Philadelphia doctor writes about scarcity of supplies and lack of planning at one city hospital

The predicted surge of coronavirus patients has begun, which has doctors, nurses and other health care workers in many hospitals feeling the effects from the lack of safety equipment, lack of resources and lack of space.

In New York City and New Orleans, necessities, like N95 masks, ventilators and albuterol inhalers, are scarce. In a video last week by the New York Times, a doctor at Elmhurst Hospital in Queens, New York, illustrated the differences between what her hospital's administrators are saying about Elmhurst''s preparedness and what she is seeing in the emergency room, where the daily patient load had doubled; she wore the same N95 mask for multiple days; and there aren't enough ventilators.

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"If this goes on for a month, or two, or three, or five, like it did in China, we don't have what we need," the doctor said.

P.J. Brennan, chief medical officer of the Pennsylvania Health System, told the Inquirer that Philadelphia is about two weeks behind New York City. Hospitals across the city are running out of supplies and health care workers at Einstein Medical Center have resorted to making improvised face shields.

On Monday, Rolling Stone published an article by an anonymous Philadelphia neurologist working at an unnamed hospital in a "poor, inner city, predominately African-American" neighborhood. The physician describes personal concerns about the hospital's preparedness and things happening in the community.

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Philadelphia hospitals will be similar to what is already happening at Elmhurst when this city is in the throes of the coronavirus pandemic, and "It makes me cry just thinking about what they’re going through," the doctor says.

The hospital is "already on the razor's edge of resources." Staff has been assigned one N95 mask "People should stop hoarding and bring that stuff to the hospital," the neurologist says. "They can keep enough for themselves, but they certainly don’t need boxes of them, and in all honesty health care workers are going to die because of it."

To keep up with the demand, the doctor spent $1,500 on masks from China for personal use and coworkers. The hospital's administration had been slow providing updates to staff, the physicians says, and is lagging in preparing for emergency contingencies, like providing refresher training session to health care workers on intubating patients to connect them to ventilators.

The lack of resources is worrisome and so is what the doctor is seeing in the neighborhood where people have been asked to practice social distancing to slow the spread of COVID-19.

"What I’ve noticed driving back and forth to work is that in the neighborhoods around my hospital nothing seems to have changed. People are out. It doesn’t look like anyone’s social distancing at all. There is just no difference in behavior. Based on that and what I know about my patients, I anticipate a massive swell of very ill patients, and we’re just not going to have the resources to manage them appropriately. We barely have the resources to handle them on a good day."

A University of Washington study found that Pennsylvania appears well-equipped to handle the surge of patients. The state is expected to need 6,182 hospital beds compared to a total capacity of 14,395 beds. The state will also needs 949 ICU beds compared to a total capacity of 1,043 ICU beds. However, it's not clear how much the model accounts for geographic distribution of hospital resources with needs in cities, such as Philadelphia. 

While there have been nearly 5,000 confirmed COVID-19 cases and 63 deaths in Pennsylvania reported Tuesday. Philadelphia, through Tuesday, has 1,197 coronavirus cases and 10 people have died.