Medical workers at New York City hospitals describe fear, desperation and confusion as the coronavirus creates chaos in the health care system, with facilities rationing protective equipment and changing the playbook in unprecedented ways.
"You have all these things that keep changing every single day," said a medical resident who works at multiple public hospitals in Brooklyn. "It's very terrifying to be flying the plane at the same time you're building it."
There were nearly 45,000 coronavirus cases in New York City with more than 1,100 deaths as of early Wednesday. Some hospitals are overwhelmed as the state projects that the peak could be weeks away at the end of April.
The state and some hospitals said this week that after an influx of supplies, they have enough personal protective equipment, or PPE, for immediate needs, but residents described confusing, fluctuating policies and restrictions. Some questioned what qualified as "enough" protective equipment and said they no longer felt safe.
The resident in Brooklyn described over the past few weeks first being given an N95 mask and eventually being told to keep it for five days.
"In the last week, it has been day and night. Imagine when we get to the apex where we'll be," said the resident, who spoke on condition of anonymity.
"If they're telling me keep this mask for five days, do we really have enough PPE?" the resident asked. "Are they going to say next keep it for 10 days?"
Dr. Sarah Iosifescu, a resident physician at Mount Sinai Morningside and West in Manhattan, said Tuesday that she believed there was a "huge discrepancy" between messaging from the government and hospitals on having enough protective equipment and what front-line workers were feeling.
"We have providers that same week going and asking for an N95 mask in the emergency department and explicitly being told you do not get an N95 mask," she said during a video teleconference Tuesday in her capacity as a member of the Committee of Interns and Residents, a national union representing interns, residents and fellows.
"There's a huge discrepancy going on," she said.
Iosifescu said she wrote an email to the hospital saying: "I have a 7-month-old child. I have asthma. I work in the emergency department. I don't feel safe."
"The response I got was that a surgical mask is sufficient for you," she said, adding, "I wouldn't be reaching out to friends and family begging them to help me get masks if I felt safe."
Multiple residents described watching scenes of doctors in China and Italy in full-body protective suits and questioned why the same could not happen in New York City. They also sharply criticized guidance from the Centers for Disease Control and Prevention that bandannas could be used as a last resort, citing data showing how penetrable bandannas were to the coronavirus.
A resident who works in Brooklyn hospitals on the city, state and federal levels said health care professionals were trying to raise funds to afford enough equipment to protect themselves.
The resident, who spoke on condition of anonymity, said that even when workers do have masks, they still lacked other forms of protective equipment, such as booties, hairnets and the full-body coverall suits seen in some countries. Sometimes they do not have visors or face shields, either, the resident said.
"I don't feel safe. I'm sorry," the resident said.
New York Gov. Andrew Cuomo has called for hospitals across the state to work together as one united system and for centralized distribution of critical medical supplies.
On Wednesday afternoon, New York City Mayor Bill de Blasio said recently retired Police Commissioner James O'Neill was returning to city government to oversee the supply and distribution of personal protective equipment and medical equipment within the city's hospitals.
So far, New York City has distributed more than 2 million N95 masks, 8.2 million face masks and nearly 2 million surgical gloves, the mayor's office said.
But de Blasio has said it is not close to enough. All 2,500 ventilators the city got from the federal government have been dispatched to hospitals. De Blasio said they needed 2,500 to 3,000 more by the end of next week.
He said that by Monday, the city will need 3.3 million N95 masks, 2.1 million surgical masks and 100,000 isolation gowns. He said the city also needed more nurses and medical staff to relieve health care workers on the front lines.
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New York's Health Department, NYC Health + Hospitals, NewYork-Presbyterian and the Mount Sinai Health System did not immediately respond to requests for comment.
The CDC said it has not changed it's guidance regarding use of masks. It recommended those who are sick should wear face masks around others, and if a person who is sick is not able to wear a mask then the care giver should wear a mask.
In settings where masks are not available, health care professionals might use homemade masks like bandanas or scarves "as a last resort."
"We thank citizens for their efforts, but it’s important to note that this strategy is considered a last resort and does not adhere to the typical standards of care in the U.S., but acknowledges the hard realities on the ground," the CDC said.
NYC Health + Hospitals, the city's public hospital system, said in a statement that it was "working with all local, state and federal agencies to ensure that resources are strategically allocated throughout to accommodate the surge caused by COVID-19."
"We are committed to our mission to care for all New Yorkers regardless of immigration status and ability to pay, and are focused on keeping all our patients and staff safe," it said.