NEW YORK — According to Dr. Eitan Dickman, the atmosphere inside the emergency room at Maimonides Medical Center in Brooklyn amid the COVID-19 pandemic is one of heightened vigilance.
“The idea of working an entire shift in personal protective equipment, the idea of working with a large number of very sick patients, of consistently seeing patients who are struggling from a respiratory perspective, is something the staff is getting used to,” Dickman, vice chairman of the Maimonides emergency department, told The Times of Israel via Zoom. “They’re settling into a rhythm from that perspective.”
But there was virtually no time for staff at Brooklyn’s largest hospital, located in Borough Park, one of Brooklyn’s densest neighborhoods, to get used to that rhythm. There was no dress rehearsal for fighting COVID-19 — in fact, there was barely enough time to set the stage.
Back in February, according to an article in Business Insider, Dr. Patrick Borgen, the hospital’s chair of surgery, noted how quickly the coronavirus spread on the cruise ship Diamond Princess and realized it would spread as quickly through the densely populated neighborhood of Borough Park.
Plans were enacted and beds were put wherever they would fit – from the hospital’s rehabilitation gym and a vascular testing unit, to the nursing home across the street and an unused nursing home in Crown Heights. The hospital went from 620 total beds pre-COVID-19, including 55 ICU beds, to a surge capacity of 1451 beds. This includes 162 ICU beds and 546 medical and surgical beds.
“The hospital was quite nimble in how rapidly it adapted on all fronts, from a staffing perspective, from an equipment perspective, from dealing with this new disease that no one has ever seen before, perspective,” Dickman said of the plan.
And then, seemingly overnight, the type of patients coming through the hospital’s emergency room doors changed. In what seemed like an instant, patients suffering from strokes and heart attacks, bike accidents and household injuries, seemed to vanish. Instead it seemed to be all COVID-19 all the time, Dickman said.
The hospital still sees patients with more routine illnesses and injuries — but they are fewer than those with COVID-19 symptoms.
As of Friday, Brooklyn reported 32,499 positive cases of COVID-19, putting it behind Queens, which reported 37,447 cases, according to the New York City health department.
Statewide, the death toll from COVID-19 now stands at 14,636 deaths, according to the New York State Health Department. Of those, 8,893 were from New York City. Breaking it down by borough, Queens had more than 2,100 deaths as of April 14, while Brooklyn reported nearly 1,900 deaths. The Bronx followed with more than 1,500 deaths.
And while it appears the number of deaths is declining statewide — there were 540 deaths across the state reported on Friday, down from a record 800 — the vigilance of front line health care workers is not.
“I have noticed that my dreams seem to be centered one way or another around COVID. The challenging situations you face during the day you tend to revisit at night in your dreams,” Dickman said.
The following interview was edited for brevity and clarity.
The Times of Israel: If I were standing in the ER with you right now what would I see?
Eitan Dickman: If we were standing in the ER you would see, from my perspective, that it has a different feel. There are no visitors allowed so that gives a different feel to it.
You would see patients who are receiving supplemental oxygen, whether it’s simple nasal cannulas, or face masks — some of them even requiring much greater supplemental oxygen through high flow nasal cannula, and some are even intubated.
Also, although the total number of patients is down compared to the pre-pandemic time period, the patients that are there are generally sicker, especially from a respiratory perspective. There are a much higher percentage of critically ill patients, of patients who require ICU-level care.
Why do you think the patients coming in now seem sicker than before?
I think there’s a hesitation to come to the hospital. I think people want to prolong things at home with their loved ones and so they are potentially waiting too long before they come to the hospital.
How do you keep up staff morale? Whether they are interns and first- and second-year residents, or people who have been working in the emergency room for decades, this must take its toll.
For sure. It’s an issue because what we’ve seen with this disease is it affects all ages of adults, from young adults who are 30- to 40-years-old all the way to the 80-year-old and 90-year-old and 100-year-old patients. It takes an emotional toll on the staff. The main thing we are doing is giving them a forum to talk about what they’re feeling and what they’re seeing.
I try and provide them with regular updates for what we’re doing. I meet on a weekly basis with the residency as a group. I meet individually with the teams multiple times a day to see where they’re at. It’s critically important to keep the lines of communication with the teams open.
What has been among the most emotional moments so far?
These are stressful times and challenging times from an emotional perspective.
I think that it’s really difficult when you have patients who are, as I said, on the younger side, and because we’re trying to protect families and friends there are no visitors, the patients are alone. That’s at every hospital, not unique to Maimonides, but that makes it really difficult. It puts the physician and really the whole health care team — the nurses, the residents, the techs — in the position of being the conduit who must convey very serious messages to the family.
Some healthcare workers are isolating themselves from the rest of their families, or friends or roommates, if they don’t live alone. Did you decide to do that?
My wife is also a physician and we’ve had several discussions about this.
When I come home I have a very specific pattern. I start to undress even before I walk into the front door. I go directly to the laundry and put my clothes in the laundry and then go directly to the shower. My kids hide. It’s the reality.
Some of my colleagues are sleeping separately and some I know are staying at different homes during this time period. We haven’t taken that route. But if and when I get sick we have our contingency plan ready to go.
What kinds of things are you doing in the ER now that you might continue doing when we do return to normalcy?
If someone had said you have one week to double your bed capacity, or you have one week to quadruple your ICU capacity, people would have looked at them like they had two heads. But we were put in that situation; we received the directive from the governor and we made it happen.
For me, one of the takeaways is it’s amazing what can be accomplished when you have all the key hospital leadership, both from the operations and the clinical side, all aligned with one specific goal.
I’m optimistic that we’re going to be able to carry that momentum forward. I don’t know in what shape or form, but I know normality will come back. We’re going to be taking care of more routine heart attacks, strokes and appendicitis and we need to retain this ability to remain nimble and make rapid adjustments.
As the number of new COVID-19 cases appears to be steadying, what do you want the public to know?
It looks like, and everything is based on preliminary data, that social distancing works. I’m going to cautiously say it looks like we’re entering a plateau phase. The numbers are not continuing to increase. I hope that persists but I would caution against the pendulum swinging too far in the opposite direction where people say “Oh! It’s over we can go back to our daily routines.”
I think that 600 deaths in one day is still a large number. It’s a devastating number. We want to make sure we don’t go back to our regular lives too prematurely before the situation is stabilized.