ER Doctors At SUNY Downstate Are Taking It One Day At A Time: “I don’t look till tomorrow. I think that will break all of us.”

As the coronavirus pandemic burns through Brooklyn, nearly every bed in SUNY Downstate Medical Center’s emergency department is dedicated to coronavirus patients, doctors said Friday.

“This corona is nothing like I’ve seen before. I feel like people are dropping like flies. Even young people with no comorbidities—30-year-olds, 40-year-olds—just struggling,” said Sneha Topgi, MD, a clinical assistant professor in the department of emergency medicine at SUNY Downstate Health Sciences University.

For people who are not very sick but are thinking of coming to the ER, Topgi advised first calling their doctor, 311, or the ER itself for advice, due to the risk of contagion: “The hospital’s a very dangerous place to be right now.”

“I don’t think this would be described as anything less than a war zone right now. This is definitely not what any of us thought we would see in our lifetimes,” said Ninfa Mehta, MD, an assistant professor in the department of emergency medicine.

The large training hospital in Brooklyn’s East Flatbush neighborhood normally serves a largely lower-income community, many of them older and with underlying health problems.

Even before the pandemic, it wasn’t unusual for ER patients already admitted as inpatients to wait in hallway beds for a hospital room to open up, according to Topgi.

“Usually that, at baseline, is a lot for our ER to handle,” Topgi said.

Now it’s far worse. Topgi said that patients who would have been seen in the main ER a few months ago are now being seen in the pediatric emergency room, the fast-track area, or nearby outpatient offices, as well as via telemedicine. Many patients are waiting for ICU beds. A refrigerated morgue trailer waits outside.

In the waiting room, each patient receives a mask, Topgi said.

To reduce the spread of the virus, patients are not allowed to have visitors. That’s a problem, as the ER is so busy that it’s hard to update loved ones, even by phone, according to Mehta. Off-campus medical students are using technology to help care teams and families stay in touch, she said.

Many patients show up at the ER expecting a coronavirus test, Topgi said. As of last week, she said, coronavirus testing was being reserved for patients being admitted to the hospital, and those deemed well enough to go home are not tested.

“People have literally wanted to punch me” after being denied a test, Topgi said. She tells them she doesn’t have a test to give them, nor would it change their treatment plan if she did. But, she added, “It’s frustrating for the patient and I understand why they’re angry.”

With regard to personal protective equipment, Topgi said she and her colleagues were wearing zip-up hazmat suits with goggles and receiving one new N95 mask per shift.

“We’re trying. My hospital’s trying. My bosses are trying. They’re working around the clock to update things every day and give us what we need. And I’m lucky I’m at a hospital that they actually support us,” Topgi said.

Still, Topgi added, she is saving all her N95s.

As of late last week, care teams were not yet at the point of having to make life-or-death decisions about the allocation of scarce ventilators, according to Kathleen Powderly, CNM, PhD, director of the John Conley Division of Medical Ethics and Humanities and a clinical ethicist at SUNY Downstate and Kings County Hospital.

But they were nearing that point.

“Let’s face it—we’re two safety-net hospitals” that must often make difficult decisions about the allocation of scarce resources, Powderly said. “But not like this. Not like, ‘we have 10 patients and 2 ventilators.’

“We are not at the point yet where we don’t have an empty bed or a ventilator not in use,” Powderly added. “But it is getting close. I think that’s true around the city.”

As of 4 PM Monday, March 30, 37,453 coronavirus cases have been reported in New York City, according to the state department of health.

Across New York State, hospitalization rates for coronavirus were doubling every 6 days, according to Governor Andrew Cuomo. That’s an improvement over what had been faster doubling rates just days earlier and a sign that social distancing is helping.

Still, more and more people are requiring hospital admission, and the city is marking hundreds of coronavirus deaths each day. The Brooklyn Cruise Terminal is one of several federally approved temporary hospital sites in the city, according to the state department of health.

Mehta said she expects the coming weeks to be overwhelming for the health system, and she fears losing colleagues to the virus.

“I have really been just taking one day at a time,” she said. “I don’t look till tomorrow. I think that will break all of us.”