Report from Paramedic Evan Beaton via FaceBook: “My wife, a NAVY GM-2 ‘Beach Master/Sharpshooter’ veteran who served two tours, gave me the biggest hug last night when I came home from my six-day stretch at work and said ‘I know exactly how you’re feeling. You’re in a constant state of tension and fear but you have a job to do that must be done no matter what. This, my love, is exactly what war feels like and only a small glimpse into what veterans feel’.”
World War C’s enemy is a novel virus that, if not controlled, can exponentially (geometrically) expand and infect a significant percentage of the population and overwhelm the healthcare system.
Let’s look at New York state with 15,783 COVID-19 cases on Sunday afternoon March 22nd: 2,178 patients may require hospitalization and 742 of those patients may need an ICU bed. New York has 3,157 ICU beds – 2,136 of them in the New York City region. Governor Cuomo says they will need somewhere between 18,600 and 37,200 ICU beds to meet the coming wave of COVID-19 patients.
Without COVID-19 the national ICU bed occupancy rate is around 67%. Imagine the impact of a flood of feverish COVID-19 patients with trouble breathing entering the hospitals.
What happens if you have a heart attack but the ambulance takes 50 minutes to come instead of 8 (too many coronavirus cases) and once you arrive, there’s no ICU and no doctor available? You die. (Pueyo 2020b)
Lack of Personal Protective Equipment
Just like the start of World War II, we are dramatically short of vital materials. There was just 1% of the facemasks needed to protect all of the U.S. healthcare providers. We need facemasks, gloves, gowns, and eye protection.
JEMS executive editor emeritus A. J. Heightman provides a Facebook tutorial on making facemasks out of pleated “MERV13” air conditioning filters, a Maxi-Pad and a yellow towel.
Others are repurposing construction and industrial facemasks. Fire-based services have SCBA as a last resort.
Inconsistent Organizational Response to COVID-19 Exposures
The challenge with COVID-19 is that infected people do not initially show symptoms. Throughout March we received a non-stop flow of research information on how COVID-19 is transmitted, how long it remains infectious (in air and on surfaces) and how long emergency service caregivers should be quarantined when exposed. While we know more than we did in February, information is inconsistent and unverified.
While most agencies are doing the 14-day self-quarantine or isolation of emergency service caregivers, New Orleans, Louisiana, took a dramatically different approach.
Exposed New Orleans firefighters will now be required to wear medical masks and closely monitor themselves for any potential symptoms, including taking their temperature twice a day. All EMS workers, meanwhile, will wear masks and take their temperature regardless of exposure.
New Orleans EMS Spokesperson Johnathan Fourcade said that five EMS workers who were originally quarantined have been called back to work. The fire department has been dealing with the lowest staffing numbers in the department’s history. As a result, it is dealing with excessive mandatory overtime demands. Many firefighters work 96-hours each week.
New York City (FDNY) firefighters and EMS providers received new directives Wednesday night:
… they would be required to work even if they had been exposed to the coronavirus — as long as they were asymptomatic. The guidance was in line with what the New York State Department of Health had suggested in recent days for health care facilities, the Fire Department said in an announcement to its staff. All those currently under quarantine would remain so.
FDNY accelerated the graduation of 309 probationary firefighters by 10 days as the department moved to a strict system of 24-hour shifts that change at 9 am to reduce firefighter COVID-19 exposure. Taking mutuals in other companies is halted.
FDNY EMS is making two-caregiver partner assignments to reduce the number of different employees working together. About 107 firefighters, 47 EMS providers, and 4 civilians are under home quarantine.
Field Operations in Austere Environments – Shelter in Place and closed businesses
California, New York, Illinois, Ohio, Delaware, and Louisiana governors issued a “stay-at-home” directive. So has Philadelphia. Most other states have closed schools, gyms, “non-essential businesses” and prohibited sit-down dining at restaurants. The goal is to flatten the curve or reduce the growth of COVID-19 until a treatment plan is in place. Tomas Pueyo’s “The Hammer and the Dance” article provides an explanation of how such a plan works.
Strong coronavirus measures today should only last a few weeks, there shouldn’t be a big peak of infections afterwards, and it can all be done for a reasonable cost to society, saving millions of lives along the way.
