I serve is poor. Some are homeless. Most work in “essential,” low-paying jobs, where distancing isn’t easy. Nevertheless, the wave passed over us, peaked and subsided. The way this transpired tells me the ebb and flow had more to do with the natural course of the outbreak than it did with the lockdown.
Second, I worry about non-coronavirus care. While the inpatient units remain busy with sick COVID-19 patients, our ER has been quiet for more than a week. We usually average 240 patients a day. For the last week, we averaged fewer than 100. That means our patients in this diverse, low-income community are afraid to come to the ER for non-COVID care.
Gotham-wide, the number of 911 ambulance runs declined to 3,320 on April 18, down from a peak of 6,527 on March 30, according to New York Fire Department data. The current nadir is significantly below the average.
A large share of those staying home surely have emergency medical and surgical conditions not related to the novel coronavirus. The growing numbers dying at home during this crisis must include fatal myocardial infarctions, asthma exacerbations, bacterial infections and strokes.
Meanwhile, our pediatric volume in the ER has practically disappeared. Visits to primary-care pediatricians are also down, with vaccine schedules falling behind. Everyone seems to be avoiding the health system — an important and unfortunate consequence of the stay-at-home strategy.
Third, inordinate fear misguides the public response. While COVID-19 is serious, fear of it is being over-amplified. The public needs to understand that the vast majority of infected people do quite well.
Finally, COVID-19 is more prevalent than we think. Many New Yorkers already have the COVID-19 infection, whether they are aware of it or not. As of today, over 43 percent of those tested are positive in The Bronx. We are developing a significant degree of natural herd immunity. Distancing works, but I am skeptical that it is playing as predominant a role as many think.
More testing will better establish the numbers among those with mild illnesses and no symptoms. My professional experience tells me the number of infected people will be high. Testing is important work, but it should happen in parallel to the immediate resuscitation of the economy and getting people back to work.
At present, the testing is imperfect. We can’t wait months. We must protect the vulnerable and mitigate without destroying the economy.
Standing up to this virus can’t be the job of essential workers only. We’ve been strong, but we’re tired, and we need the rest of you to help us. By getting back to work.