The SARS COVID-19 Pandemic of 2020

Patrick Ivan Borgen, MD, Chairman, Department of Surgery Maimonides Medical Center Brooklyn, New York

More than 200,000 Americans have been infected with COVID-19, and more than 4500 people have died from the virus across the country. Even the most seasoned physicians and researchers are alarmed and admit to being “scared” of something that they simply have never dealt with in their careers. The White House has confirmed that its own modelling shows between 100,000 and 240,000 are likely to die before the crisis is over—even if people heed social distancing guidelines. By comparison, a total of 58,209 Americans died in the Vietnam War between 1955 and 1975.

The only real weapon against a virus that the healthcare world has 100 days of experience with has been social distancing, quarantines, and lockdowns that slow down the spread of the virus and simultaneously paralyzes the economy.

Chris Miller, director in the Foreign Policy Research Institute’s Eurasia Program, reported that the stock market has sunk a quarter from its peak in just over 1 month, wiping out 3 years of gains.¹ The sharp decline was driven by economic fears triggered by the pandemic and market short-sellers, and had little to do with industry fundamentals suggesting a type of “panic sell-off.” Miller also reported that in late March 2020, a record 3.3 million Americans applied for unemployment benefits, which is the highest number ever recorded in this country All indicators suggest strongly that we have entered a recession.

Moreover, the impact of COVID-19 is being felt across all sectors of the United States economy. Miller explained that personal consumption makes up 70% of America’s gross domestic product (GDP), but consumption has slumped as businesses close and as households hold off on major purchases as they worry about their finances and their jobs. Investment makes up approximately 18% to 20% of GDP, but businesses are putting off investment as they wait for clarity on the full cost of COVID-19. Similar declines in the arts, entertainment, recreation and restaurant sectors have been observed and are certain to continue or worsen until quarantines are lifted. Even manufacturing has suffered from factory closures, and supply chain disruptions ultimately driven by reduced demand.

The COVID-19 pandemic is resulting in disruption across an impossibly wide segment of American life. In an article by CBS News, it was noted that for the first time since the 1918 Spanish flu outbreak, the Supreme Court postponed 11 oral arguments scheduled to be heard during its March sitting.² Prior to that, the court shortened its case log in 1793 and again in 1798 in reaction to the yellow fever epidemic.³ Across the country, all large public events have been canceled in favor of social distancing including all major league sports, the Summer Olympics, and concerts. The federal government has pushed the April 15 filing date for income taxes into the fall of 2020. Universities have canceled live classes and gone to a virtual educational model. Non-critical businesses are closed, as are national office support and management companies, national real estate companies, and technology companies with thousands of employees who are either laid off or furloughed.

No state has been hit harder than New York, which reports over 40% of all cases in the country. As of this writing, the state has over 122,000 documented cases, which has completely overrun the hospitals and healthcare systems. The US government dispatched the Navy hospital ship, the USNS Comfort, to New York City (NYC); however, it curiously did not allow the 1000 bed floating hospital to care for COVID-19—positive patients engendering frustration in the overworked NYC medical community. Similarly, the Jacob K. Javits Convention Center was converted to a space for beds for non-COVID-19 patients although it appears that this space may be used to care for infected patients. Hospital tents have been erected in New York City’s Central Park and serve as a shocking visual reminder of the magnitude of this healthcare crisis.

As of this writing, our hospital Maimonides Medical Center in Brooklyn sits in one of the highest incidence zip codes, at 11219, in New York City—only 2 zip codes in West Queens are higher with an incidence of 9 in 1000 inhabitants. Eighty percent of our emergency department visits are COVID-19 related and we have surged our in-patient capacity from 711 beds to well over 1000 beds.

Our intensive care areas, which previously held 57 beds, is expected to surpass 250 beds. We currently have over 170 patients on mechanical ventilatory support and worry constantly about the day when we have no additional ventilators and may be forced to make nightmarish choices. Staff morale is surprisingly sound, but the marathon nature of this episode will test even our strongest, most stalwart employee. Severely limited testing availability, experienced across the country, further hampers our ability to identify and segregate COVID-19—positive patients.

Each and every evening in Manhattan, at 7:00 PM sharp, New Yorkers are opening windows and streaming onto balconies and loudly cheering and energetically applauding the healthcare workers on the frontlines who are risking it all to care for their fellow citizens. This is an incredibly powerful reminder that we are all in this together and we will only prevail TOGETHER.

Editor’s Note: This column is the first in a series by Patrick I. Borgen, MD, on the COVID-19 pandemic and how it is impacting the healthcare system.

References

1. Miller C. The effect of COVID-19 on the US economy. Foreign Policy Research Institute. Published March 30, 2020. https://bit.ly/3aNaYlL. Accessed April 1, 2020.
2. Quinn M. Uncertainty plagues rest of the Supreme Court's term amid coronavirus crisis. CBS News. Published April 1, 2020. https://cbsn.ws/2xUaV8W. Accessed April 1, 2020.
3. Beeken E. Supreme Court postpones oral arguments amid COVID-19 pandemic. JURIST. Published March 16, 2020. https://bit.ly/2V4ux2m. Accessed April 3, 2020.

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The SARS COVID-19 virus pandemic came out of nowhere, circling the globe with shocking speed and with a vengeance. It has collapsed financial markets, overwhelmed healthcare systems, filled hospitals, and emptied public spaces. And, it has undoubtedly taken lives.