Testing Is Biggest Obstacle to Reopening States, Experts Say


interposing voices

Good morning, everyone. Hi.

sheri fink

So every morning in the Intensive Care Unit at the Brooklyn Hospital Center, the doctors gather for something called morning report.

doctor 1

So now, I want you all to present in a straight, true way —

sheri fink

The people who were on overnight, they stand around and the head doctor is there, and they kind of give a report of what happened. And then, the new doctors who are coming on, they get that information.

doctor 2

Yeah. When she was at rest this morning, she was breathing 23. She’s very comfortable, thumbs up.

sheri fink

They talk about, you know, who was admitted, who got critically ill.

doctor 3

The overnight patient is not doing well. He had to be re-intubated almost immediately.

sheri fink

And one recent morning report was particularly intense.

[music]
doctor

OK. All right. OK. Next patient.

sheri fink

There were patients in their 80s and patients in their 30s.

doctor 1

31-year-old female, 30 weeks pregnant, asthma, obesity, admitted to the I.C.U. She was intubated yesterday evening.

doctor 2

Jesus.

doctor
doctor 3

All right. Good. Next.

sheri fink

There were patients from nursing homes and patients who were homeless.

doctor 4

She was intubated overnight. She’s on azithromycin, klonopin, ceftriaxone.

doctor

OK. Next.

sheri fink

Patients with asthma and diabetes, and patients with no underlying conditions at all.

doctor

— male. We just past medical history here for acute hypoxic respiratory failure.

sheri fink

But as the doctors race to get through the cases —

doctor

Next patient.

sheri fink

— they all shared a nearly identical description.

doctor 1

He was upgraded from acute hypoxic respiratory failure.

doctor 2

OK, next.

doctor 3

Male, acute hypoxic respiratory failure secondary to confirmed Covid.

doctor 4

All right. Next.

doctor 5

Admitted for acute hypoxic respiratory failure with confirmed Covid-19.

doctor 6

Next.

doctor 7

Male, it looks like acute hypoxic respiratory failure.

sheri fink

Acute hypoxic respiratory failure secondary to Covid-19.

doctor 8

All right. Next.

michael barbaro

From The New York Times, I’m Michael Barbaro. This is “The Daily.”

[music]

Today: It’s been more than a month since the coronavirus descended on New York City’s hospitals and on Brooklyn Medical Center, where the vast majority of patients in critical care have the virus. My colleague, Sheri Fink, followed one doctor through a single day there.

It’s Wednesday, April 15.

doctor

Morning, everybody. [AMBIENT CHATTER]

doctor 1

Josh, do you want to spend the — do you mind? This is Sheri.

doctor 2

Sure.

doctor 1

She’s with The New York Times, and she’s gonna spend some time here a little bit.

doctor 2

Pleasure.

doctor 1

It’s up to you.

doctor 2

I’m fine with —

sheri fink

I’m a physician.

doctor 1

A physician and a writer.

sheri fink

So for the past few weeks, I’ve been embedded in the Brooklyn Hospital Center.

doctor 1

I’m going to finish rounding here, and then I’m going to go downstairs and cover SI.

doctor 2

OK.

sheri fink

And what I’ve been able to see there is incredibly unique — what’s happening? What is it like inside a hospital during a pandemic?

dr. josh rosenberg

— then we’ll figure out the rest.

doctor

OK. All right.

sheri fink

Do you want to give him your mic, or are you willing to wear a mic?

sheri fink

And there was one doctor I met who really embodied that transparency.

dr. josh rosenberg

Does it beep every time I say a four-letter word like South Park?

sheri fink

Dr. Josh Rosenberg.

dr. josh rosenberg

I am mildly inappropriate. I’m just warning you.

sheri fink

An attending physician in the Intensive Care Unit.

sheri fink

How are you, Peter?

doctor

Hi, how are you —

dr. josh rosenberg

I didn’t see you hiding over there, my friend.

sheri fink

There are people from all over the hospital recruited to work in the I.C.U., so it’s not just, like, I.C.U. doctors and nurses who are used to intensive care treatment, but in fact —

dr. josh rosenberg

And she’s one of the podiatry residents, so all people who are good with knives and big needles.

sheri fink

When I was there that day, there was a podiatry doctor and two of her residents. Those are doctors who work on the feet.

dr. josh rosenberg

No, no, no. What I would like to do is that, as much as possible, we’re going to try to get all of the Covids on one side, and then the whole area is a dirty area.