For on-duty emergency service workers, that means a challenge in finding food, vehicle repair, and supplies when they are on-duty. Many crews find empty grocery store shelves. Imagine weeks when every day is a national holiday with no food available except in the Qwick Mart/Gas Station.
Overwhelmed and Understaffed Health Care Staff and Facilities
In the last dozen days, we have seen the equivalent of a firefighter telling a crowd in a smoky theatre to “leave the building in a quiet and orderly fashion” and, a few minutes later, the firefighter is screaming “Get. Out. Now!”
The numbers are staggering and the implications are grim. Even if we could build hospitals as fast as China did, we do not have the medical staff or the specialized equipment to fully operate. How long would it take New York state to establish, equip and staff 16,000 additional ICU beds?
When the USNS Comfort arrives in New York City that will add 80 intensive care beds and 280 intermediate care beds.
Our healthcare colleagues are working in difficult circumstances. Hubei, China, and Italy provide previews of an overwhelmed healthcare system:
Healthcare workers spend hours in a single piece of protective gear, because there’s not enough of them. As a result, they can’t leave the infected areas for hours. When they do, they crumble, dehydrated and exhausted. Shifts don’t exist anymore. People are driven back from retirement to cover needs. People who have no idea about nursing are trained overnight to fulfill critical roles. Everybody is on call, always. (Pueyo 2020a)
(Title changed and grammar corrected 3/26/2020)
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John Hopkins University (2020 March 22 @ 2:13;55 PM) Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU). Accessed 3/22./2020: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
Pueyo, Tomas (2020b March 19) Coronavirus: The Hammer and the Dance: What the Next 18 Months Can Look Like, if Leaders Buy Us Time. medium.com Accessed 3/22/2020: https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56
Pueyo, Tomas (2020a March 10 and 19) Coronavirus: Why You Must Act Now
Politicians, Community Leaders and Business Leaders: What Should You Do and When? medium.com Accessed 3/22/2020: https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca
Esposito, Frank (2020 March 18) Here’s how New York City and suburbs will tackle the potential shortage of hospital beds. lohud.com. Accessed 3/22/2020: https://www.lohud.com/story/news/local/new-york/2020/03/18/hudson-valley-nyc-coronavirus-hospital-bed-shortage/5068189002/
Halpern, NA, & Pastores, SM (2010) Critical care medicine in the United States 2000-2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Crit Care Med. 2010 Jan;38(1):65-71. doi: 10.1097/CCM.0b013e3181b090d0.
Wallace-Wells, B. (2020 March 18) The Coming Coronavirus Critical-Care Emergency. The New Yorker. Accessed 3/22/2020: https://www.newyorker.com/news/news-desk/the-coming-coronavirus-critical-care-emergency
Stein, M. I. (2020 March 16) Fire department, EMS no longer quarantining first responders exposed to coronavirus patients. The LENS. Accessed 3/22/2020: https://thelensnola.org/2020/03/16/fire-department-ems-no-longer-quarantining-first-responders-exposed-to-coronavirus-patients/
Watkins, A. (2020 March 20) Last Week One Paramedic Was Infected. Now Over 150 Are in Quarantine. New York City’s ambulance crews, which are stretched thin, have been told to work even if exposed to the coronavirus — as long as they are asymptomatic. The New York Times. Accessed 3/22/2020: https://www.nytimes.com/2020/03/20/nyregion/coronavirus-nyc-emergency-response.html
Steier, R. (2020 March 20) FDNY Adopts 24-Hour Shifts for Firefighters As Virus Safeguard. The Chief-Leader. Accessed 3/22/2020: https://thechiefleader.com/news/news_of_the_week/fdny-adopts–hour-shifts-for-firefighters-as-virus-safeguard/article_f4e3b454-6a27-11ea-9513-eb8ae9097bc2.html
Khell, R. (2020 March 18) Navy hospital ship deploying to New York to help with coronavirus crisis. The Hill. Accessed 3/22/2020: https://thehill.com/policy/defense/488235-cuomo-navy-hospital-ship-deploying-to-new-york
Featured image: Patient care area created last week in a Vanderbilt University Hospital parking garage. Nashville, Tennessee. Georgia Lynn via Twitter