Coronavirus Frontlines: What It’s Like to Be a NY Doctor
Jeffrey Zilberstein, MD, in New York, shares what it's like to be on the frontlines running an ICU during the Covid-19 pandemic.
Courtesy Jeffrey ZilbersteinNew York has been at the epicenter of the coronavirus pandemic. And the people fighting the battle on the frontlines are the doctors and nurses caring for us. Jeffrey Zilberstein, MD, chief of the division of Critical Care Medicine as well as Pulmonary Medicine Critical Care at Northwell Health’s Southside Hospital in Bay Shore, New York has been stunned by the spread of Covid-19.
As head of his department, Dr. Zilberstein has had to make sure doctors are protected from infection—and that the deluge of patients get the care they need. “Covid-19 has taken over,” he says. “We now have about six to seven times more patients than we are used to in terms of the intensive care unit (ICU). We don’t have enough beds so now we are using floor beds and converting them to ICUs as are many other hospitals.”
With new admissions every day, medical staff working around the clock, and medical supplies extremely limited, Dr. Zilberstein and his colleagues feel the wear and tear of this novel coronavirus.
The hours blend together
The demand is nonstop, says Dr. Zilberstein. “I am not even sure that I can even tell you my hours. I got in at 5:30 a.m. today.” As a director, he pitches in to see ICU patients where and when he can.
Running the service is crucial as the hospital doesn’t have enough critical care physicians to see all of the Covid-19 patients. Therefore, Dr. Zilberstein needs to make sure that other specialists are up to the task. Critical care physicians are trained to provide care for critically ill patients such as those in the ICU, according to the Society of Critical Care Medicine.
“Normally I am seeing more patients, but there are so many moving parts that for now, my time is better spent taking care of the people who are taking care of the patients,” says Dr. Zilberstain, who’s also vice-chairman of Pulmonary Medicine and Critical Care.
As a medical professional who wears many hats, he’s constantly looking for ways to improve the management of patients. “I am working on care models to allow cardiologists, internists, thoracic surgeons, and others to help us manage these patients in a way that is standardized.” He is implementing telemedicine services in the ICU so that these specialists can see Covid-19 patients and make recommendations about their care. Telemedicine allows doctors to see and assess patients virtually using apps or video conferencing. “We are innovating on the fly and trying to create a lot of safety nets,” he says.
Medical supplies are running out
Like many health care professionals on the frontlines of this pandemic, Dr. Zilberstein is reusing his N95 masks, a practice the Centers for Disease Control and Prevention recently okayed. “We are being conservative,” he says. “Everyone is going to run out.”
Fortunately, Northwell Health has been ahead of the curve, so Dr. Zilberstein and colleagues currently have adequate supplies of gowns and gloves and are disposing of them after each use, he says. However, ventilators may prove to be another story—these are the devices that can help keep severely ill Covid-19 patients alive. Although New York is expecting more, Dr. Zilberstein is concerned that the supply will outweigh demand sooner rather than later.
Part of the potential shortfall is due to the nature of the illness in its most severe forms, he says. “Normally we place patients on ventilators for three to four days, then they are extubated, off the ventilator and out of the ICU, Dr. Zilberstein explains. But with Covid-19, he says the patients can be at the hospital for 10 days, still on ventilators and still sick. “This disease, more than anything I have seen, requires a long time on the ventilator,” he says. As a result, fewer are available.
Still, he remains hopeful that many of the Covid-19 patients in the ICU will be discharged in good health. “We haven’t seen that many folks get better in the ICU yet, but the experience in China and Italy suggests that these patients are in the ICU for 10 to 12 days, so my hope is that more will get better.”
Another aspect of the job that has changed since the outbreak is the amount of time and precautions needed to don and doff protective equipment, he says. “It takes us a little longer to get into the room and when we leave the room, we take off protective gear in a thoughtful and judicious way,” he says. “It probably adds about two to three minutes on the front end and two to three on back end per patient.”
The reason for the extra precautions is the infectious nature of Covid-19 compared to other illnesses. “It’s so infectious and can be spread by respiratory droplets when an infected person coughs or sneeze and can be airborne,” he says. Check out the 10 ways doctors protect themselves from coronavirus.
Family life takes a back seat
Unlike many of his colleagues, Dr. Zilberstein didn’t come into the hospital this weekend. “I was on my phone with the hospital from 5 a.m. to 10 p.m. I am no longer present at the house and a shell of what I once was for my family,” he says. Still, he adds that he is lucky to go home. Many of his colleagues are staying at Airbnbs to avoid exposing their family to Covid-19.
Dr. Zilberstein says his family is concerned about him and very happy to see him when he comes home. However, he notes, the greeting he gets from his two children has changed. “I come home, leave my shoes outside and I don’t get hugs,” he says. “I take a shower and then I get hugs.”
In the pre-Covid-19 days, his kids would run up and hug him. “There are no hugs in the land of Covid until I take a shower.”
What the public should know
There are a few things Dr. Zilberstein wants the public to know about Covid-19. The vast majority of patients do not get very sick and are asymptomatic or mildly symptomatic—and that’s what makes the virus so smart,” he says. “It doesn’t sicken the host, but the host continues to pass it along, which is why being at the grocery store is potentially dangerous.”
People with no symptoms are continuing to shed and spread the virus. Be on the watch for these 9 coronavirus symptoms. “This is not a disease of the elderly,” Dr. Zilberstein stresses. “We have patients in their 20s to their 90s and the average age is 40s or 50s.” Wonder about your risk of infection? Check out the people at the highest risk from coronavirus.
Dr. Zilberstein also wants to applaud the public and the outpouring of support for health care workers on the frontlines. He and his staff are incredibly grateful for food and other donations from the public. “The food is really, really nice and it feels great in the hospital to know that the community is behind us,” he says.
Instead of donating homemade masks, however, he suggests making donations toward the purchase of protective gear like masks, gloves, and gowns. “We need to protect doctors, nurses, respiratory therapists, and other health care workers not because they are more important, but because without them, there are fewer people taking care of patients,” Dr. Zilberstein says.
“We are the only business that doesn’t want more business—stay at home. We are all in this together.”
(Do you have a story to share about coronavirus? Click this link to share your Covid-19 story with us.)
- Jeffrey Zilberstein, MD, chief of division, critical care medicine of medicine, pulmonary medicine, and critical care at Northwell Health's Southside Hospital in Bay Shore, New York
- Society of Critical Care Medicine: "Shortage of ICU Providers Who Operate Ventilators Would Severely Limit Care During COVID-19 Outbreak"
- Centers for Disease Control and Prevention: "Strategies for Optimizing the Supply of N95 Respirators"