sheri fink

And the I.C.U. had actually effectively doubled in size, so it was completely full. And they had to turn to other areas of the hospital to turn them into Intensive Care Units. In fact, a big part of the I.C.U. is now in a place that just a few weeks ago was where patients would come for outpatient chemotherapy treatments. That’s now in I.C.U..

dr. josh rosenberg

Frankie, watch out. Don’t trip Don’t trip Don’t trip. Don’t trip. Don’t trip.

sheri fink

It was also a bit of an obstacle course.

dr. josh rosenberg

Don’t trip.

sheri fink

There were cords everywhere.

dr. josh rosenberg

Please be careful, Do you have gloves?

sheri fink

They had pulled apart the ventilators. They had the control — parts of the ventilators that were helping people breathe, those were in the hallways so that nurses and respiratory therapists didn’t have to go in and out as much and expose themselves to risk.

dr. josh rosenberg

What?

speaker

This is a disaster waiting to happen.

dr. josh rosenberg

Yes and no, though.

sheri fink

And the nurses were doing the same thing with IVs, with the tubing that the medicine flows through. So they had pulled the IV pumps out of the room so that they can not have to go in and out and use up the personal protective equipment.

dr. josh rosenberg

It’s great. And yeah, I mean, you can trip over it.

sheri fink

You all have to be very careful.

dr. josh rosenberg

You just have to be careful.

sheri fink

Yeah.

dr. josh rosenberg

Right. It’s making the best of what you can do.

sheri fink

Yeah.

dr. josh rosenberg

OK, guys, can we start with number two? I appreciate everybody being here and everybody’s support massively.

sheri fink

So now, Dr. Rosenberg is taking over for the doctors who were working the night before, and he’s beginning to make his rounds.

dr. josh rosenberg

Let’s start with number two, and then just go around the unit please. All right, so lucky number two.

sheri fink

So nearly all the patients in the I.C.U. are on ventilators.

dr. josh rosenberg

So do we have any history of smoking, shisha use, anything like that?

sheri fink

Some have asthma. Some have diabetes.

dr. josh rosenberg

All right. What did he do for a living? Occupational exposure?

sheri fink

But a lot of these patients don’t have any underlying conditions at all.

dr. josh rosenberg

I’ll just write — because I mean, listen, on some of these you have a real reason why. You know, they may have bad lungs, and that makes it worse. Sometimes it’s just the disease, but if there’s something we can do to —

sheri fink

So Josh and the other doctors are kind of confounded by some of the patients. They don’t understand why, if they don’t have a lot of underlying health issues, why their lungs look so bad.

dr. josh rosenberg

Crap. Reported any asthma?

sheri fink

And they also just don’t have that much to offer.

dr. josh rosenberg

OK. So what are we going to do with him?

doctor

Right now, we are — well, at this point, I’m not too sure what we can do with him. We have — we tried to [VOICE FADES].

dr. josh rosenberg

So what is he on drug-wise?

sheri fink

So, I mean, for most patients, they’re trying this thing called the Covid cocktail, which is that hydroxychloroquine and azithromycin. That’s that combination the President talks about a lot.

dr. josh rosenberg

I don’t think it’s doing much.

sheri fink

But there’s really very little evidence, and Dr. Rosenberg in particular is very unsure that those drugs really help.

dr. josh rosenberg

We’ll see about remdesivir, and we’ll see if we get some Covid results and see what we can do.

sheri fink

So they start talking about other possibilities. There’s this experimental drug called remdesivir that you have to apply to the manufacturer for each patient, and they have to meet certain criteria. You have to have a test result. They can’t have certain complications.

dr. josh rosenberg

How do you guys feel about Kaletra or our other PIs?

doctor

They don’t work at all.

sheri fink

There’s another drug called Kaletra that doctors think might have some effect.

dr. josh rosenberg

The data’s very — I mean, I think the data is very weak all over the place. That’s the basic problem. So I always look at it as, where are you starting these drugs? It’s near the end of a sporting event. You’re down by a lot, and I don’t care you throw out there, right? Even freaking Jordan couldn’t recover that basketball game outside of Space Jam when you’re down by 100 points and starting the fourth quarter.

doctor

That’s why I don’t think we should be giving it to patients who are already near the end.

sheri fink

So they kind of toss this around.

dr. josh rosenberg

Yeah. And so we don’t know. I mean, that’s the point. We really just don’t know our data, but like, so looking at this —

yeah. So we’ll figure out. We’ll see if we get the remdesivir, which I doubt we’ll be able to. We’ll try to get a positive test result.

Next. Let’s move on along.

