Monday, March 30, 2020

CORONAVIRUS IN NYC - WHO SHOULD DIE FIRST?


N.Y.C.’s 911 System Is Overwhelmed. ‘I’m Terrified,’ a Paramedic Says.

With coronavirus cases mounting, emergency workers are making life-or-death decisions about who goes to a hospital, and who is left behind.

Credit...Mark Abramson for The New York Times

The first of many calls that night involved a 24-year-old man who had a fever, body aches and a cough that sounded like a cement mixer.
While the Brooklyn paramedics took the man’s fever — 103 degrees — they noticed frightening vitals that hinted at coronavirus: a critically low level of oxygen was flowing into his otherwise clear lungs, while his heart thumped with the intensity of a marathon runner’s. He was taken to the nearest hospital.
Then almost immediately came the next call: a 73-year-old man with symptoms similar to the young man’s. They took him to the hospital, too.
“It’s all a war zone,” one of the paramedics said.
Days later, another paramedic, Phil Suarez, was dispatched to two homes in Manhattan’s Washington Heights neighborhood, where entire families, living in cramped apartments, appeared to be stricken with the virus.
“I’m terrified,” said Mr. Suarez, who has been a paramedic in New York City for 26 years and had assisted in rescue efforts during the Sept. 11, 2001, terror attacks and later served in the Iraq war. “I honestly don’t know if I’m going to survive. I’m terrified of what I’ve already possibly brought home.”

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Credit...Jessica Hill for The New York Times
Even as hospitals across New York become inundated with coronavirus cases, some patients are being left behind in their homes because the health care system cannot handle them all, according to dozens of interviews with paramedics, New York Fire Department officials and union representatives, as well as city data.
In a matter of days, the city’s 911 system has been overwhelmed by calls for medical distress apparently related to the virus. Typically, the system sees about 4,000 Emergency Medical Services calls a day.
On Thursday, dispatchers took more than 7,000 calls — a volume not seen since the Sept. 11 attacks. The record for amount of calls in a day was broken three times in the last week.
Because of the volume, emergency medical workers are making life-or-death decisions about who is sick enough to take to crowded emergency rooms and who appears well enough to leave behind. They are assessing on scene which patients should receive time-consuming measures like CPR and intubation, and which patients are too far gone to save.
And, they are doing it, in most cases they say, without appropriate equipment to protect themselves from infection.
The paramedics described grim scenes as New York City has become the epicenter of the coronavirus pandemic in the United States, with more than 30,000 cases as of Saturday, and 672 deaths.
If the rate of growth in cases in the New York area continues, it will suffer a more severe outbreak than those experienced in Wuhan, China, or the Lombardy region of Italy.
One New York City paramedic described responding to a suicide attempt of a woman who had drunk a liter of vodka after her cancer treatments had been delayed, in part because hospitals were clearing their beds for coronavirus patients.
Another paramedic said she responded to so many cardiac arrests in one shift that the battery on her defibrillator died.
“It does not matter where you are. It doesn’t matter how much money you have. This virus is treating everyone equally,” the Brooklyn paramedic said.
The amount of work has been record-setting for the city’s 911 system, said Frank Dwyer, a Fire Department spokesman.
“Our E.M.T.s and paramedics are on the front line during an unprecedented time in the department’s history,” Mr. Dwyer said, adding: “They’re doing it professionally, and they’re doing it because they care about their patients. They care about this city.”
The department said it has started rationing protective gear in an attempt to stave off potential shortages. Earlier this month, the department told workers that they must turn in their used N95 masks — which filter out 95 percent of airborne particles when used correctly — in order to receive a new one.
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“The department is carefully managing and monitoring usage of personal protective equipment and critical supplies to ensure we have what’s needed for this long-term operation,” Mr. Dwyer said.
Inside ambulances, on rudimentary digital screens, the dispatches are listed — call No. 2,488, sick; call No. 2,555, sick; call No. 2,894, sick with a fever. The screen goes on for rows, a catalog of the city’s ill and dying. Peppered among them are the usual every day calls still demanding attention: injuries, accidents, heart attacks.

