The New Yorker Radio Hour - E.R. Doctors on the COVID-19 Crisis, and the Politics of a Pandemic

Episode Date: March 27, 2020

Across the country, doctors and nurses are being forced to care for an increasing number of COVID patients with dwindling supplies and no clear end to the outbreak in sight. Two emergency-room doctors, Jessica van Voorhees, in New York City, and Sana Jaffri, in Washington State, describe the scope of the crisis as seen from their hospitals. “It would be typical in a twelve-hour shift to intubate one patient who is critically ill, maybe two,” Dr. Voorhees says. “The last shift I worked, I intubated ten patients in twelve hours.” Plus: it’s been just over a month since Donald Trump gave his first public statement about the coronavirus—saying, in essence, that the virus did not pose a substantial threat to the United States. Why did he so dramatically underplay the risks of COVID-19? “With Trump, sometimes the answer is pretty transparent,” Susan B. Glasser, The New Yorker’s Washington correspondent, told David Remnick, “and, in this case, I think the answer is pretty transparent. He didn’t want anything to interrupt his reëlection campaign plan, which entirely hinged on the strength of the U.S. economy.” New Yorker Radio Hour listeners, we want to hear from you.  We have a few questions about the show and how you listen to it. The survey takes about twenty minutes, and your feedback will help us make our podcast better.  Take the survey here.

This is The New Yorker Radio Hour, a co-production of WNYC Studios and The New Yorker. Welcome to The New Yorker Radio Hour. I'm David Remnick. It's looking very much like New York City is for now, the epicenter of the COVID-19 crisis here in the United States and perhaps the world. It's a very difficult time to be a New Yorker. The number of confirmed cases is doubling every three days, and there's not nearly enough hospital beds and equipment for the influx of patients in New Yorker. to the city's hospitals. One hospital in Queens had 13 dead in a single day. And Andrew Cuomo, New York's governor, lashed out last week at the federal government's response. FEMA says, we're sending 400 ventilators. Really?

What am I going to do with 400 ventilators? When I need 30,000, you pick the 26,000 people who are going to die because you only sent 400 ventilators. Cuomo got extra ventilators from FEMA eventually, but New York is still on an alarming trajectory, and the full scope of the crisis is already being seen in the city's emergency rooms. Dr. Jessica Van Voorhees is an ER doctor at Methodist Hospital in Brooklyn, and I caught up with her on Thursday as the city's number of confirmed cases past 20,000. Doctor, how are you doing today? another bright and sunny morning but a little crazy at work obviously well tell me what you're seeing

this morning well our numbers certainly continue to rise i haven't started my shift yet but i'm ready to go in again as soon as we get off the phone actually um but you know i've been amazed at how many healthy young people i've seen with really severe enough disease to be admitted to the hospital. It's very unusual for me to admit a completely healthy 34-year-old, but I've had patients like that who are in their 30s, or early 40s, who have no real health problems and are getting admitted to the hospital because they need oxygen, they're struggling to breathe. That's really very unusual. And just the volume, you know, it would be typical in a 12-hour shift to intubate one patient who is critically ill, maybe two,

three would be a lot. You would have had a crazy, busy shift. And the last shift I worked, I intubated 10 patients in 12 hours. Now, officially there are 20,000 confirmed cases here in the city, and we know that testing has really lagged behind where we'd want it to be in a terrible way. Based on what you're seeing, what would you estimate the true total number of cases are at in the city? enormously, enormously larger than that. So we, each day, and, you know, each day at my hospital, we're turning away hundreds of patients who definitely have COVID-19. You're turning away hundreds every day who definitely have it? Yes, for sure. More than 100. I would say maybe even 200.

Monday is typically at this day. So last Monday, we are involved. volume was down, like the number of patients who came to the ET was down, but obviously with all those intubations, the acuity was up. The thing that's wild, too, is now seeing case after case after case after case for the past two weeks, you know, they really form a pattern. And like I said, some have more GI gastrointestinal, some more respiratory. But you can sort of recognize it, you know, pretty quickly at this point when you just see patient after patient. I mean, I almost feel like if another emergency physician tried to tell me that 98% of the patients they're seeing in the ER are all the same disease, I mean, we'd never believe it. You say, oh, you must be exaggerating. There's no way they all have it.

