/cdn.vox-cdn.com/uploads/chorus_image/image/66549435/1208026485.jpg.0.jpg)
The key to weathering the coronavirus pandemic will be to utilize social distancing and other techniques to “flatten the curve” and keep the health care system from becoming too overwhelmed at any one moment.
Except, in some places — including in the US — those systems already are.
Hospitals have only a limited number of ICU beds with which to treat patients with Covid-19, the disease caused by the novel coronavirus, and hospital systems were generally unprepared for the pandemic. Policymakers have started to try to increase capacity to handle the oncoming surge of cases, but a total collapse of the system is still very possible.
And it’s not just equipment that’s in short supply — health care workers themselves are spread thin and overwhelmed.
In Italy, doctors have had to choose between patients for who gets put on a ventilator. Elsewhere, medical personnel are begging for personal protective equipment like masks, face-shields, and gloves to treat the onslaught of infectious patients.
While we know what we need to do to support doctors, nurses, and other health care workers to adequately deal with the pandemic, the everyday reality of caring for so many patients at once is sometimes difficult to report.
But in a viral tweet thread Tuesday, one emergency room doctor shed light on what is happening inside America’s hospitals and why it’s so important to follow the rules of social distancing in the first place.
Craig Spencer is the director of global health in emergency medicine at Columbia University’s Irving Medical Center and New York Presbyterian Hospital. He mentions that he worked during an Ebola outbreak in West Africa several years ago (he was then isolated and treated for disease in the US) and yet coronavirus scares him. He’s been working around the clock treating patients in New York City, which is one of the hardest-hit cities in the US so far. And he described a typical day as an ER doctor in the age of coronavirus in a recent viral tweet thread.
It starts, he says, when you walk in at 8 am and the previous shift hands off their cases to you, including one patient they’re “really worried about,” who is “very short of breath, on the maximum amount of oxygen we can give, but still breathing fast”:
You immediately assess this patient. It’s clear what this is, and what needs to happen. You have a long and honest discussion with the patient and family over the phone. It’s best to put her on life support now, before things get much worse. You’re getting set up for that, but...
You’re notified of another really sick patient coming in. You rush over. They’re also extremely sick, vomiting. They need to be put on life support as well. You bring them back. Two patients, in rooms right next to each other, both getting a breathing tube. It’s not even 10am yet.
He talks about how doctors and staff have become intimately familiar with the symptoms of Covid-19 — cough, shortness of breath, fever — and he wonders about what happened to the heart attack cases he used to see before the pandemic. You should read his thread in full:
Thank you everyone for your incredible messages of support and encouragement.♥️
— Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020
Many of you asked what it was like in the ER right now. I want to share a bit with you. Please RT:
A Day in the Life of an ER Doc - A Brief Dispatch from the #COVID19 Frontline:
Wake up at 6:30am. Priority is making a big pot of coffee for the whole day, because the place by the hospital is closed. The Starbucks too. It's all closed.
— Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020
On the walk, it feels like Sunday. No one is out. Might be the freezing rain. Or it's early. Regardless, that's good.
Walk in for your 8am shift: Immediately struck by how the calm of the early morning city streets is immediately transformed. The bright fluorescent lights of the ER reflect off everyone's protective goggles. There is a cacophony of coughing. You stop. Mask up. Walk in.
— Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020
You take signout from the previous team, but nearly every patient is the same, young & old:
— Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020
Cough, shortness of breath, fever.
They are really worried about one patient. Very short of breath, on the maximum amount of oxygen we can give, but still breathing fast.
You immediately assess this patient. It's clear what this is, and what needs to happen. You have a long and honest discussion with the patient and family over the phone. It's best to put her on life support now, before things get much worse. You're getting set up for that, but...
— Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020
You're notified of another really sick patient coming in. You rush over. They're also extremely sick, vomiting. They need to be put on life support as well. You bring them back. Two patients, in rooms right next to each other, both getting a breathing tube. It's not even 10am yet
— Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020
For the rest of your shift, nearly every hour, you get paged:
— Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020
Stat notification: Very sick patient, short of breath, fever. Oxygen 88%.
Stat notification: Low blood pressure, short of breath, low oxygen.
Stat notification: Low oxygen, can't breath. Fever.
All day...
Sometime in the afternoon you recognize you haven't drank any water. You're afraid to take off the mask. It's the only thing that protects you. Surely you can last a little longer - in West Africa during Ebola, you spent hours in a hot suit without water. One more patient...
— Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020
By late afternoon, you need to eat. Restaurant across the street is closed. Right, everything is closed. But thankfully the hospital cafeteria is open. You grab something, wash your hands (twice), cautiously take off your mask, & eat as fast as you can. Go back. Mask up. Walk in.
— Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020
Nearly everyone you see today is the same. We assume everyone is #COVIDー19. We wear gowns, goggles, and masks at every encounter. All day. It's the only way to be safe. Where did all the heart attacks and appendicitis patients go? Its all COVID.
— Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020
When your shift ends, you sign out to the oncoming team. It's all #COVIDー19. Over the past week, we've all learned the signs - low oxygen, lymphopenia, elevated D-dimer.
— Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020
You share concerns of friends throughout the city without PPE. Hospitals running out of ventilators.
Before you leave, you wipe EVERYTHING down. Your phone. Your badge. Your wallet. Your coffee mug. All of it. Drown it in bleach. Everything in a bag. Take no chances.
— Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020
Sure you got it all??? Wipe is down again. Can't be too careful.
You walk out and take off your mask. You feel naked and exposed. It's still raining, but you want to walk home. Feels safer than the subway or bus, plus you need to decompress.
— Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020
The streets are empty. This feels nothing like what is happening inside. Maybe people don't know???
You get home. You strip in the hallway (it's ok, your neighbors know what you do). Everything in a bag. Your wife tries to keep your toddler away, but she hasn't seen you in days, so it's really hard. Run to the shower. Rinse it all away. Never happier. Time for family.
— Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020
You reflect on the fact that it's really hard to understand how bad this is - and how bad its going to be - if all you see are empty streets.
— Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020
Hospitals are nearing capacity. We are running out of ventilators. Ambulance sirens don't stop.
Everyone we see today was infected a week ago, or more. The numbers will undoubtedly skyrocket overnight, as they have every night the past few days. More will come to the ER. More will be stat notifications. More will be put on a ventilator.
— Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020
We were too late to stop this virus. Full stop. But we can slow it's spread. The virus can't infect those it never meets. Stay inside. Social distancing is the only thing that will save us now. I don't care as much about the economic impact as I do about our ability to save lives
— Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020
You might hear people saying it isn't real. It is.
— Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020
You might hear people saying it isn't bad. It is.
You might hear people saying it can't take you down. It can.
I survived Ebola. I fear #COVIDー19.
Do your part. Stay home. Stay safe.
And every day I'll come to work for you
Do you work in health care? Vox wants to hear about your coronavirus experience. Fill out this Google form to share your story.