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Credit...Juan Arredondo for The New York Times
New York City’s soundtrack has always included the sound of ambulance sirens. But now, with many of the city’s businesses closed and its neighborhoods quiet, endless wailing seems to echo through the deserted streets.
Three weeks ago, the paramedics said, most coronavirus calls were for respiratory distress or fever. Now the same types of patients, after having been sent home from the hospital, are experiencing organ failure and cardiac arrest.
“We’re getting them at the point where they’re starting to decompensate,” said the Brooklyn paramedic, who is employed by the Fire Department. “The way that it wreaks havoc in the body is almost flying in the face of everything that we know.”
In the same way that the city’s hospitals are clawing for manpower and resources, the virus has flipped traditional Emergency Medical Services procedures at a dizzying speed. Paramedics who once transported people with even the most mild medical maladies to hospitals are now encouraging anyone who is not critically ill to stay home. When older adults call with a medical issue, paramedics fear taking them to the emergency room, where they could be exposed to the virus.
One paramedic told a 65-year-old patient in Brooklyn, whom she had previously transported to the hospital for recurring issues, to stay home this time and call a doctor.
In New York City, 911 calls are handled by both Fire Department ambulances and ambulance companies staffed by area hospitals. Their duties are effectively the same: They respond to the same medical calls, largely determined by what crew is closer and which is available fastest.
Neither the city, the State Department of Health or the federal Centers for Disease Control and Prevention have issued strict rules as to how paramedics should respond to a coronavirus call. In recent days, Fire Department policy — which applies to all ambulance crews in the 911 system — has given more latitude to paramedics to make decisions on how to handle patients they believe have the virus.
Recent guidance has also directed paramedics to wear surgical masks, gloves, gowns and eye protection for suspected coronavirus patients. N95 masks, in short supply, are only worn for certain procedures.
Since many hospitals are in dire need of personal protective equipment like N95 masks, paramedic crews employed by the hospitals also face shortages.
The Brooklyn paramedic said she had started sewing her homemade masks with bandannas and coffee filters.
Another paramedic in Brooklyn said she had been using the same N95 mask for days. Last week, as she and her partner exited an apartment building after tending to a patient, the building’s supervisor — noticing the pair’s worn equipment — met them downstairs and shoved new N95 masks and a can of Lysol into their arms.

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Credit...Jose A. Alvarado Jr. for The New York Times
Like doctors and nurses, many paramedics fear they are already infected and have brought the virus home to their families. On March 18, three members of the Fire Department tested positive for the virus. By Friday, 206 members had positive results.
Officials for the union that represents the city’s paramedics believe the actual number who have been infected is far higher. At a single station in Coney Island, Brooklyn, seven Emergency Medical Services workers were infected, one union official said.
At least one E.M.S. worker with the virus was in an intensive care unit last week and on a ventilator.
The growing pandemic has tested paramedics physically and mentally, said Anthony Almojera, an E.M.S. lieutenant for the Fire Department who said he cried on the job for the first time in his 17-year career.
He and his team had responded to a cardiac arrest dispatch for a middle-age woman, a health care worker, who had been infected. When paramedics arrived at her home, the woman’s husband, who was also a health care worker, said she had been sick for five days.
The husband frantically explained that he had tried to stay home and tend to his ill wife, but his employer had asked him to work because their facility was overrun with coronavirus patients.
Grudgingly, the man told the medics, he went to work. When he returned home after his shift that day, he found her unconscious in their bed. For 35 minutes, Mr. Almojera’s team tried to revive the woman, but she could not be saved.
Usually, Mr. Almojera said, he tries to console family members who have lost a loved one by putting his arm around them or giving them a hug.
But because the husband was also thought to be infected with the coronavirus, Mr. Almojera delivered the bad news from six feet away. He watched the man pound on his car with his fist and then crumble to the ground.
“I’m sitting there, beside myself, and I can’t do anything except be at this distance with him,” Mr. Almojera said. “So, we left him.”

Ali Watkins is a reporter on the Metro desk, covering crime and law enforcement in New York City. Previously, she covered national security in Washington for The Times, BuzzFeed and McClatchy Newspapers. @AliWatkins

