(Bloomberg) -- From behind his N95 mask and fogged-up face shield, Jolion McGreevy, director of the emergency department at New York City’s Mount Sinai Hospital, looked at the four members of his medical team, who were pulling on their own layers of protective gear.
It was Wednesday. McGreevy, 39, reviewed the chart detailing the condition of the patient waiting in the room he and his charges were about to enter: respiratory issues, low oxygenation, likely Covid-19 infection. The patient lay in a negative-pressure room, where air is held tightly to contain a pathogen. “Is everybody ready?” asked McGreevy, who’s worked at the Upper East Side campus just under two years. The others met his gaze from behind their face shields and nodded: Good to go.
They went in. They kept the door shut and limited their entrances and exits. They anesthetized the patient, then inserted a thin tube through her mouth into her trachea so a ventilator could help her breathe. Attendants moved the patient to an intensive-care unit and McGreevy moved onto his next challenge. Of his 40 patients that day, almost all had Covid-19, the disease caused by a novel coronavirus that’s caused a global pandemic. Each was part of a surge in New York that gave the U.S. a grim new distinction: home to the most coronavirus cases in the world.
Two days ago, infections in the U.S., with a population of 334 million, trailed those in China, population 1.4 billion, by about 15,000. As of Friday, the U.S. had more than 93,000 versus the 81,000 mainland China’s government has publicly reported, and the fastest pace of new cases. Even as President Donald Trump has pointed to Easter Sunday, April 12, as a wished-for turning point, a look inside hospitals, assisted-care facilities, businesses and communities across America suggests the U.S. health-care system will be stretched to the breaking point well beyond that.
The virus struck hard not only at medicine, but at the economy, as Jack Endres knows too well. The Portage, Michigan, plant he oversees carries about a day-and-a-half of inventory of air-induction systems that supply Detroit’s three major automakers and Toyota Motor Corp. The Big Three said March 18 that they’d be closing plants until April.
Endres, a vice president of operations for a unit of Germany’s Mann + Hummel, had little choice but to follow. “We went down pretty quickly,” said Endres. Almost 400 workers went home without pay March 23. They joined 129,000 Michigan employees who filed for unemployment benefits last week, among an unprecedented 3.28 million nationwide.
The economic devastation and gyrations of the financial markets emerged from a fog of fear and sickness during an extraordinary few weeks that made the U.S. the pandemic’s epicenter.
America had no Covid-19 deaths until more than three weeks after China recorded its first. Indeed, in early March, fewer than 50 people in the U.S. had fallen to the coronavirus when Richard Curren started feeling more fatigued than usual.
The 77-year-old and his wife, Sheila, 76, lived in the Atria Willow Wood assisted-living facility in Fort Lauderdale, Florida. He was a retired travel agent who’d also been a professional magician.
On Friday, March 13, an ambulance took Curren to Holy Cross Hospital. A physician kept asking if he’d been out of the country, said his daughter, Tracy Wieder. “I was like, ‘No, they haven’t left their place,” she said. (Holy Cross said it doesn't comment on the care that specific patients receive, in accordance with privacy laws.)
Curren and Sheila had moved to the Atria home in early 2019 from their daughter’s house in Cutler Bay, Florida. He’d brought along some magic tricks that he hadn’t yet been able to perform. Curren was the caretaker, helping Sheila eat and pushing her around in her wheelchair. He wasn’t enthusiastic about moving to assisted living, but he had his own medical problems, from diabetes to cracked ribs suffered falling out of bed. “I think he came to like it,” Sheila said, her voice cracking. “I loved it there.”
As the ambulance shuttled Curren to the hospital that Friday, young people on spring break frolicked on Fort Lauderdale’s beaches. Governor Ron DeSantis, a staunch Trump ally, had declined to shut the party down.
