Frank Huyler is an emergency physician in Albuquerque, New Mexico. His latest book, White Hot Light, will be published in August.
Eight days ago, I drove in for the night shift. The moon was out, and I could see scattered clouds in the darkness. I pulled into the parking garage. It was nearly empty. I walked into the hospital, and to the new unit.
The new unit is one of the few practical steps we have taken that might delay the spread of COVID-19 within the hospital. It’s a large conference room by the lobby, just outside the ER. It looks like the empty ballroom of a mid-scale corporate hotel—a Marriott, or a Holiday Inn. But now they’ve put blowers in it, to create negative pressure so contaminated air doesn’t escape. They roar.
I gowned up. I put on my N95 and my face shield and my gloves. It was midnight. I relieved my colleague, who did the evening shift. He gave me an eye-roll and a wry smile, and scrubbed his shoes with a wipe in the corner for a while before he took off his gear and left. We’re all doing these shifts now.
The room was chilly, but the gown kept me warm. There were four of us—two nurses, a tech, and me. There were rows of empty plastic seats, as if someone was going to give a lecture. There was a sense of space, and distance. The carpet at our feet had been shrink-wrapped in the haste—covered with a thin sheet of plastic, because carpet can’t be fully cleaned.
There were bubbles in the plastic. We soon discovered that if we stepped on the bubbles, they crackled. It was strangely satisfying.
Patients with respiratory symptoms were being sent to the room from triage. We were trying to keep them out of the main Emergency Department, which they would contaminate. They walked in through a different door. We asked them questions—have you travelled? Are you coughing? Do you have a fever?
That night I talked to them quickly. I was almost certain they were people with colds who were afraid. I didn’t think any of them yet had COVID-19. I kept my distance nonetheless. We swabbed their noses, and ran the swabs up to the lab to avoid contamination of the tube system. I sent all of them home.
Only a handful of patients came in. The hours passed with excruciating slowness. We talked at first, the nurses and I, but quickly realized that it’s hard to talk in an N95 mask. Voices are muffled by them; you have to speak loudly, and strain to listen. We took a selfie. A patient came at three in the morning, a college student with a cough and a sniffle who couldn’t sleep, his mind playing tricks on him. I discharged him immediately.
After that we dozed on our chairs, the four of us, in the big room. The surreality of the moment escaped none of us. My nose itched episodically for hours, and I reminded myself not to scratch it. Finally I gave in.
By then the blowers were white noise. Finally, early in the morning, I stood up, and stretched, and walked around, stepping on bubble after bubble, listening to them pop one by one.
Now positive tests are beginning to appear around us with chilling and increasing frequency. A couple in the south, resting at home. A young woman in Santa Fe, resting at home. An 80-year-old man in the ICU. A child, who is doing well. They’ve detected community transmission, and everyone knows what this means.
Already we are low on N95 masks. We have only 131 ventilators in the hospital, and most of them are already being used. As of this moment, there are roughly 400 ICU beds in a state of 2 million people. Almost all of them are currently occupied. If 1 percent of our state catches COVID-19 at nearly the same time, we will need 1,000 new ICU beds. But 10 percent could catch it at nearly the same time, or 20 percent, or 30. What are we going to do?
The hospital cannot quite believe what is happening to it. It’s a slow, dim animal, so used to its own plodding, heavy steps and steady breathing that it can’t conceive of any other speed. Each meeting is a nudge, a suggestion, a distracting concern, a cacophony. Both relevant and irrelevant points are raised simultaneously. Patient privacy, Federal regulations and permissions, revenue, staffing, triage, reports from nursing, reports from the ICUs, the plan to cut the ER in half and seal it off. The money is tight, the resources limited. On it goes.
The meetings are calm. Everyone sounds as if they are making sense. Everyone is afraid. Another meeting is planned.
We need whips and torches. But somehow we are still waving wands and penlights, cautious and timid and late, reactive and mild, as if secretly unwilling to see what lies so clearly ahead.
Most hospitals in the United States are behaving in precisely the same way, huddling by the fire in bewilderment, reflexively clinging to the familiar, to the small protocols designed for better times, and milder threats.
This should not be a surprise to anyone. When people are afraid, and uncertain, they embrace panic and denial in equal measure, and the comfort of the known.
Failures of testing have been widely reported, but there is another failure, a greater failure, that plagues us. Hospitals across the country have no central guidance, and are planning independently, repeating the same work over and over again. Vital lessons from hospitals in China and Italy have been neither learned nor shared in any organized way. It’s a terrible lapse.
Bold, proactive, unified, and above all quick action is needed everywhere. Everything should be done to keep COVID-19 out of the general hospital population and on separate, isolated units. Every effort must be made to keep hospitals functioning, to keep them from becoming accelerators of community transmission, and to keep clinical staff protected and working. Tents must be erected in parking lots, whole buildings commandeered and emptied, isolated units for staggering numbers of infected patients created. Gymnasiums must be opened, oxygen must be found, and the playbook of the past resurrected once again.
But hospitals are not bold or proactive places. They are run by people who follow the rules and always ask for permission. They are run by people whose first instinct is to wait and see, and therefore act too late.
Right now we need a central Federal authority with a light in its eyes and a flag in its hand. The tyranny of the Chinese government is a dark thing. But we should be thinking, and above all acting, like the Chinese right now with respect to COVID-19. This is D-Day and 9/11 and the Great Depression rolled into one. Hospitals, like states, need aggressive national guidance. Hospitals need a call to arms, and specific, bold, unified plans for collective action on a military scale. They must be led, and decades of habitual bureaucracy must be shaken out of them. None of this has happened, and the fracture lines in American life are already beginning to gape. We’ve lost two months of preparation due to our incompetent provincialism, to our false notions of exceptionalism, to our conceit that the world is large, and that Wuhan and Lombardy are far away. But the world is small, and we are wide open, and the enemy is here.
I drove home in the morning. The sun was bright. The city looked the same.