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What doctors are seeing in emergency departments across the country

What doctors are seeing in emergency departments across the country

JUDY WOODRUFF: As you know, there’s growing
concern around the country about how health care workers will deal with a potential surge
of patients and the fears that doctors, nurses and others have for their own safety, as well
as for their families. William Brangham and I are going to explore
some of these questions this evening with several voices. We’re going to start with William and focus
on the biggest hot spot in the U.S. we begin with a view from one emergency department
in New York City. That’s one of the city’s hardest hit by this outbreak so far. And for
that I am joined by Dr. Billy Goldberg. He’s an emergency room physician at We’re going to start with William and a focus
on the biggest hot spot in the U.S. WILLIAM BRANGHAM: We begin with a view from
one emergency room in New York City. That’s one of the cities hardest-hit by this outbreak
so far. And for that, I’m joined by Dr. Billy Goldberg.
He’s an emergency room physician at NYU Langone Health. Dr. Goldberg, thank you very much for doing
this. Can you just give us a sense of what it’s
like in the hospital today? DR. BILLY GOLDBERG, NYU Langone Health: It
changes every day. So you know, what it was like yesterday and
what it is like today is a different story. Things are getting real here in New York.
We’re getting sicker and sicker patients. We are all concerned about what is going to
happen in the days and weeks to come. But we’re hanging in there. This is what we
are trained for, as emergency medicine doctors. And we are there for you. WILLIAM BRANGHAM: One of the things that we
have read a good deal about is this concern that there is simply not enough protective
gear for masks, face shields, gowns for people like yourself. Are you guys OK on equipment right now? DR. BILLY GOLDBERG: So, describe OK. We’re not exactly where we want to be. Both
of our hospital systems, both NYU and Bellevue, are doing everything we can to get the gear
we need. On a normal day, when we see a patient, like a patient with COVID — prior to COVID,
that is — we would be free to put on the full protective equipment that we need. When we leave the room, we change that equipment
and we put on new equipment for the next patient. That is not the case now. We do have equipment
for the short term, but we don’t know what is going to happen. And we are doing things like using a mask
for the entire shift, until it visibly soiled. And those are things that are tricky for us
on the front line. WILLIAM BRANGHAM: So, normally, you would
take one mask, one face shield per patient? DR. BILLY GOLDBERG: Yes, the whole concept
is, is, you want to protect yourself, you want to take anything that may have gotten
on that, carefully remove the mask, and discard it, and then you start fresh with the next
patient. So, sometimes, we have what we are calling
super spreader events. And these are events, such as an intubation, which is when we have
to put a breathing tube down somebody’s trachea. Now, these are super spreader events, because
the virus is spread much more rapidly. It’s because we are aerosolizing the virus. Mostly,
we’re concerned about droplet transmission. But in these cases, because of the proximity
to the airway and the exposure to the virus, it’s much more risky for those of us in the
health care field. So we’re trying to really protect ourselves
during those times. And we will have a shield that kind of protects the mask. So you’re
hoping that no splash gets on the mask. But, again, when the virus is everywhere,
it’s inevitable that this these — you know, these precautions are not perfect. WILLIAM BRANGHAM: So you’re talking about
the need to put someone on a ventilator. That’s something else that we have heard that there
is a great deal of concern about that, that we simply don’t have enough ventilators for
all the patients who might need them. Are you guys equipped well enough now, or
not? DR. BILLY GOLDBERG: So, again, now, yes, but
tomorrow, we don’t know. We’re seeing more and more patients like this.
We have a shift report at the end of every day, and, occasionally, we will put one or
two people to shift on a ventilator. Yesterday, I got a shift report that said 10 people in
one 12-hour period. And the numbers are just — just increasing.
So we don’t know where this is going. So we need more supplies. WILLIAM BRANGHAM: So many of us, of course,
were following what was going on with the medical staff at all of those hospitals in
Italy and the sort of heart-wrenching struggles that they had to make about who to care for
and who not, simply because they had run out of that capacity. Were you following that? Were you reading
those dispatches from doctors? And were you talking amongst your colleagues about this? DR. BILLY GOLDBERG: So it’s a very active
thing that a lot of us are doing, not only to follow the stories, the way everybody is,
but also to learn about the disease process. So we’re learning things all the time through
our physician chat groups, through some of these online discussions. And, yes, we’re
following it. And we think about patients. What’s in their best interest? We try to discuss
advanced directives with them. It is going to become a much different situation
with this, because, as we get closer to kind of running out of some of these supplies,
we’re going to have to make tough decisions about who has the highest likelihood of surviving. And that may mean you’re not providing this
high level of care to patients who perhaps could have had a chance. WILLIAM BRANGHAM: And how are you — I’m just
curious how you’re personally doing. I mean, this seems to be something that much of the
nation is alarmed about and watching the news and scared and worried and hoping for the
best. But, as someone who is obviously directly
on the front lines of all of this, how are you personally doing? DR. BILLY GOLDBERG: You know, we’re hanging
in there. This is what we’re trained to do. It’s scary. We’re still trying to protect
our families and protect ourselves. There’s a lot of people — people are paying a lot
of attention to E.R. doctors now, which is great, but our colleagues in the ICU and on
the medicine floors and all the people who work in the hospital are also dealing with
it, the clerks, the people who clean the floors. It’s — we’re all together in this. It’s a
scary time. I think our reserve is a little low, so small little things will tip us off.
