Medical News Today spoke to New York City anesthetist Dr. Sai-Kit Wong about his experiences as the COVID-19 pandemic takes hold in the United States.
Please note: This interview contains some content that our readers may find distressing.
As the number of COVID-19 cases in the U.S. continues to rise, the pressure on hospitals to treat severely sick patients is growing.
New York State, and New York City in particular, has seen a steep increase in COVID-19 cases and deaths.
Dr. Sai-Kit Wong, an attending anesthetist in New York City, told Medical News Today about the jump in COVID-19 cases he has seen in the past 10 days, about making heartbreaking choices about which patient gets a ventilator, and what each of us can do to help him do his job.
Steep rise in cases
MNT: Can you tell me what has happened in the past couple of weeks as your city and the whole country has seen an increase in COVID-19 cases?
Dr. Sai-Kit Wong: About 9 or 10 days ago, we had roughly five COVID-19-positive patients, and then 4 days later, we had about 113 or 114. Then, as of 2 days ago, we had 214. Today, we have a total of three or four surgical medical floor units that are filled with nothing but COVID-19-positive patients. Medical intensive care units (ICUs), surgical ICUs, and the emergency room (ER) are all jam-packed, shoulder-to-shoulder, with COVID-19-positive patients. I have never seen anything like this.
MNT: Are these cases all severe enough that these patients have to be in hospital?
Dr. Sai-Kit Wong: The ones on the floors, yes, they are. The patients with the mild symptoms — they’re not even admitting them. They send them home. Basically, if they’re not exhibiting shortness of breath, they do not qualify for testing. The ER doctor will send them home and tell them to come back when the symptoms get worse.
MNT: When was your last shift? What was the mood like among the team?
Dr. Sai-Kit Wong: So yesterday was my last shift, and I took on what we call the “airway role.”
We had two teams, and each consists of one anesthesiologist and one certified registered nurse anesthetist, and we respond to every emergency intubation in the whole hospital.
Over a 10-hour span, we had a total of eight intubations among our team in the anesthesia department. While we are on shift, we just do what we gotta do.
I mean, we do what we are trained to do, it’s like a knee jerk reflex.
Early in the morning, I kind of lost it a little bit. I overheard a conversation. There was a patient in labor and delivery, 27 weeks gestation, who was going into respiratory failure.
And from what I heard, we didn’t have a ventilator for her. We were talking about how there were two cardiac arrests in progress. Both of those patients were on ventilators and if one of them passed, we could use one of those ventilators for this patient.
So after I heard that, my heart was just so broken. I went into an empty room, and I just broke down. I just cried uncontrollably. Then I called my wife, and I told her what happened. All four of our children were with her.
We just got together, we prayed, we lifted up a prayer for the patient and for the baby. Then I called my pastor from church, but I couldn’t even talk. I was just weeping and sobbing.
So, that was hard. And that was just the beginning of the day. After that, I pulled myself together, and for the rest of the day, I just went on and did what I have to do.
Isolating from family
MNT: I imagine that you probably have tough days at work, but this sounds like it’s in a different league. How do you pull yourselves together so that you can go and do the rest of your shift?
Dr. Sai-Kit Wong: I think you just try not to think about it while you’re there, taking care of the patients. You deal with it after you come home.
The worst part is that after a day like that, when I come home, I have to isolate myself from the rest of the family.
I have to stay away from them. I can’t really touch them or hug them. I have to wear a mask and use a separate bathroom. I can talk to them, but it’s kind of tough.
There’s no specific way in how we deal with it. I will probably have nightmares in the future. Just thinking about yesterday, walking down the halls of the units.
Patient doors that are normally open were all closed to prevent aerosolized spread. The sounds of the ventilators, cardiac arrests, and the rapid response team overhead page throughout the day.
I have just never seen anything at this level, never.
I just never imagined, nor did I ever think for a second, that I would be thrust into this position as an anesthesiologist. In the U.S., for the most part, we’re in the operating room, anesthetizing the patient, and monitoring them throughout the surgery. We make sure that they live through the surgery without any complication.
In the 14 years of my career, thus far, I have had less than a handful of deaths on the operating table. I never dealt well with death, let alone this many deaths all around me.
It was traumatizing to say the least. It was like a scene straight out of a horror movie.
Protective equipment levels are ‘critically low’
MNT: Is your hospital doing anything to support the staff going through this situation?
Dr. Sai-Kit Wong: They are trying their best to secure all the personal protective equipment. We are running critically low, and my department is trying its best to keep us safe, as far as personal protective gear is concerned. So I am very thankful for that. But overall, as far as New York State and the U.S. is concerned, I don’t know how we sank down to this level that there are hospitals running out of gloves and N95 masks. From what I’ve seen in the past, we normally switch from one N95 mask to a new one every 2–3 hours. Now we are asked to keep the same one for the entire day.
And that’s if you’re lucky. In some hospitals, you are asked you keep it and reuse it until it gets soiled and contaminated, then maybe they’ll get a new one. So I just don’t know how we got down to this level.
MNT: Do you already feel that you’re running low on supplies now?
