COVID-19

L.I. doctors on front lines publish their experience to help others fight COVID-19 battle

Suffolk County has over 28,000 confirmed cases of COVID-19. Last week, Adam J. Singer, M.D., Eric J. Morley, M.D., and Mark C. Henry, M.D., three leading physicians from Stony Brook University Hospital’s Emergency Department, published an article in the New England Journal of Medicine that details their experience — Stony Brook has seen over 3,500 COVID-19 patients — in an effort to help clinicians in areas that haven’t been hard hit yet, prepare for the inevitable pandemic wave.

The Times Review Media Group recently conducted an interview with Dr. Singer. His answers have been condensed for space and clarity.

Dr. Adam J. Singer

Times/Review: What’s the response been to the article in the medical community?

Dr. Singer: We’ve received a lot of emails and text messages from people around the country. I don’t know yet how much this is helping them prepare. At Stony Brook, we were quick to anticipate needs. We knew there was going to be a need for surge capacity for both general beds, ICU beds and ventilators. We also knew that we were going to have many, many patients presented to the emergency department and that we weren’t going to be able to see them using our normal processes.

Times Review: How did you modify those processes to keep up?

Dr. Singer: We realized very quickly that we needed to split our flow process and take the suspected COVID-19 patients out of the hospital so that they were not going to infect other patients, many of whom had many comorbidities.

Times Review: Increasing beds was identified very early on as a priority. How did that happen at Stony Brook?

Dr. Singer: They cancelled elective surgeries very early on, which freed up a lot of bed capacity. Within days, we had moved our operations [to tents set up by the National Guard and Department of Health] and changed our protocols to accommodate the waves of people coming with symptoms suggestive of COVID-19.

We had to move rapidly, which required coordination with IT. Teamwork has been extremely important. There’s been such a camaraderie in stepping up to the plate.

Times Review: What are some ways you’ve managed the supply of Personal Protective Equipment?

Dr. Singer: All patients are initially seen, but when follow up is required, it’s all done with an iPad. That minimizes contact with the patient but also helps preserve the important PPE which you need to change from patient to patient.

Reusing N95 masks has been a major achievement, using a process to sterilize the masks while maintaining its ability to filter out the particles.

Times Review: The first mobile testing site in Suffolk was set up at Stony Brook. How is that going?

Dr. Singer: Word got around and patients started coming from places that normally were not in our catchment areas. For example, the percentage of patients who are Hispanic was much higher than we normally see.

Testing ramped up to 1,000 tests a day. Our volume became very very high very quickly.

Times Review: Is it surprising, the way the virus has spread, compared to others? 

Dr. Singer: We didn’t have much experience with SARS, MERS and Ebola, or any large pandemic like this, besides influenza. While influenza does kill thousands every year, we never saw so many sick patients over such a short time period. I don’t remember having young people who were otherwise healthy with no comorbidities being so sick and being on ventilators. It is certainly a ferocious beast.

Times Review: The governor’s daily updates have indicated that the curve may be starting to plateau. Is there any indication social distancing is working?

Dr. Singer: We were all set up to open up a big field hospital with hundreds of beds. In the last week, there’s been a flattening of the curve, so we haven’t had to move there and we may not have to.

This emphasizes the need for social distancing. If people celebrate too early and they go out again, there will be another surge and that can be very difficult.

Times Review: What can you tell me about progress on a vaccine?

Dr. Singer: Everyone is working furiously to test whether any of these therapies that sound promising are effective and safe.

There’s a lot of hope for a vaccine. Influenza often mutates from season to season, so the vaccine is generally built on what were common strains the year before. So even having a vaccine, the coronavirus also may have the ability to mutate and change. Time will tell.

Times Review: Who is being discharged and what’s happening to patients that might not have COVID-19?

Dr. Singer: In the past, we never would have thought of sending people home who have pneumonia on both sides of their lungs. If they’re not in respiratory distress and their oxygen saturation is OK, we’ve been sending them home with strict instructions to come back if they’re worse.

Where are those heart attacks and strokes? Maybe later we’ll find out that the mortality from the other diseases has gone up because people are afraid to come in. We have to assume that everyone now potentially has the virus when they come in to be seen.

Times Review: What are your thoughts on the governor requiring the public to wear masks?

Dr. Singer: Some people are still not taking this seriously enough. We have to take precautions not just for ourselves, but for others. I still see people walking around without masks, and I say to myself either they’re ignorant or they’re selfish or they’re both.

Times Review: What are some of the major lessons you think this pandemic should leave us with going forward?

Dr. Singer: The world is global. We can’t assume that we’re isolated. It’s better to err on the side of caution and not be cavalier and assume that because we have one of the most developed medical systems in the world and we’re the richest country that we could somehow be immune to this. It reminds us that we’re all in this together, the entire world, and we have to coordinate our efforts and learn from each other.