But we’re trying to do the best we can to seek solace in the people who are doing the
same things and just keep pushing along. WILLIAM BRANGHAM: OK, Dr. Billy Goldberg from
NYU Langone Health, thank you so much, and best of luck to you out there. DR. BILLY GOLDBERG: Thank you. WILLIAM BRANGHAM: And now we turn to get a
broader perspective, how an entire health system is preparing for this outbreak. For that, I am joined by Dr. Anish Mahajan.
He’s the chief medical officer for Harbor UCLA Medical Center, which is operated by
the Los Angeles County Health Department. Dr. Mahajan, thank you very much for being
with us. Could you just give us a sense of how your
hospital system is doing? How are preparations going? DR. ANISH MAHAJAN, Harbor UCLA Medical Center:
Well, we are working very hard to be prepared for a larger number of patients that we anticipate
as we get into the curve. Here in Southern California. we are maybe
a few days behind New York City and other places, certainly around the world. And so
we are working very hard to increase our capacity through ICU level care and other types of
care. WILLIAM BRANGHAM: Approximately how many COVID
patients do you have right now? DR. ANISH MAHAJAN: Well, I will speak for
the public hospital system here in L.A. County. We have about 10, or maybe a few more than
that, that are confirmed positive. But, as you know, there’s very little testing available.
And we know that, in the community in L.A. County, there are likely to be many more confirmed
cases of COVID. We just don’t have the ability to test them. WILLIAM BRANGHAM: So, is that your sense,
that, absent good testing, we really just don’t understand how widespread the virus
is right now? DR. ANISH MAHAJAN: That’s correct. We have proxies without testing, such as patients
that we are seeing presenting with flu-like type illness. So that gives us a sense, but
we know already that there is community transmission occurring here in Southern California and
many other places in the nation — community transmission, of course, being patients acquiring
the infection, but not really knowing that they had contact with someone who was positive. WILLIAM BRANGHAM: You mentioned that, systemwide,
you’re going through a lot of preparation. What does that preparation look like? What
are you guys actually doing? DR. ANISH MAHAJAN: Well, a number of things. One of the first things we’re doing are making
sure that we have sufficient protective gear on hand, and using that protective gear wisely
and when it’s absolutely needed to protect staff from getting the infection. The second thing we’re doing is making sure
that we’re protecting patients from each other, ensuring that patients that have symptoms
that suggest flu-like, or in this case coronavirus, are separated from other patients that we’re
seeing. A third thing we have done is, of course,
cancel all nonessential care, such as nonessential clinic visits, operations and surgeries. We’re
doing that, one, so that people can stay out of the hospital and clinics, so that they
can be safe. WILLIAM BRANGHAM: And are you confident that
you have that capacity? I mean, do you have enough protective gear, do you have enough
ventilator, do you have enough beds to do all of those things if the spike is, as we
— as many people fear, the worst could be? DR. ANISH MAHAJAN: Well, we are working very
hard to shore up our resources on all of those things. You know — you have heard and all of us know
that there’s global shortages of protective gear. As it relates to ventilators, same thing.
All jurisdictions at all levels of government are helping us find those ventilators. But perhaps the most significant problem is
that we need staffing for these critical care beds. And so we are asking nurses who used
to practice critical care who may be in administrative roles to reacquaint themselves with how it
is to take care of patients, because this is really going to be an all-hands-on-deck
approach, if we don’t flatten the curve. WILLIAM BRANGHAM: What is the general sense
amongst the staff? I mean, for those of us who are reading reports,
say, out of Italy, there seems to be a great deal of concern amongst medical staff about
the difficult road that lies ahead. How are staff telling you, how are they doing, how
are they coping with all of this? DR. ANISH MAHAJAN: Well, I think Americans
know that people who come to work in hospitals and clinics are compassionate. And these are not just the doctors and nurses,
also the clerks, the people who clean the rooms and make sure they’re safe and turn
over the rooms. These people are very compassionate and mission-driven. But what we are seeing now is, they’re showing
courage, because, in a public health crisis like this, where the infection can be transmitted
so easily, naturally, our staff want to continue to help their patients and the community,
but they also have to protect themselves. And so, yes, we are seeing a lot of anxiety
among all levels of staff about whether they may bring the infection home to their kids
or to their parents. How do they protect themselves when we have shortages of protective gear? WILLIAM BRANGHAM: We know your governor, Gavin
Newsom, issued basically a stay-at-home order for the entire state. Is it your sense that people thus far have
been heeding that? Have you noticed more people seeming to stay away, to stay at home, to
isolate themselves? DR. ANISH MAHAJAN: Well, certainly, we have
probably all seen the reports of the fact that L.A. freeways are no longer choked. We
can get around easily. Pollution is down in major cities that have stay-at-home orders. That said… WILLIAM BRANGHAM: One small silver lining
to this crisis, I take it. (LAUGHTER) DR. ANISH MAHAJAN: Right, and a proxy that
people are generally staying home. That said, there are groups of patient — people
who maybe don’t yet understand the message, and particularly young people. Young people
in general feel they’re invincible. So, it’s extraordinarily important that everybody heed
the stay-at-home orders, so that they protect the entire community and protect the — protect
us from the infection spreading very rapidly, because, as you know, if the infection spreads
rapidly, we will quickly be overwhelmed in being able to take care of the patients that
need the help. WILLIAM BRANGHAM: All right, Dr. Anish Mahajan,
chief medical officer of Harbor UCLA Medical Center, thank you very much. And from all of us, best of luck to you out
there. DR. ANISH MAHAJAN: Thank you very much.

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