OK. I.C.U. six. Going for c-section?

doctor

Supposedly today, yeah.

sheri fink

There was another Covid patient in the Intensive Care Unit on a ventilator, and she was pregnant, which adds a whole layer of complexity.

doctor

She needs another dose of decadron, and then —

dr. josh rosenberg

Decadron? No. Beclomethasone.

doctor

Oh, sorry. Beclomethasone. Did I say decadron?

dr. josh rosenberg

Yes.

sheri fink

And they actually decided to deliver the baby by c-section two months before the due date. They had to give a couple of doses of steroid medication to help mature the baby’s lungs. The whole goal was to save the mother’s life, because I think part of it is that it gives more space for the lungs to expand once the baby is taken out.

doctor

So if she’s going for a c-section then she won’t need remdesivir, right?

dr. josh rosenberg

I have no clue.

sheri fink

So far what’s known is it tends to be quite rare that a baby would be born with Covid if the mom has it. At least that’s what the early studies say.

dr. josh rosenberg

All right. Number four. Number four. How are we doing here?

sheri fink

It might be surprising how enthusiastic Dr. Rosenberg sounds while discussing these patients, but he’s leading this team. He’s trying to keep morale up.

dr. josh rosenberg

All right. So I’m going to stop here and head downstairs. Again, he’s going to take six, seven, nine. Thank you. I will circle in with you guys. Good job.

doctor

Thank you. OK.

dr. josh rosenberg

Good job.

doctor

Oh, me?

sheri fink

But actually, when we were going from one part of the I.C.U. to another —

dr. josh rosenberg

Let’s go downstairs.

[SIGHS] I don’t like taking the elevators.

sheri fink

He runs into one of his medical students.

sheri fink

Hi, guys.

dr. josh rosenberg

How are you doing, buddy?

doctor

As best as I can.

dr. josh rosenberg

One, shouldn’t you be home?

doctor

Yeah.

dr. josh rosenberg

Shouldn’t you be home?

doctor

My mom’s here.

dr. josh rosenberg

Oh, fuck.

doctor

I know.

dr. josh rosenberg

Which bed is she in on that side?

doctor

She’s in 10.

dr. josh rosenberg

OK. I’m rounding her now.

doctor

OK. May I speak to you at some point today when you have a chance?

dr. josh rosenberg

Call me at any point. All right?

doctor

Thanks, Doctor. Appreciate it.

dr. josh rosenberg

I’ll see you later. Call me if you need anything, in all seriousness. You have my cell, right?

doctor

Yeah.

dr. josh rosenberg

Perfect. He’s one of our medical students. He’s been here forever. So we sent home all the medical students that rotate with us very early in this crisis, because I kind of looked at this and I said, one, we don’t have enough PPE, you know, for all of the medical students that are coming through. And two — you know, I hate to say it like this — like, I don’t want to expose them. They have enough time to get the living daylights scared out of them.

sheri fink

Right.

dr. josh rosenberg

[LAUGHS] Let them actually be students for a bit.

[music]

[AMBIENT VOICES]

doctor 1

I’m going to give myself the option, because it’s my clinic.

doctor 2

OK, because tonight we’re going to publish the new schedule, OK?

dr. josh rosenberg

Next patient. Santos.

doctor

Yeah. So this is our — she’s our 54-year-old female, history of hypertension, came here with shortness of breath, fever, is admitted for acute hypoxic —

dr. josh rosenberg

She’s the mom of our med student, right?

doctor

Yes. She’s confirmed positive Covid.

sheri fink

And when we get to this medical student’s mom, things are not looking good.

doctor

Her FI, too, has been hovering between 100 to 80. I just want to make sure you know that she’s not doing OK.

dr. josh rosenberg

She’s not doing well. Um, yeah, I’ll speak to the son. I know him pretty well.

doctor

Yeah he’s in here always.

dr. josh rosenberg

Is he the next of kin? Is he the next of kin? He’s the decision maker?

doctor

Right now he has family —

sheri fink

And Dr. Rosenberg wants to find out, is the son — is the medical student — the one who will be making decisions about her further treatment, about even possibly end of life care.

dr. josh rosenberg

But is he giving us consents?

doctor

Yes.

dr. josh rosenberg

Or does she have a husband?

doctor

Yeah, yeah. He’s been giving consent.

dr. josh rosenberg

This is going to be hard, because he knows. He’s a smart kid.

sheri fink

I mean, to me it sounded like he feels that this medical student, even though he’s still a student, is enough of a doctor to understand that the prognosis isn’t great — that perhaps his mom has some risk factors for this being more severe, and for her to possibly not make it.

