What It’s Like in a New York City ICU Right Now
A Q&A with a critical care cardiologist on the front lines of the pandemic
New York City is considered the epicenter of the ongoing coronavirus epidemic in the United States, though there are early signs the situation is improving. Dr. Jennifer Haythe, MD is a critical care cardiologist at Columbia University Center and one of the many health care professionals combatting Covid-19 on the front lines. Only a few weeks ago, doctors realized that the virus can also cause heart problems, and these symptoms have kept Haythe and her colleagues busy. She spoke with Medium about treating people with Covid-19 in the intensive care unit (ICU) — and why she’s also worried about the patients she’s not seeing at the hospital.
Medium: What’s the experience like in the ICU now?
Dr. Haythe: All of the patients right now in the cardiac intensive care unit, for the most part, are Covid-19 patients and not the typical cardiac patients that we would normally have. People [on my team] are rotating for one week, including the weekend, and then they get a week off, then they come back for a week. And then in the interim week, we do all of our televisits and support our outpatient using telemedicine. Most of the people in the ICU are intubated, some in kidney failure and on dialysis or supportive care. Sometimes there are four patients in a room on ventilators.
What kinds of heart-related issues are you seeing among people with Covid-19?
One thing that has emerged is myocarditis, which is a condition that we see with other viruses. Basically it’s an inflammation of the heart muscle, and these people develop a form of heart dysfunction that’s probably directly related to the virus itself. Unfortunately, it’s a little bit hard to acquire data because we would normally biopsy these people who present with myocarditis, and we are avoiding unnecessary procedures.
Are these among people who have had past heart-related health issues, or are these people who don’t have a history?
We’re seeing a whole range. We’re seeing what’s been more typically described in medical literature: older people or people with multiple risk factors like diabetes, hypertension, underlying heart disease, or underlying lung disease. But I can’t deny the fact that we’re also seeing people in their 40s and 50s and 60s who don’t really have that many underlying medical problems and some progress to very severe disease. We’re not entirely sure why that is.
We don’t have enough information to know if there’s going to be long-term heart failure syndromes related to this virus. Will the heart recover? There’s a lot of unanswered questions and research being done.
Is your team experiencing shortages of protective gear and ventilators?
I actually feel very lucky where I work, we seem to have an adequate supply of necessary items. There was a period when the surge first started to happen a few weeks ago where there was a concern about potential shortage, but our hospital system has done a good job of acquiring necessary items. I wouldn’t say that there’s a surplus. People are conserving their products and their supplies. But overall I feel we are well stocked.
I think the biggest problem that a lot of hospitals are facing is nursing. There’s already a shortage of nurses in general, before this all happened. And now we need a lot of nurses, and we need a lot of nurses that have experience with ICU-level care, which is also not easy to come by. There are tons of people volunteering, but you have to be trained to take care of these ICU patients. It’s a hard job and not easy to just stick any random person in there. There’s a lot of IVs to manage, ventilator management, frequent blood draws, turning and manipulating, and cleaning patients. These patients can’t do anything for themselves. And so these nurses have to know how to manage multiple things going on with a patient at the same time.
You mentioned that so many of the people you’re seeing in the ICU now are people with Covid-19. Where are the people you might normally be seeing in the ICU?
Everybody’s been asking that same question, where are the typical heart attack patients that come in with chest pain and EKG changes? It’s not clear. Are those people developing symptoms of cardiac issues but staying home because they’re scared to go to the emergency room? Are they staying home so long that they’re dying in their home? There’s a huge number of deaths at home during this coronavirus outbreak. How much of it is coronavirus, and how much of it is someone having a heart attack or stroke and not wanting to go to the emergency room, and then they die at home? That’s also a question that needs to be answered.
We are still seeing some of our more typical cardiac patients, and we have tried to keep at least one unit available for non-Covid-19 patients. Patients that repeatedly test negative for Covid-19 and have other medical problems are put in a separate unit to try to preserve some sense of separation for them. It’s not always possible to do that, but we’ve tried to do that.
I do think that there will be downstream effects. There’s going to be a downstream effect of not just cardiac patients, but all the other medical problems that aren’t being attended to, like people with cancer, people who need to have elective procedures. If you need a mastectomy for breast cancer, it’s elective — sort of. You know, it’s not like you need an emergency mastectomy, but if you don’t have the mastectomy, you’re at increased risk for metastasizing your breast cancer.
So these are the kinds of things that I think are worrisome. We’re trying to do our best with telemedicine and adjusting medicines, but it’s not ideal.
People following New York’s progress are hearing that we might be flattening the curve. Does it appear things are getting better from the ICU?
I would say that this week to me felt like a peak moment. For a while, it had been one patient to a room like we normally have in the ICU, and then suddenly overnight I walked through the same ICU and there are two people in every room. That was shocking to me. That felt like we’ve reached another level of trying to manage these patients. But at the same time, I’m also hearing reports that our number of admissions is going down, and the number of intubations is going down. Now is that because we don’t have any room available or we have run out of ventilators? I don’t think we’ve run out of [ventilators or room], so that is promising. I think the biggest concern is what happens when we open the doors and let people out again, are we going to see the same thing all over again?
What would you like people to know about this pandemic from your perspective?
It’s very heartbreaking. People being in a hospital that has no visitors is pretty shocking. There are worried family members. In the ICU it’s slightly different because most of our patients are on a breathing tube and then not really awake. But for so many patients that are struggling to breathe and are scared, I think that it’s heartbreaking and that we can’t allow visitors in is very hard. I implore people, for the sake of the greater good of the world, to just try your best to stay inside. And I really think people are doing a good job with that and trying really hard. I think people are good at heart, and I think that when you look from afar you see how much people are risking and giving up. If they can just keep doing what they’re doing, it would be great.