1,200 Dead in N.Y. and Cuomo Says Worst Is Still to Come: Live Updates

A Navy hospital ship docked in Manhattan this morning and is expected to provide relief to New York City’s overwhelmed hospitals.
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Gov. Andrew M. Cuomo said that 1,218 people had died in New York State, up from 965 Sunday morning.
NEW YORK TODAY
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Gov. Andrew M. Cuomo, briefing reporters on Monday, said that the worst of the coronavirus outbreak was yet to come, even as another 253 people died in the state in a 24-hour period.
“If you wait to prepare for a storm to hit, it is too late,” the governor said. “You have to prepare before the storm hits. And in this case the storm is when you hit that high point, when you hit that apex. How do you know when you’re going to get there? You don’t.”
The governor spoke at the Javits Center, a convention hall in Manhattan that was quickly turned into a 1,000-bed emergency hospital. His remarks came shortly after a Navy hospital arrived in the city.
The setting for Mr. Cuomo’s briefing underscored New York’s urgent efforts to prepare its health care system for the wave of sick people that is expected to overwhelm hospitals in just a few weeks.
Here are other developments from Monday:
  • New York reported almost 7,000 new cases of the virus, bringing the total to nearly 66,500. Most of the cases are in New York City, where 36,221 people have tested positive, the city says.
  • Gov. Philip D. Murphy of New Jersey announced 3,347 new positive coronavirus cases in the state, bringing the total to 16,636. There were 37 new deaths, for a total of 198.
  • In New York, the number of people hospitalized was 9,517, up 12 percent from yesterday. Of those, 2,352 are in ventilator-equipped intensive care rooms.
  • In a hopeful note, Mr. Cuomo said that while the number of hospitalizations continues to grow, the rate which it is growing was tapering off. “We had a doubling of cases every two days, then a doubling every three days and a doubling every four days, then every five,” Mr. Cuomo said. “We now have a doubling of cases every six days. So while the overall number is going up, the rate of doubling is actually down.”
  • More than 4,200 people have been discharged from hospitals.
  • New York has tested more than 186,000 people in March, about one percent of the state’s population. But while New York’s testing capacity far outpaces that of other states, it has not reached the critical-mass level public health experts say is necessary to more precisely identify the spread of the virus.
A Navy hospital ship that docked in Manhattan this morning is expected to provide relief to the city’s overwhelmed hospitals by freeing up beds to be used for coronavirus patients.
The 1,000-bed ship, the Comfort, with 12 operating rooms, a medical laboratory and more than 1,000 Navy officers, arrived at Pier 90 off West 50th Street in Manhattan just before 11 a.m., and Mayor Bill de Blasio said that 750 of its beds will be put to use “immediately.”
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The Comfort will treat patients who do not have the virus. The city’s hospitals are now so full that paramedics in the field are being forced to make on-the-spot judgments about who gets to go to the hospital and who is left behind, perhaps to die.
“This is like adding another hospital here in New York City,” Mr. de Blasio said. “It’s such a boost to see the military arrive to help us out.”
Still, he acknowledged that the city’s health care system would need far more support.
“We started with around 20,000 working beds in New York City,” Mr. de Blasio said. “We have to get over 60,000 by the beginning of May according to what we know now — like adding 40 U.S. Comforts. And that’s the magnitude of what we’re talking about.”
Along the Hudson River, people gathered in bunches to watch the ship arrive — in apparent violation of social distancing rules.
The Comfort, a converted supertanker, was used as a floating base for rescue workers in New York after the Sept. 11, 2001, terror attacks.
In sending the ship, Navy officials acknowledged that they had taken a risk. They insist that they are doing everything short of Saran-wrapping the vessel to try to keep it virus-free,
“We will establish a bubble around this ship to make sure we’re doing everything to keep it out,” said Capt. Joseph O’Brien, commodore of the military’s Task Force New York City.
CALCULATED RISK
 Officials acknowledged that it would take special effort to keep the Comfort virus-free.
Separately, officials have been transforming the Jacob K. Javits Convention Center in Manhattan into a 1,000-bed hospital. Officials with the Army Corps of Engineers have said the hospital should be ready to open today.
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Credit...Mount Sinai Health System and NetJets
Private jets donated by Warren Buffett’s company. Special approvals from two governments. And a frenzied trip to China.
That’s how far the Mount Sinai Health System had to go last week to obtain N95 respirators, the heavy-duty face masks that are most effective at blocking particles carrying coronavirus.
The effort, which was not publicly disclosed, illustrates the scarcity of protective equipment for health care workers in New York, the epicenter of the U.S. outbreak.
It began last Monday, when Mount Sinai got a call from Taikang Nanjing International Medical Center saying that the hospital had hundreds of thousands of extra masks and other supplies because the outbreak in China had peaked. Mount Sinai could have them if it picked them up.
After China said it did not have room for the cargo plane Mount Sinai wanted to send, the health system got a Goldman Sachs executive to convince a Buffett-owned company called NetJets to send two small 13-seat jets.