Dr. Sai-Kit Wong: We are at critically low levels. We probably have enough for another 2 weeks, but I was told that we have a large shipment coming in.
So we’ll wait and see.
MNT: In addition to getting you personal protective equipment, is your hospital doing anything to help you on a personal level to deal with the situation, or is there no time to think of you as individuals working there?
Dr. Sai-Kit Wong: I don’t think that’s one of the priorities right now. And on our end, I don’t think that’s on our priority list as individual practitioners. I think the most nerve-racking parts are taking care of the patient and not bringing this home to our families.
If we get sick ourselves, it’s bad. But I don’t know how I would live with myself if I brought this home to my family.
MNT: And that’s why you are in isolation within your house. Because the infection rate among healthcare workers is higher, as you are exposed to the patients with high viral loads every single day.
Dr. Sai-Kit Wong: Absolutely.
The kids are having a ‘hard time’
MNT: How are your family coping with this?
Dr. Sai-Kit Wong: Well, the kids are 8, 6, 4, and 18 months. So I think they probably understand more than I think they do.
They’ve missed me when I come home. They want to come and hug me, and I have to tell them to stay away. Especially the little baby, she doesn’t know any better. She wants to come and hug me, and I have to tell them to stay away.
So, I think they’re having a hard time with that, and my wife is pretty much doing everything because I don’t even feel comfortable setting the dinner plates, even though I’m wearing a mask.
If I do have the infection, I don’t want to be dropping loads of droplets on the plates.
There are a lot of people with mild symptoms or who are in the asymptomatic phase. We have no idea what the transmission potential of those asymptomatic patients is or how long that phase is.
MNT: When are you next at work?
Dr. Sai-Kit Wong: I’ll be going back to work tomorrow morning, as usual. I’ll be wearing my mask and my goggles.
MNT: There are calls for vaccines and treatments. At MNT, we have also heard about the concept of using serum from people who’ve had COVID-19 and built up neutralizing antibodies, and then giving this to people who are in a very serious condition or to frontline healthcare staff. Is that being discussed at all at your hospital or among your colleagues?
Dr. Sai-Kit Wong: It is not. In fact, I only saw an article this morning about that. We have not discussed that at all.
I saw an article that someone tried to do that in China. I don’t know how much success they had, but that is not something that we’re discussing right now.
‘It is absolutely going to get worse’
MNT: In terms of your work, presumably, things are going to get worse because the cases are rising. Do you have any thoughts on when and where the peak will be?
Dr. Sai-Kit Wong: It is absolutely going to get worse. If I have to take a guess, I would say the peak will come within the next 5–15 days. If the numbers are right, I think we are about 2 weeks behind Italy.
In New York right now, I think we’re the epicenter of the U.S. From what I’ve seen in the past 10 days, it’s been increasing exponentially. At the moment, we are at the beginning of the surge. We are nowhere close to the peak right now.
MNT: How do you think your hospital will cope with that increase in demand? We’ve seen reports that New York State has about 7,000 ventilators, but your governor said that you will need 30,000. Do you think that’s about accurate?
Dr. Sai-Kit Wong: It depends. We did initiate social distancing. But from what I seen, I don’t think people are taking it seriously enough. I hope I’m wrong. If the social distancing is working and everyone is following it, heeding the advice, heeding the recommendations, and staying at home, then I hope we never see that surge.
But if we do have a surge, we are going to be in the position of Italy, where we are going to be overwhelmed, and then we are going to have to make a decision about who gets on the ventilator and who we just simply can treat.
I don’t want to make that decision. I’m an anesthesiologist. My job has always been to keep patients safe, to bring them out of surgery without any complication.
I don’t know how I would be able to hand that death sentence to someone.
‘Stay healthy. Let me do my job’
MNT: Is there anything you wish people would know about the new coronavirus and how to keep themselves and their families safe, so that they can help flatten that curve so that the hospitals aren’t overrun to the point where you’re having to make those decisions?
Dr. Sai-Kit Wong: Well, this is not rocket science. It really isn’t.
We have countries that are ahead of us. They have dealt with this before. Places such as Hong Kong, Singapore, South Korea, and Taiwan. They had the severe acute respiratory syndrome (SARS) epidemic, and they are handling this so much better than we are. And I don’t know why, but even today, we still don’t have enough testing kits.
One of the strategies in South Korea was to initiate massive surveillance testing, a strict quarantine early on, and contact tracing. All these things allowed them to control the outbreak, and we did none of it.
Here in New York, and here in the U.S., we did none of it. We didn’t do any contact tracing. Instead, we waited and waited, and then we told people to start social distancing.
What I would like people to know is this: Trust the experts.
If the experts tell you to stay at home, or to stay 6 feet away, do it. You don’t have to be happy about it. You can complain about it. You can rant about it. You can complain about how bored you are at home and about the economic impact. We can argue about all of that when this is over. We can spend a lifetime arguing about that when this is over.
You don’t have to agree, but just do what the experts say. Stay healthy, and don’t overwhelm the hospital. Let me do my job.
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