A Department of Health employee trains New York Army National Guard soldiers at a drive-through coronavirus testing center in New Rochelle, New York, on March 14, 2020.
Sgt. Amouris Coss/U.S. Army National Guard/Handout/Reuters
  • Business Insider spoke to an internal medicine doctor at a hospital in New York CIty five times in seven days as the coronavirus was ramping up in the city.
  • He described the constant need to find more space to put patients, the severity of the disease in the patients he's seeing, and what he's concerned about as NYC becomes the epicenter of the pandemic.
  • It shows just how quickly patients with coronavirus are overwhelming doctors inside the New York City health system.
  • For more stories go to www.BusinessInsider.co.za.

Sunday, March 15, was the day it all changed.

That day, New York Governor Andrew Cuomo called on President Donald Trump to mobilise the military in response to the coronavirus pandemic. Hospitals in New York began calling off elective procedures. The state had 729 reported cases, 329 of which were in New York City.

The same day, the coronavirus pandemic became very real in the life of an internal medicine doctor practicing in a hospital in New York City. A handful of doctors he works with had been sent home for potential coronavirus exposure.

"I was realising that every day the number was doubling," he told Business Insider. The cases of Covid-19 were drastically going up day by day. "This is the beginning."

Over the week starting March 16, the number of cases in New York skyrocketed to 20,875, 12,305 of which were in New York City as of March 23. Overall, the state accounts for nearly 6% of worldwide cases, making it an epicenter of the pandemic.

Business Insider spoke with the doctor five times over the course of the week by phone and text to get a sense of the day-to-day changes he was seeing.

The doctor, whose identity is known to Business Insider, spoke under the condition of anonymity because he had not been authorised by his hospital to speak to the press.

What the doctor described gives a sense of how hospitals are grappling with that skyrocketing case count. The following is a day-by-day diary of my interactions with the doctor.

Monday, March 16: Learning on the go

NYC has 463 cases reported and 7 deaths

The doctor was already tired after his 12-hour shift.

"It is exhausting," he said on a phone call that evening.

Caring for the increasing number of coronavirus patients in the hospital requires a lot of learning on the go, he said. He was treating patients who had tested positive for the Covid-19 virus with oxygen and the anti-malarial medication hydroxychloroquine.

He noticed that more patients with confirmed cases were being admitted into the hospital than were being discharged. There was still space in regular hospital beds, known as the floor, and in the intensive care unit for more critical patients, but doctors were already discussing what to do once they filled up, he said.

At that point, the situation was already overwhelming the hospital compared to pre-pandemic day-to-day operations.

"It's not built for rapid-onset pandemics," he said.

Tuesday, March 17: 'It's like we're fighting a ghost'

NYC has 923 cases and 10 deaths.

On Tuesday, March 17, the reality of shortages and challenges to the hospital were becoming clearer.

"Maybe not tomorrow, but I can't see how it won't happen in the coming weeks, " he texted me.

The threat and mystery of the pandemic had crystallised as well.

"It's like we're fighting a ghost," he said. "I know it's out there, but I have no idea where it's coming from, who it's affecting the hardest, and how to stop it. We're collectively flailing in every direction, but at this point it's always one step ahead - undetected."

Wednesday, March 18: The ICU is full

NYC has 1,871 cases and 11 deaths.

By Wednesday, the intensive care unit had filled up.

For overflow, the hospital converted a unit that was usually used for patients transitioning from intensive care to the general hospital into another ICU. The only problem: compared to the ICU, doctors treating patients with Covid-19 in the new unit had to wear full protective gear, sometimes referred to as "bunny suits," to manage patients.

"There just aren't enough ICU beds" he told me by phone. By Wednesday, he had transferred multiple patients from the floor to the ICU.

"Everything's accelerated," he said.

To make sure staff weren't getting overwhelmed, the hospital had been adding additional doctors to the floor. Each oversees about 20 patients.

By Wednesday, supply shortages were starting to hit the hospital, too. That meant re-using equipment, limiting the number of times healthcare workers went into patient rooms, and reserving materials like N95 masks.

With elective procedures halted, the surgical intensive care unit was lined up for patients once the converted unit was full. It's the first time the doctor's seen a hospital convert units on the fly.

"Everyone knows they can get called in," the doctor said. "We don't know what the ceiling is."

Thursday, March 19: The case count doubles

NYC has 3,615 cases and 22 deaths.

On Thursday, a day the case count doubled, I didn't hear from the doctor.

Friday, March 20: Worries about ventilators mount

NYC has 5,151 cases and 29 deaths.

Friday brought an almost 50% increase in patients on the floor, the doctor said. Supplies were becoming an issue as materials were being used in quantities the doctor hadn't seen before.

"No one could be prepared for such an insidious and rapid rise," he said on the phone that evening.

The needs of patients getting admitted to the hospital were becoming more complex too, he said, and patients in the hospital weren't getting discharged as quickly as they once were.

Over in critical care, the first unit that had been converted to intensive care had filled up, and patients with Covid-19 had started filling the surgical ICU as well.

The doctor said he was trying hard not to send patients from the hospital floor to the ICU unless absolutely necessary.

Once the surgical ICU is full, the hospital plans to convert more units into critical care. By then, the hospital may be at risk of running short on ventilators, the equipment used to help patients breathe.

"If we don't slow down the progression, and really tangibly flatten the curve, that could very well happen," he said. "I didn't expect it to be this quick. "

Saturday, March 21: Cases continue to rise

NYC has 6,211 cases and 43 deaths.

On Saturday, I didn't hear from the doctor again. That day, he later told me, the number of patients admitted to the hospital with Covid-19 had risen by 30%.

Sunday March 22: 'It's like leaning over the edge of a cliff'

NYC has 10,764 cases and 99 deaths.

Sunday saw the patient count rise 18% on the hospital floors.

By that point, staff were being pulled in from other parts of the hospital. Floors had been repurposed for Covid-19 patients, and some deaths had occured among patients who were on the hospital floor, but not admitted to the ICU.

The doctor said he was still using hydroxychloroquine to treat patients, though he noted shortages that make it difficult for patients to get prescriptions when they leave the hospitals.

In his practice, he's using it only when patients are having a hard time breathing as a result of the virus.

The number of patients who've been admitted continues to grow as more are in for extended stays. And the patients who were stable enough to go home, he found, didn't always want to go home for fear of what would happen next. The doctor's patient load has continued to grow.

"We've gotten used to a certain level of chaos," he said.

Overall, as the hospital has tackled the pandemic, camaraderie among his colleagues has been strong, he said. Teammates have been supportive of one another even when stretched to the limits.

As the hospital sees admissions go up, the number of patients in the ICU has also swelled, he said.

For now, his big worry is finding places to put all the patients admitted and make sure they're cared for.

"I still feel like we haven't seen the full extent," he said. "It's like leaning over the edge of a cliff."

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