In some parts of the country it may seem as though the worst of the coronavirus is only hitting New York City due to the region's soaring number of cases. But to the extent that the New York metro area is presently bearing the brunt of the epidemic, it's only a preview of what is to come for the rest of the country. In fact, some doctors and nurses believe the number of coronavirus-related deaths presently reported in the U.S. is a clear undercount based on what they are experiencing on the frontlines. That underrepresentation is likely due to lags in testing, getting test results, and reporting, but also to an untold number of people who are dying without being tested at all. "We just don't know," one ER doctor in California told Buzzfeed News. "The numbers are grossly underreported. I know for a fact that we’ve had three deaths in one county where only one is listed on the website.”
But it's not just the breadth of the problem that's staggering, it's also the depth of how it's impacting communities, families, friends, and especially the people who are trained to deal in tragedy and helping us heal our wounds. Social media posts from medical workers across the country offer a glimpse of the mental and physical toll this disease is already taking on our frontline healthcare workers. And frankly, it's horrific.
"I don't know who will see this," a nurse wrote on Wednesday from an unverified Twitter account, @gaeliclass149. "I worked 12hrs in the ER today. We intubated 5patients. 4 people died. Seasoned nurses were found hiding & crying in storage rooms. I'm literally in a war zone & the battle has only just begun."
When former federal prosecutor and now Westchester County D.A. candidate Mimi Rocah replied, "We hear you," and asked what people could do to help, @gaeliclass149 pleaded, "Please.... stay home. Quarantine. Lock down. You don’t want to be where I am.”
A self-identified Advanced Practice Registered Nurse (APRN) in Georgia also responded to the thread, "Same here in my hospital, I got nurses ready to abandoned ship, screaming at me and I'm the supervisor, its getting crazy and I've been here in the ER since 5:45am ... Jesus help us!"
Normally, I wouldn't highlight unverified Twitter accounts, but social media is providing some of the rawest accounts of what it's like to be in the trenches right now. The distress signals being sent out over platforms like Twitter and Facebook also match the accounts being reported by many news outlets, with some New York healthcare workers calling the situation "apocalyptic" and "war." Just about everything that can go wrong for frontline medical workers, is. They don't have enough personal protective equipment like masks and gowns. They don't have enough ventilators to handle the coming surge in patients. They don't have enough beds. They don't have enough space to safely keep other patients separate from coronavirus patients (and who even knows what’s safe at this point anyway?). They may not have enough staff to staff the sickest patients, especially as medical personnel fall ill. Doctors are writing their wills. The sky is falling, as one surgeon and critical care specialist wrote in the New York Times.
And then there’s a self-identified internal medicine resident in New York City named Meredith, who tweeted Wednesday, "Tough day. Floor beds were converted to ICU beds on the fly as a cascade of patients in the ED and on the floor required emergent intubation." She called it "inspiring” to watch the team of registered nurses, nurse practitioners, physicians assistants, and doctors "come together" to care for the patients.
Meredith also noted that staffing the beds requires an incredible amount of resources and said it was hard to know what would run out first—staffing, physical beds, ventilators, or other life support devices that were needed simultaneously in some cases.
"Today was the worst day anyone has ever seen," she added, "but tomorrow will be worse. We are on the precipice of rationing. Needless to say, these decisions run counter to everything we stand for and are incredibly painful."
I take "rationing" to mean they would soon be faced with deciding who would live and who would die based on who becomes a recipient of the limited resources available. Can you even imagine how gut-wrenching this on-the-job training would be for a medical resident? The day before, Meredith had tweeted that she felt "compelled" to start tweeting because press reports were failing to reflect their reality. "The deluge is here," she wrote. "Our ICU is completely full with intubated COVID patients." Before signing off Wednesday night, Meredith said she was delivering the equivalent of Tylenol, a fever reducer, to a fellow resident who had developed a fever that day. "She is one of many in recent days. This is where we are."
Where we are is, in fact, the international leader in COVID-19 cases worldwide, surpassing both China and Italy in the overall number of confirmed cases. It's not going to end anytime soon. And our frontline healthcare workers—those fortunate enough to survive this epidemic—will be living with the sounds, images, decisions, and the wins and losses of the coming months for the rest of their lives.
The very least the rest of us can do is help lessen their burden. If at all possible, in the words of the first nurse above, "Please.... stay home. Quarantine. Lock down."
Godspeed to our frontline healthcare workers.