Coronavirus Conversations:

David Reich

Season 1: Episode 22
March 31, 2020

Photo courtesy of Mount Sinai Health System

This episode is part of a limited series of conversations with people who are being forced to make difficult decisions in a rapidly evolving situation with many unknowns.

If you have a story you’d like to share, you can email us at info@tradeoffs.org.

Listen to the conversation below or scroll down for the transcript and more information.

David Reich, MD, President and Chief Operating Officer of Mount Sinai Hospital

Gov. Andrew Cuomo: Want to give you an update on some of the numbers today…

Dan Gorenstein: New York Gov. Andrew Cuomo held a press conference Monday, March 30 with the latest on the coronavirus outbreak in the state.

AC: In terms of the overall numbers, 66,000 have tested positive, 9,500 people are currently hospitalized.

DG: Hospitals in New York City are among the nation’s first medical providers to grapple with a shortage of supplies and staff as more and more people seek out care.

Dr. David Reich: We continue surging well beyond normal capacity. Every day, it’s usually about 50 more patients in isolation in the hospital.

DG: Today from the Annenberg Studio at the University of Pennsylvania we  speak with Dr. David Reich, President and Chief Operating Officer of Mt. Sinai Hospital.

DG: About 400 people are hospitalized with COVID-19 at Mount Sinai.

DR: We have shrunk almost every other service at the hospital. Ninety percent of our normal surgical schedule is gone. The only surgery that happens now are dire emergencies. And some people with cancer that if we didn’t operate within a few weeks, it would spread and that would be a death sentence for them.

DG: What’s it like to say those words? Can you believe that that’s the case?

DR: Well, there isn’t really a lot of time for reflection. It is almost like a situation where there is no playbook, and so you’re so busy writing the playbook that you have to focus on the tasks at hand, because there’s so much opportunity now to save lives by doing the right thing that normal operations just moves to the side and you find that it’s just a new reality, hopefully not one that last more than a few weeks, but still an entirely new reality that requires a different approach and a different mindset.

DG: Explain that, Dr. Reich. What do you mean there’s an opportunity to save lives right now? That’s what you guys are in the business of.

DR: Well, yes, but in this case, if we look at what happened in China, in Italy, and now it’s happening in Spain, we just know we have to keep staying ahead of this by creating more isolation space and more isolation space. A field hospital went up today in Central Park, right across from Mount Sinai Hospital of 70 beds. We’re building patient pods, over 50 of them that could hold 100 or even 150 patients if we triple up in our lobbies in the atria of the hospital.

DG: You’ve turned your lobby into a space for patients?

DR: We’re preparing that, and we hope we don’t have to use it. But at the rate that the number of cases still continue to increase in New York City and New York state, it is entirely conceivable that by the end of the week that we could have so many patients that we would need to use that space.

DG: And so right now, what is your ventilator capacity? Have you run out of ventilators?

DR: No, we’ve been able to stay ahead. A combination of our purchases and connections throughout the community, distributions from the federal stockpile that came through to us, and some ingenuity. We’ve taken donations of the ventilators that were designed to be only used at home and souped them up to give her higher levels of oxygen and a little bit of know-how here and there to take things that were generally used for transportation and turn them into critical care capable ventilators.

DG: Can you estimate, back-of-the-envelope, how many ventilators of whatever type have you secured in just the last two to three weeks?

DR: Probably more than 400 now. We’ve more than doubled our capacity in the health system.

DG: How much has that cost?

DR: Well, at this point, we’ve probably spent my guess is somewhere between $10 and $20 million. I don’t have an exact number, but a significant amount of money has been spent on ventilators.

DG: I think it can be very confusing for many of us where we know people are dying every day and hospitals like yours are seeing a surge in patients. But at the same time, you have ventilator capacity. So can you explain to us what is going on, who is dying? Why are these people dying?

DR: Well, it’s a bad disease and there’s no cure for it. So there are people, especially those who are older and those with underlying health conditions that get sick very quickly. And those individuals, some of them will succumb very quickly to this disease, and there’s not much that you can do about it. And then there are younger people who get sick very suddenly as well. And it’s unpredictable, but it’s quite tragic because you have a disease for which there’s not much you can do that’s staring you in the face.

DG: What challenges are you facing right now? What is concerning you most? You have, thanks to a lot of ingenuity, have not run out of space yet. So what is it that’s really concerning you right now the most?

DR: Well, the normal staffing in a hospital is something that we all have been used to for years. And now that staffing is no longer possible at the same level. So we’re stretching the number of nurses that can cover a unit by bringing in other people. We’re using residents in from the different specialties, and so it’s possible that that level of care that you would normally receive in an intensive care unit or a medical surgical floor is not going to be the same because people are stretched to a limit. And I think that people are doing a superb job right now, but it’s not normal. And that’s the key issue.

DG: What’s the status of your PPEs, your personal protective equipment for staff?

DR: It’s limited and it is something that we have to practice techniques of conservation just like everyone else in the nation is forced to do right now. And it’s of great concern because the N-95 mask is the new Cadillac or whatever you want to say. It’s become an object of extreme desire and something that really helps people feel that they are not being put in harm’s way, even though there are circumstances where we believe they’re not necessary if we don’t give those devices to our staff. They feel exposed.

DG: So when you think about your supplies and your capacity, you think about probably testing, you think about simple space to put people, you think about ventilators, you think about PPEs. What are you in need of most today as of March 30?

DR: Well, we’re blessed in that we have several days supply of many things, but we have no idea if that same supply will arrive next week. So we have to be careful stewards of what we have and realize that we’re only ever going to have several days supply and as such just have to remain very vigilant, a little bit nervous, but focused on what we can do with what we have.

DG: One final question here, Dr. Reich. We’ve heard a lot of people talk about this being a war, being on wartime footing. Is that the right sort of mental framing for what’s going on, a war?

DR: Well, I think I want to frame it a little differently. All of the normal rules are gone, right now. We have moral compasses, we have professional standards and we have knowledge and we have willpower. And so everyone has to use all of those internal guides that they have, all of that skill, all of that knowledge. And then they have to extend themselves well beyond what is normal in their capacity.

DG: We close out today’s show with a little more from New York Gov. Andrew Cuomo’s press conference on Monday, March 30.

I’m Dan Gorenstein. This is Tradeoffs.

AC: Anyone who says this situation is a New York City-only situation is in a state of denial. You see this virus move across the state. You see the virus move across this nation. There is no American who is immune to this virus. I don’t care if you live in Kansas. I don’t care if you live in Texas. There is no American that is immune. What is happening to New York is not an anomaly. There is nothing about it. A New Yorker’s immune system that is any different than any other American’s immune system. So in many ways, New York is just a canary in the coal mine. What you see us going through here, you will see happening all across this country. So part of what we’re doing here is not only serving New Yorkers, but we believe that we’re dealing with this pandemic at a level, intensity and density that no one has seen before. And hopefully we’ll learn lessons here that we can then share with people across this nation.

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