At a landing strip in Nanjing, a city of 8 million northwest of Shanghai, the pilots squeezed 5.5 tons of N95 masks — about 130,000 masks in all — into the jets.
The gambit required special approval from Customs and Border Protection, the Food and Drug Administration and the Chinese government. But it worked. At 3 a.m. Friday, the jets landed at Teterboro Airport in New Jersey and workers began taking masks to Mount Sinai’s eight hospitals.
The supplies will alleviate shortages for now — and more masks will be coming next week, the hospital said. But for some, the fact that even a wealthy private institution like Mount Sinai had to go through this ordeal showed how unprepared the U.S. was for the pandemic. “The masks coming in from China is welcome but is not nearly enough,” said Pat Kane of the New York State Nurses Association.
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Credit...Gregg Vigliotti for The New York Times
Day after day, doctors and nurses keep going to work, earning cheers on the streets for fighting on the front lines.
But inside New York’s hospitals, medical workers face scenes that are incredibly grim. Their colleagues are falling sick.
Two nurses in city hospitals have died. Protective gear for those who are relatively healthy remains scarce.
Across New York, anxiety is growing among even the most even-keeled health care workers. “I feel like we’re all just being sent to slaughter,” said Thomas Riley, a nurse at Jacobi Medical Center in the Bronx, who has contracted the virus, along with his husband.
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Credit...Gabby Jones for The New York Times
Governor Cuomo’s approval rating surged over the last month, fueled by overwhelming support for his handling of the coronavirus crisis, according to a Siena College poll released Monday.
Mr. Cuomo is viewed favorably by 71 percent of voters, up from 44 percent in February. Just 23 percent saw him unfavorably, his best negative rating since 2012.
The third-term Democrat stands as the state’s most popular politician, far outpacing President Trump, the Queens native who is seen favorably by only 35 percent of New Yorkers.
The governor’s popularity seems directly related his handling of the outbreak: 87 percent of those polled approved of his performance as the virus has spread.
The disease itself has the state’s residents deeply worried, Siena reported, with 92 percent of respondents either “very” or “somewhat” concerned about it.
Mr. Cuomo, who has long denied presidential ambitions, polled 20 points higher than former Vice President Joseph Biden, who was seen favorably by 51 percent, and unfavorably by 40 percent.
The telephone poll of 566 New York State registered voters was conducted between March 22 and 26, with an error margin of 4.5 percentage points.
Nearly 100 people living in New York City’s main homeless shelter system have tested positive for the coronavirus, officials said.
As of Sunday, 99 people staying in 59 shelters had tested positive for the virus, according to the city’s Department of Social Services. Two of them, a man in his 60s and a man in his 70s, died last week. Twenty-seven homeless people remained hospitalized on Sunday, officials said.
The city’s main shelter system for homeless people is made up of about 450 traditional shelters, hotels and private apartment buildings. There are an estimated 79,000 homeless people in the city; about 5 percent live unsheltered on the city’s streets.
Seven people living on the streets and three people who were staying in what is considered unstable housing have tested positive for the virus, officials said.
As of Sunday, there were 140 people staying in special isolation units operated created by the social services agency at four locations.
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Credit...Gabriela Bhaskar for The New York Times
Subway ridership in New York City has plummeted in recent weeks. But in poorer areas, many people have jobs that do not allow them the luxury of working from home. So they keep riding.
In the Bronx, two stations that have had relatively low drops in ridership serve neighborhoods with some of the highest poverty rates in the city, a Times analysis found.
The 170th Street station in the University Heights neighborhood and Burnside station in Mount Eden are surrounded by large Latin American and African immigrant communities where the median household income is about $22,000 — one-third the median household income in New York State, according to census data.
It is a striking change on a system that has long been the great equalizer among New Yorkers, where hourly workers crowded in with financial executives. Now the subway is more like a symbol of the city’s inequality.
Many residents say they have no choice but to pile onto trains with strangers, potentially exposing themselves to the virus. Even worse, a reduction in service in response to plunging ridership has sometimes caused crowding making it impossible to maintain the social distancing public health experts recommend.
“This virus is very dangerous. I don’t want to get sick, I don’t want my family to get sick, but I still need to get to my job,” said Yolanda Encanción, a home health aide who works in Lower Manhattan.
INEQUALITY IN A CRISIS
 The subway underscores the divide between those with the means to safely shelter at home and those who must venture out to keep their jobs.
As The New York Times follows the spread of the coronavirus across New York, New Jersey and Connecticut, we need your help. We want to talk to doctors, nurses, lab technicians, respiratory therapists, emergency services workers, nursing home managers — anyone who can share what they are seeing in the region’s hospitals and other health care centers. Even if you haven’t seen anything yet, we want to connect now so we can stay in touch in the future.
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