With COVID-19, it’s one step forward, two steps back.
That’s what doctors battling the devastating viral lung infection on its frontlines are saying, as hospitals face shortages not only in ventilators to keep patients alive, but in doctors to operate them.
The problem is particularly acute in the hotspot of New York City, which is projected to run out of ventilators this week.
One doctor at a Manhattan hospital told TPM that he had been put on ventilator duty, despite being trained — and working in — a completely different medical speciality.
“It was back to first semester medical school for me,” the doctor, who requested anonymity out of fear of retaliation by his employer, told TPM.
Another — a surgery resident in the Bronx — volunteered to care for COVID-19 patients in the hospital’s medical intensive care unit under the supervision of a medical attending physician, starting next Monday.
“I don’t even know what I don’t know, at this point, about COVID and its effect on the lungs,” the person added. “I don’t know what I don’t know about this kind of management.”
A fixture in intensive care units, a ventilator requires near-perpetual management. Pulmonologists work with respiratory therapists and nurses to diagnose, intubate, drug, and manage patients hooked up to the devices.
“That’s why it’s the ICU,” said Joshua Denson, an assistant professor and associate director of pulmonology at Tulane University School of Medicine. “It’s all very intensive, between the nurse, the doctor who is looking at the bloodwork, making changes to the patient’s meds, and doing procedures on the patient.”
New York has roughly 7,500 licensed mechanical ventilator operators. But in the city, in other hotspots, there are not enough of these trained professionals to go around. The country as a whole faces a shortage with a limited supply of personnel and ballooning patient totals.
Denson said that New Orleans hospitals are relying on surgeons with experience in critical care to help manage patients on ventilators.
“Usually, I have one or two of these types of patients, so having so many that require such intensive, detailed work is really challenging,” Denson said, adding that “it doesn’t seem to matter what we try, nothing works. I saw 20 people today with this disease.”
Delphine O’Rourke, partner at the Duane Morris law firm in Philadelphia who advises health care providers on emergency preparedness, told TPM that hospitals were increasingly relying on doctors from other specialties to operate the complex machines.
“There’s a limited number of pulmonologists, so you get increased demand — especially when pulmonologists are working around the clock on this,” she said.
O’Rourke added that the situation partly comes down to what has become a standard policy among hospitals coping with the pandemic: cancel all elective surgeries and non-critical procedures to free up space for COVID-19 treatment.
That, in turn, leaves scores of doctors who normally perform elective work and may have some experience running ventilators with idle hands.
She added that hospitals are not training people up from no knowledge at all — rather, they’re focusing on taking those with some ventilator experience and requisitioning them for the job.
“Generally, elective surgeries have been cancelled, so an anesthesiologist who works in surgery or does elective procedures — they have nothing going on right now, so they’ll take them and move them to the ICU,” she said.
One official with SEIU 1199, the New York City union representing respiratory therapists, echoed that account. He told TPM that the staffing shortage has been addressed by waves of doctors who normally conduct elective surgeries instead running the ventilators themselves.
But the devil comes down to the details: The machines can be difficult to operate, requiring a mixture of training combined with diagnostic intuition that comes with having spent years treating patients on them. Some doctors – like critical care surgeons – are familiar with operating mechanical ventilators, but many are not.
The Bronx surgery resident, who asked to remain unnamed, is currently learning about the disease through other hospitals’ handbooks, anecdotal experiences from fellow residents, and even from other medical professionals’ posts on Instagram.
“The problems that patients have in a medical ICU are very different than what we’re used to,” the surgical resident said. “I basically am hoping they’re going to teach me on day one, because I’m going to have no idea what I’m doing.”
Denson, the Tulane doctor, is treating dozens of COVID-19 patients at his hospital.
“It’s kind of like Groundhog’s Day, but the sun is never coming through,” he said, adding that a respiratory therapist he works with had coined a term: “the corona shuffle.”
“One day I’ll be leaving the ICU, telling a patient I’ll try to take them off the vent tomorrow, and the next morning he’s taken two steps back,” Denson said. “The next day he looks great, and then it’s worse.”
“It’s one step forward, two steps back for a lot of patients,” Denson added.