dr. josh rosenberg

He’s a good dude. He’s a very sweet man, so we’ll figure it out.

sheri fink

Of course, when it’s your family member, it’s not so simple.

dr. josh rosenberg

All right. Here.

sheri fink

There are many cases where the doctors and the patient’s families have very different views of how to proceed with treatment.

dr. josh rosenberg

Covid?

doctor

Acute respiratory — yeah. Well, it’s pending, but most likely.

dr. josh rosenberg

OK. So his pulmonary prognosis is horrible, right?

doctor

Yes.

dr. josh rosenberg

He’s not getting better.

doctor

No, he’s not.

dr. josh rosenberg

Blood gas is —

doctor

Not good enough.

dr. josh rosenberg

Not good, and he’s on 100%.

doctor

Yes.

dr. josh rosenberg

So what does the fam want us to do?

doctor

The family wanted us to continue treatment. They agreed to the NI.

sheri fink

Where the family still wants to press forward with all the intensive care available.

dr. josh rosenberg

Right. So how many organ systems do we have down on him? We have our kidneys are down, our respiratory system’s down, his cardiovascular is bad. He’s on multi-organ system failure, right? So I have three out of my systems down already. His prognosis at that point, given his disease status, is just poor, unfortunately.

sheri fink

And where the doctors had come to a different conclusion and really felt like there wasn’t much hope, and that in fact the goals of care should shift away from trying to extend life and much more toward comfort and end of life — accepting that the patient was likely going to die.

dr. josh rosenberg

And I hate to say it like this, but I don’t know what I’m able really to offer in terms of getting him back to where he was before.

[SIGHS] Next.

[music]
doctor

Check vitals from there too —

speaker (on intercom)

Attention, please. Attention, please. Code blue, 6B.

sheri fink

Suddenly, we hear this announcement go out over the hospital loudspeaker saying, code blue —

speaker (on intercom)

Code blue, 6B. [KNOCKING]

doctor

Josh?

sheri fink

— which means that somebody needs to be resuscitated, that they are basically dying.

dr. josh rosenberg

OK. It’s code blue. you’re on outreach or RESA?

doctor

RESA.

sheri fink

OK. All right. Can we follow you?

doctor

Yeah.

[music]

[AMBIENT CHATTER]

doctor 1

Covid or non-Covid?

doctor 2

No, it’s not Covid.

doctor 3

OK.

sheri fink

So the code blue, it turned out, wasn’t for a Covid patient, but for a patient who had other medical problems.

doctor

192. That’s the code for 6A.

sheri fink

And they did CPR, and the patient survived.

doctor

I got it. You’re good.

sheri fink

And for me, the moment was really just highlighting the fact that, in a hospital, that that work goes on — that there are all these other patients, too, who have different medical problems, and people are still having other emergencies. So hospitals can’t just stop being hospitals for everybody else. I But it’s hard, because the number of patients with Covid is increasing. Usually, if you have people with a scary, infectious disease you would put them in specific rooms in the hospital, but, of course now there’s many more patients than there are isolation rooms. So I think the doctors are very concerned about this possibility that somebody could come into the hospital for something else —

dr. josh rosenberg

She’s Covid negative?

doctor

— and then, you know, catch Covid there. That’s the real worst case scenario.

dr. josh rosenberg

She’s not a Covid issue?

doctor

Not really, no.

dr. josh rosenberg

Let’s try to get her the heck out of this unit, please. OK? Get her out.

sheri fink

But of course, one of the big risks is to be a person who is walking into that hospital every day to work there.

dr. josh rosenberg

Hello. Dr. Rosenberg speaking. I was paged.

sheri fink

And in fact, at one point —

dr. josh rosenberg

Yes, yes, yes.

sheri fink

Dr. Rosenberg gets word that one of his residents —

dr. josh rosenberg

He has Covid.

sheri fink

— tested positive for Covid and is in the emergency room downstairs.

dr. josh rosenberg

Thanks. All right.

