NYC ERs Are Getting More ‘Normal’ Type Cases — But The Mood Is Anything But

New York City’s COVID-19 curve has begun to flatten. But for some doctors in the metropolitan area, life in the emergency room remains a roller coaster.

After an “avalanche” of coronavirus-related activity, where some New York hospitals were pushed to the brink, some emergency rooms saw an equally precipitous decline in overall cases cases in recent weeks, as social distancing orders took hold and the types of patients ERs typically see avoided getting treatment out of fear of the virus.

The number of daily COVID-19 hospitalizations began to drop after the first week in April, according to New York City data, and by early May the city was seeing under 200 coronavirus hospitalizations a day — a seven-fold decrease from the outbreak’s peak. The emergency department visit rates for people with influenza-like and pneumonia symptoms are also now below where they were at the start of the outbreak.

But even that slowdown has proven to be only temporary. ER activity is ticking back up, some doctors told TPM last week. Emergency physicians are seeing two months of pent-up demand for chronic conditions, routine care, and more serious non-coronavirus problems and infections.

This fluctuation in workload is being accompanied by undeniable anxiety that this too could be just another brief phase. Sighs of relief are being chased by waves of guilt.  The next big shock to the health care system could be just around the corner and a return to normal — even as others in New York discuss reopening — remains elusive.

“Look at where we are right now: we have no treatment, no prophylactic, no vaccine, a blood test that doesn’t give you real reliable results about whether you’ve been infected or not, or tells you about immunity,” Dr. Manish Garg, an emergency medicine doctor, told TPM last week. “But all we have is physical distancing, and now people are not observing that.”

‘Most Of The People Stopped Coming, Period’

At Garg’s Manhattan hospital, which he asked that TPM not identify in order for him to speak candidly, he expected at the beginning of the outbreak to see a surge of respiratory complaints. What they saw was a “a ton of cases,” like an “avalanche,” exhibiting all sorts of symptoms — nausea, body aches, heart attacks — that ultimately were coronavirus-linked.

“It really went up exponentially,” he told TPM, with his hospital fearing that cases might start doubling daily and “adrenaline” powering his high-speed days.

“Thankfully, we never hit that, and the numbers did plateau, and then precipitously dropped after that, because most of the people stopped coming — period — to the emergency department,” Garg said.

Around late April, his department was seeing less than half of the cases it would normally see in non-pandemic times.

“Which got us scared because, where did all the appendicitis and gallbladder infections and other types of infections go?” he recalled.

Sure enough, those patients did begin to return this month, with case volume picking up last week by about 25 percent.

“It’s all the people who have been having chest pain for six weeks and were too scared to come in, but now are coming in, because ‘I don’t think I can take it anymore, I am taking a chance now,'” Garg said.

‘The Mental Anxiety Is Still There’

Dr. Kamal Kalsi, who practices at health care facilities throughout the New York-New Jersey metropolitan area, noticed a similar dynamic in the ER he was working at last week.

(Kalsi asked to not name the specific facility, for fear doing so would cost him his job.)

“We were definitely overwhelmed with the COVID cases through March and April, and then it started to drop off — maybe about two weeks ago, things started to slow down — and now we’re seeing resurgence of just regular stuff that we had not seen,” Kalsi told TPM on Thursday.

Annual flu season usually is followed by a “well deserved lull,” according to Kalsi, “so we were expecting a slowdown way back in like, March, beginning of April, which never happened,”

“I think a lot of us were relieved,” he said, when the potential COVID-19 cases started to come down.

But he also fears that there will be a “maddening wave after wave of infection” now that social distancing is being taken less seriously in New York.

“The inability to predict the future is what’s driving us crazy,” said Dr. Calvin Sun, who spoke to TPM late last month after posting an image to his Instagram of empty ER beds at a New York City hospital.

Sun, a per diem doctor, said that things had chilled out to the point that shifts were starting to be cut back. (He asked not to identify the hospital, given the active presence he’s had on social media documenting the outbreak).

“Even if patients are down,” Sun said, “the mental anxiety is still there.”

‘What Did We Just Go Through?”

Another feeling has settled among ER staff: guilt — survivors’ guilt; guilt on days that they’re off, that they’re not on the front lines; guilt about the families who could not be at their loved ones’ side as they died.

“Emergency medicine folk, I hate to stereotype, but they tend to be fun, passionate, excited, take-the-bull-by-the-horns type of people, and now I see us just kind of like quiet, contemplative,” Garg said. The mental struggles are being compounded by the fact that many doctors are still staying isolated from their families.

“The running has stopped and many of us have started to just contemplate, tried to wrap our heads around and reflect on: what did we just go through?”