Over the weekend, Dr. Ernest Patti spent two 12-hour tours at the emergency room at St. Barnabas Hospital in the Bronx, a medical center ordinarily slammed given its status as a Level One Trauma Center. And it wasn’t an ordinary weekend.
With COVID-19 sweeping the city—and the projected apex arriving soon—the Emergency Room at the nonprofit hospital was busier than ever this weekend, said Dr. Patti, who treated a spectrum of some 50 critically ill patients, a larger number than his usual intake.
The weekend shift, in Dr. Patti’s estimation, was brutal. Wearing scrubs, an N-95 mask, two pairs of gloves, face mask, and gown, Dr. Patti went from case to case, evaluating patients who’ve experienced shortness of breath on top of their medical emergency. Between the ventilators and personal protection equipment, speaking to his patients became a challenge, as Dr. Patti had to speak even louder.
“After working this weekend, it seemed like we were just basically working in a war zone,” recalled Dr. Patti, who was accompanied by three resident emergency room doctors throughout his tour. “Case after case of people unable to breathe, unable to oxygenate, requiring us to put them on respirators or ventilators was really distressing. I tell you it leaves its mark emotionally and physically.”
Some patients had arrived to the ER for different reasons—a broken leg, a heart attack—but accompanied with a dry cough or shortness of breath. Doctors would run tests and evaluate a patient’s medical history to determine suspected COVID-19 cases.
“So many people are coming in at one time with these problems, and we’re putting so many of them on ventilators that we have no place to move them to,” said Dr. Patti. “In the old days you would move them up to the ICU. The ICU’s been running at max capacity and we even extended it into other areas of the hospital.”
His other suspected COVID-19 patients—barred from seeing their families due to the high infection rate—had pre-existing conditions. “It just makes it a hell of a lot more challenging to try to treat them appropriately,” said Dr. Patti. “And you see that when you them on a respirator. You don’t get the same good response that you would in a lot cases to folks who just don’t have those underlying condition.”
Though Queens remains the epicenter for COVID-19 cases and deaths, the Bronx—ranked the state’s unhealthiest county—is now leading in the number of hospitalization rates for people with the virus, with chronic conditions largely suspected by health experts in the recent uptick. Bronxites are twice as likely to die from COVID-19, THE CITY reports.
As of Monday, of the 12,739 people testing positive for COVID-19 in the Bronx, 3,588 of those cases have been hospitalized, translating to 28% of cases and surpassing the rest of the city. The Bronx has had fewer deaths, with 627, when compared to Brooklyn and Queens, but the case fatality rate (the number of deaths divided by positive cases) is highest in the Bronx.
Data also shows 541 of those deaths were people who suffered from an underlying condition.
Health experts concede that getting a definitive explanation behind the hospitalization rate will take some time, but given the borough’s high rates of diabetes, heart disease, and asthma driving the unhealthiest county ranking, health experts aren’t shocked over the prevalence of COVID-19 hospitalizations, which have been linked to complications from coronavirus deaths.
“It’s not a surprise that more people are getting sick in a place where asthma prevalence is the highest and where people have other chronic illnesses that are all known to increase the death rate in COVID,” said Dr. Neil Calman, president and CEO for the Institute for Family Health, which operates clinics in the South Bronx and a professor and chair for the Department of Family Medicine and Community Health at Mt. Sinai Health System.
What could compound the hospitalization rate is the borough’s social determinants of health, including lack of quality housing, access to fresh foods, high density, and poverty, according to Dr. Calman. “You put a disease on top of that and people who are the poorest and the sickest to begin with are the ones that are gonna have the most difficulty with the disease,” said Dr. Calman, who recalled in the early days of the pandemic that those with chronic conditions are more likely to contract the virus. “What was that? That was people with diabetes, obesity, asthma, which is the number pulmonary disease in the Bronx is asthma. And so, you end up with people who have chronic lung disease to begin with, and then you’re putting a respiratory virus on top of it. I don’t think we should be surprised with the prevalence that the disease is highest in the Bronx.”
(Dr. Calman, however, questioned the data that’s been released by the New York City Department of Health & Mental Hygiene, since testing sites have been disproportionate across the city.)
Dr. Sunit Jariwala, associate professor of allergy and immunology at the Albert Einstein College of Medicine’s Department of Medicine, suspects those who particularly treat their asthma with systemic corticosteroids—a synthetic cortisone that can be taken orally or administered intravenously—pose a higher chance at contracting the virus that’s known to wallop the lungs.
“Systemic steroids…have an impact on lymphocytes, which play a role in fighting infections,” said Dr. Jariwala, who recommends asthma sufferers to continue taking their medications and adhere to the stay-at-home guidelines.
At a news conference on Sunday, Dr. Oxiris Barbot also emphasized Bronx residents with chronic disease ride this out by staying indoors as much as possible.
But staying at home can be a two-fold challenge in the Bronx, since 32% of its residents work in the healthcare system, a higher percentage than other boroughs. And many non-medical essential personnel helping New York City live in low-income communities such as those found in the Bronx.
That prompted New York City Public Advocate Jumaane Williams to demand the city ramp up testing in low-income neighborhoods. So far, there’s been no large-scale testing site in the South Bronx, the epicenter of comorbidities in the borough. Mayor Bill De Blasio, at his daily press briefing alongside Dr. Barbot on Sunday, blamed the federal government’s slow response for not having test kits available to the public.