At the hospital, doctors diagnosed Curren with bacterial pneumonia and started pumping antibiotics and fluids into his veins. Early that Sunday, March 15, his daughter asked whether Curren should be tested for Covid-19; a doctor said he probably wouldn’t meet the criteria because he hadn’t been abroad or interacted with somebody who was sick. “I’m not sure why,” Wieder said. “He had respiratory distress and a 103-degree fever.” He was also a person over 65 with serious medical conditions, the group most vulnerable to the virus.
Curren got tested later that Sunday. Doctors inserted a breathing tube. Two days later, Wieder got a 5 a.m call. Her father was dead, she was told, infected by the new coronavirus.
Curren was the first of six people to die at the Atria facility from Covid-19. DeSantis on March 22 told reporters that Atria had allowed construction workers, staff and cooks to enter unscreened and interact with vulnerable residents.
Atria said in a Friday email that it doesn’t comment on specific residents, but called the governor’s comments “inaccurate and unproductive.” The company said it began screening all visitors March 4, and constantly monitors residents’ symptoms.
Tracy Wieder and her mother are now in quarantine in Cutler Bay with Tracy’s two children, her boyfriend, her daughter’s boyfriend, two cats and two dogs. Sheila Curren said she’s “very, very angry” with Atria. “They didn’t tell us there were infected people there.” She breaks out crying now and then.
Richard Curren “was ever so loyal to me,” Sheila said. “When we were young, we traveled together, and when we were older, we went to local places together like the zoo and the beach. He didn’t like the beach, but he would go because I liked it.”
Emergency-room doctor Marney Gruber wondered whether she’d be able to sleep. The 36-year-old physician rotates through four New York City hospitals and had ended her overnight shift Thursday morning. Heading home from a hospital that she asked not be named, all she could think of was whether it had enough intensive-care beds, and how to transfer a patient from there to another facility, and whether that facility would have a ventilator, and on and on and on, because the patients might have Covid-19, and if they didn’t get the proper care, they could die. As Gruber had seen firsthand.
She’d had a rough shift, like just about every shift of late. She goes to work most days feeling vulnerable in her personal protective equipment. When she arrived for work at 10 p.m. Wednesday, she pulled on two pairs of gloves; a standard surgical mask tied over an N95 respirator mask; then a face shield and a scrub cap. For the next 10-and-a-half hours, she avoided the restroom: If she uses it, she’s supposed to toss some of her one-time-use gear in the garbage. At the recommendation of hospital administrators, she’s been using some of those supplies, like the N95, as long as a week, even though they are supposed to be discarded after seeing a single sick person.
“We don’t feel confident that it’s safe for us or for our patients,” said Gruber, noting that some colleagues have resorted to wearing swim caps instead of medical bonnets. One hospital ran out of protective eyeglasses. Gruber, thinking ahead, had brought her own. “The procurement of much-needed items simply isn’t happening,” she said. “We’re coming up with creative measures.”
Wednesday night had started well enough. A pregnant woman showed up without an attending obstetrician. Gruber and her colleagues delivered a baby girl. The waiting room was full of patients showing symptoms of Covid-19, but, Gruber said, “It was the first time in the past few weeks that I saw smiles.”
The happy seconds didn’t last. Gruber kept fielding calls about patients with shortness of breath. She intubated a patient who wasn’t getting enough oxygen, sedating him before running a tube down his throat so a machine could help him breathe. For Gruber's personal health, it marked one of the riskiest procedures of the shift. Standing before the patient, mouth gaping, she was exposed to their airway. With clean, careful movements, Gruber successfully completed the procedure in one go. She wondered if she'd have to intubate another patient before the shift was over.
As night turned to morning, firefighters and paramedics brought in a man in his 50s, untested though presumed to have Covid-19. He had gone into cardiac arrest. Gruber and her colleagues couldn’t resuscitate him. She knew then that the U.S. coronavirus death toll had ticked up by one.