What’s up? You have his X-ray up? OK. I’ll look at it in two seconds.

sheri fink

Someone pulls up an X-ray of the resident’s lungs for him to look at, and he peels off his Personal Protective Equipment, which in this case includes his own ski goggles, and he looks at the X-ray. And immediately, the tone shifts.

dr. josh rosenberg

That’s shitty. I don’t like that. I want him here. He is one to come up.

doctor

Yeah. Is that a —

dr. josh rosenberg

He comes right up, because he’s high risk for getting intubated.

doctor

Yeah.

sheri fink

What he sees on the X-ray is something that looks bad to him.

dr. josh rosenberg

That’s what I’m worried about, because his X-ray looks crappy.

doctor

You know that he works here, right? Yeah.

dr. josh rosenberg

No.

doctor

It was just, like, let’s just go back —

dr. josh rosenberg

He’s one of our surgical residents. Bring him to the I.C.U.. Bring him here. Don’t dilly. Don’t —

doctor

No, no, I’m not saying that. I’m just saying —

sheri fink

I think what was really striking to him, or what sort of, like, shocked him was that this was another doctor.

dr. josh rosenberg

That is ours. That is one of us.

sheri fink

And close to his age, and somebody who’s been doing the same kind of work that he’s doing every day. And I think that shatters that sense of invulnerability.

dr. josh rosenberg

This is insanity. For my first day after being back from a week in this crap, holy shit.

sheri fink

I actually found out partway through that day that Dr. Rosenberg, himself, had been out the previous week with symptoms of Covid. He actually didn’t get a test until his symptoms had resolved, and it turned out to be negative, but he’s pretty sure he had Covid.

dr. josh rosenberg

Well, one of the things we’ll discuss that the nurse was telling you, but we need more nurses.

sheri fink

And this is a huge problem. A third of the doctors and nurses were out sick. A number of them had tested positive for Covid and were critically ill. And it’s not just a problem for this hospital. It’s a problem all over New York City, that as the hospitals are overwhelmed with Covid patients, you have high numbers of health staff out sick.

andrew cuomo

Good afternoon. Thank you all for taking the time for being here today. As Governor of New York, I am asking health care professionals across the country, if you don’t have a health care crisis in your community, please come help us in New York now.

[music]
sheri fink

The day that I was at the hospital, New York Governor Cuomo pleaded for doctors and nurses and health care staff from around the U.S. to come to New York —

andrew cuomo

We need relief. We need relief for doctors. We need relief for attendants.

sheri fink

— in part to help fill in for the workers who are falling ill across the state.

andrew cuomo

So if you’re not busy, come help us please.

dr. josh rosenberg

Hey.

Hey, he’s going to be in I.C.U. 12, OK? No, not yet. They’re about to bring him up shortly, but we’re getting everything done.

I know.

I know. Trust me, it’s freaky. I mean, he’s only five years younger than me, you know? I’m 45, like half of our patients upstairs. We have 40-year-olds who are intubated.

Jesus.

Geez.

[GROANS] Man, this is brutal.

All right, good. I just wanted to let you know where it would be, all right? You got it. I’ll speak to you later. Bye.

[SIGHS] I am tired.

[AMBIENT CHATTER]

michael barbaro

A few days ago, as the daily death toll in New York began to decline, state officials said it appeared that the pandemic was approaching its peak, and that the worst was over. But on Monday, New York’s daily death toll spiked again to 778. So far, nearly 11,000 people in the state have died from the coronavirus. Among them was the mother of Dr. Rosenberg’s medical student, who died the day after Sheri visited the hospital.

We’ll be right back.

[music]

Here’s what else you need to know today.

archived recording

Well, yesterday, the president at his news conference — and this is his quote — he said, he has the power. He says, when someone is President of the United States, the authority is total, and he said the governors know that. Do you know that?

andrew cuomo

No. I don’t know what the president is talking about, frankly. We have a Constitution. The Constitution —

michael barbaro

On Tuesday, governors on the East and West Coast, led by Andrew Cuomo of New York, rejected President Trump’s claim that he has the legal authority to reopen the American economy by himself once he determines that the pandemic is over.

andrew cuomo

The federal government does not have absolute power. It says the exact opposite that the president said. It says, that would be a king. We would have had King George Washington. We didn’t have King George Washington, and we don’t have King Trump. We have President Trump.

michael barbaro

Appearing on NBC and MSNBC, Cuomo said that if Trump prematurely instructed states to end their lockdowns, many governors would disregard the order.

andrew cuomo

If he says to me, I declare it open, and that is a public health risk or it’s reckless with the welfare of the people of my state, I will oppose it. And then, we will have a constitutional crisis like you haven’t seen in decades where states tell the federal government, we’re not going to follow your order.

michael barbaro

And —

donald trump

As the organization’s leading sponsor, the United States has a duty to insist on full accountability.

michael barbaro

President Trump said that he planned to end U.S. funding funding of the World Health Organization, the international group responsible for monitoring the pandemic, over what he said were its failures to properly manage the crisis. Trump singled out the WHO’s opposition to banning travel from China, a position that he said has proven disastrous for the countries that followed it.

That’s it for “The Daily.” I’m Michael Barbaro. See you tomorrow.



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