In the 48 hours that ended Thursday evening, more than 1,700 people in New York City were hospitalized with confirmed Covid-19 cases, according to the municipal health department. The virus’ apex in New York still could be 21 days away, Governor Andrew Cuomo said in a Friday morning news conference. Now, only the sickest patients are admitted to hospitals. To reduce crowding, the city has told people to stay out of the emergency room unless they’re severely ill. There’s no drug proven to work against the virus, and they would just waste resources.
Gruber estimates that about 8 in 10 patients she sees in the ER at her four hospitals show symptoms of Covid-19. “People are now coming in really, really sick,” she said. “Some of them are dying. We don’t have rhyme or reason as to why some people are having minor symptoms and others are going into cardiac arrest. It’s striking when we see patients between 30 and 60 who are otherwise healthy end up on a ventilator.”
That is, if a ventilator is available. “Without a ventilator, doctors can’t save lives,” New York Mayor Bill de Blasio said in a Friday television interview. “We have enough supplies to get through this week and next week in our hospitals — that’s all I can guarantee.”
It was just the latest plea by local officials to get thousands of the machines, a need Trump has said they overstate. The city has set up a volunteer workshop in the Brooklyn Navy Yard, which used to build ships for America’s wars. Now, it’s churning out thousands of face masks for doctors and nurses.
The shortage of protective gear and medical tools remains acute. Gruber said her facilities are running out of ventilators, and soon she and other doctors will face choices they’ve rarely considered. “To think,” she said, “in a few days, we will have to decide who lives or dies, when a week prior we had the resources to allow them to survive.”
“These decisions go against everything that we were trained to do as doctors.”
As Gruber’s day ended at 8:30 a.m., she left the hospital with her mind reeling. “It’s par for the course for us to have highs and lows on a shift,” she said. But there are so many unknowns: How many people will contract the virus? Will there be enough supplies? How long can the hospitals, can she, keep this up? “It’s definitely going to get worse,” Gruber said. “We haven’t reached our peak.”
Bruce Hamilton tossed colorful beads as he plied the streets of New Orleans in a 200-person Krewe of the Dead Beans parade during Mardi Gras, the city’s annual pre-Lent explosion of ribald joy. He wore a costume dubbed “Anubeans,” after Anubis, the Egyptian god of the dead. Crowds were three deep on the sidewalks.
Hamilton, a 48-year-old lawyer, had no idea that some health experts were warning that, contrary to what Trump was asserting, the U.S. didn’t have the coronavirus under control. “We were so blissfully unaware of the hazards,” he said.
In the days that followed, he and his friends started comparing notes. News stories were reporting more and more people infected with Covid-19, Hamilton said, “and it seemed like a lot of them had been to Mardi Gras.”
Bartender Paul Bowman at the Kerry Irish Pub in the French Quarter worked every day of the weeks-long carnival season. The bar stayed packed. People didn’t talk about the virus, he said, even after Mardi Gras, when preparations for St. Patrick’s Day began. Then, Mayor Latoya Cantrell closed the bars. Bowman boarded up as if a hurricane was on its way. He’s still unhappy with the mayor. He and his wife, who works in a store that closed, have three children and no income. And even if everything reopens in a month or so, “the locals don’t have any money because they’re out of work.”
Elizabeth Holt, a 47-year-old who restores antique picture frames, has never missed a Mardi Gras in her 25 years in New Orleans. This year, she said, she and her husband agreed: “The virus was already here.” They cut back to only two parades per weekend instead of their usual four, and they didn’t hang out for after-parties. Others were less disciplined. “Most people thought it was still too far away,” Holt said, “that it wouldn’t have made it here yet.”
By March 9, two weeks after Mardi Gras and a week before St. Patrick’s Day, Louisiana had its first confirmed infection. As of Friday, the state had 2,746 cases and 119 deaths. “It became clear that we were probably an epicenter for infection,” said Hamilton, the lawyer. “It would have taken only one person from a foreign country, or New York or Seattle, without symptoms, in those crowds. Then, it spread like wildfire.”
In California, the text messages kept coming as new infections piled up. Seven county public health officials saw them as they talked on a Sunday, March 15, conference call that lasted hours. “At that point,” said Matt Willis, Marin County’s public health officer, “it was clear that we needed to take action.”
The officials decided then and there to issue the nation’s first shelter-in-place order for their counties, including San Francisco. Almost 7 million people would have to stay home unless they were going out for groceries, essential work, exercise, caring for a relative or in need of medical attention. “We were united in our understanding that this was the right thing to do,” Willis said.
It’s just a way to buy time. Around the U.S., health workers haven’t been able to do their usual job in an outbreak: testing cases, isolating sick people, telling anyone they were in contact with to stay home and watch for symptoms. They didn’t have enough test kits. The virus spread.
Willis and his Marin County team have assembled a task force that is asking hotels and schools to find space for an overflow of hospital patients. They want 1,000 beds and as many ventilators as possible. “There is no model where our system is not overwhelmed,” he said.
A few days after the shelter-in-place order, Willis himself started feeling feverish. This week, he tested positive for the virus and has isolated himself to work from home. “I feel like a prisoner,” Willis said Thursday on the phone from his backyard. He’s one of 65 confirmed cases in the county.
He preferred to talk about Marin rather than himself. “We haven’t seen a lot of stress on the system yet,” he said. “We’re early into this, but we are seeing evidence that the epidemic curve elsewhere is steeper than it is here.”
In the early evening of Tuesday, March 17, Ninfa Mehta watched a woman die.
The doctor, who is the medical director of the emergency department at SUNY Downstate Medical Center in Brooklyn, was gazing through a glass door into a patient's room. Inside, a physician in full protective gear and gloves was sitting on the side of the bed holding a woman’s hand as she held a cellphone up to her ear so she could hear her children saying goodbye. “This is a disgusting kind of medicine that we are not used to,” Mehta said. “It’s going to break people’s hearts. Thinking that people are going to die alone, god, it’s hard not to put yourself in the shoes of every patient you see.”
Every day, Mehta said, she walks through an unrecognizable emergency department. Covid-19 patients fill every room, and staff hustle around in masks and face shields, goggled and gloved, shuffling in and out of sealed spaces. Brooklyn has the second-highest number of Covid patients in New York. “We have patients in every single slot,” Mehta said. “We are using every nook and cranny.”
At Mount Sinai on Wednesday, Doctor McGreevy left the intubated patient and sealed the door. He tossed his gown and gloves into the trash, wiped his face shield with alcohol disinfectant, then put it back on before moving to the next negative-pressure room. Mount Sinai has become a Covid-19 containment zone. “It’s an empty place dedicated to the care of these patients alone,” McGreevy said. “Every day, a new unit is converted to create capacity for caring for Covid.”
The patients arrive, young and old, some with prior medical conditions, some looking healthier than others. “People are coming in and look OK,” McGreevy said. “They start out awake and alert and are able to talk to you, tell you what’s going on and how they’re feeling. But they get very sick, very quickly. They start breathing extremely fast and get distant and don’t respond as sharply. After that, they don’t participate in any kind of conversation. They don’t know where they are.”
New York funeral director Patrick Kearns has arranged five services for people who died of Covid-related causes. One was a 34-year-old disabled man. One was a 40-year-old woman whose mother is now hospitalized with Covid. Two were women in their 70s, and one in her 80s.
The patients die alone without visitors. Their families haven’t seen them since giving them up to the hospital.
Kearns’s family owns three funeral homes in Queens and one in Long Island, and he serves a large immigrant population with strong traditions on how farewells must be conducted. Those traditions often involve an extended community convening in grief. Now he must limit viewings to immediate family.
“There’s a reason why we all gather,” Kearns said. “The gathering supports people and gives them an opportunity to express themselves. It serves a real need and a purpose. Now, we’ve taken that gathering away.
“That is a real struggle for people. There’s a reason why we hug and we seek contact with each other, especially in difficult times. Now that intimacy has been taken away. It’s just hard.”
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