You just think they all have it. But seriously, every single patient is presenting to the ED, almost every single patient really has signs and symptoms of this illness. And even when patients are presenting for something else, for example, oh, I, you know, tripped and twisted. my ankle coming down my front steps this morning, if they say they have a broken ankle and they need surgery and you do a chest x-ray, there are all these patients like that that we are incidentally finding that they have COVID-19 in their lungs when we go looking for something else. Wow.

So it's really, I think we're underestimating the problem, not by a few hundred people, but by thousands or tens of thousands. The anxiety level must be very high, too. I understand that you work at a call center. as a doctor at the end of the line giving advice to paramedics in the field in all five boroughs. Can you give me a sense

of what those phone calls are like these days? Yeah, well, certainly, I mean, our EMTs and paramedics in the field are really are seeing a lot. And the level of busy, you know, the number of 911 calls the past two days has been, again, kind of like, orders of magnitude greater than normal. A typical busy day is anything over 4,000 calls in a

single day for 911 calls to the fire department. And the past two days, we've seen more than 6,000 calls. So that's completely crazy. I mean, like, which is amazing too, because, you know, I'm not sure. It'll be interesting to see what all of those calls are. But a lot of them, I definitely I can tell you, because I get involved in the patients who are cardiac arrest patients, I can tell you that the volume of cardiac arrests in the past two days has been astronomical. You're in an emergency room. We've heard over and over again that doctors in ER do not have the masks, the gowns, the equipment, the basic equipment they need to do the job. Thankfully, we do. So my hospital system has done a good job of gas.

gathering enough masks and gowns and gloves, we have everything we need. I've been, you know, I'm very thankful and I feel, I actually feel really supported by the hospital system. There's been a big push by physicians and nurses in other areas of the hospital to really preserve that PPE for the emergency department. That's personal protection equipment, right. Yes. And so there is that fear of running out, and certainly we've heard the whole stories from other hospitals, you know, about running out of equipment. I think we just heard a report about some healthcare worker using a garbage bag as a personal protective equipment at one of the...

I know. I saw that picture, which is awful. I mean, probably works, and, you know, it certainly is like an impervious plastic. It's not a bad choice. But clearly, you'd rather have something that's made for the task. And the truth is, you know, if you're resorting to garbage bags, then it just makes you worry about, like, you know, what other equipment they're lacking and don't have available. The CDC recently changed its guidelines to allow the reuse of surgical and N95 max. It even suggests that health care workers could use bandanas or scarves as a last result. How do you feel about that? Well, so we all agree that, and even the CDC said this, that it's, you know, non-ideal.

and any infectious disease expert that you speak to will tell you that that is subpar. I think it's the sort of lands in the category of something is better than nothing. But I think we all are pretty thankful that we're not there yet. There's such an outpouring of support from the community. So I've gotten so many offers from well-meaning friends and relatives to sort of like get out their sewing machines and sew me some cloth masks. and I keep having to tell people it's okay. I have appropriate PPE at work.

Like, thanks anyway, but maybe save them for later for when we actually do run out someday down the road. Have you been tested for the virus? I have not. The indication for testing is symptoms, and I have not had any symptoms. So medical workers are not being tested routinely unless they show symptoms.

Correct. Is that dangerous? I think it's okay. I, You know, what we are doing is just wearing a mask. So if I had the virus and I didn't want to spread it to another person, what I would do is wear a surgical mask. And I'm wearing a surgical mask or higher levels of PPE at work anyway,

with every single patient. Are you concerned that you're, well, it's a silly question to ask. Are you concerned that you're going to get coronavirus? It sounds to me like you assume you are almost. Yeah, I do almost assume that we all are. And I'm not worried about it. Why is that? Because for most people, for most people, it's really a mild illness.

I'm 43. My overall mortality rate, if you look elsewhere in the world, is maybe 0.2%. So, you know, those are pretty good odds. As soon as we get off the phone, I know you're going to head to the hospital and begin your shift again. What is the mood in the room? How does it feel to be in that room? in the ER? Kind of surreal, kind of unbelievable, and I mean, we're certainly in the thick of it.

It's just you wonder how much more you can do. And then, you know, we just try to keep expanding areas where we're seeing these patients. And, you know, we have a tent outside to see these patients. We've, you know, used areas, surgical clinics and areas of the hospital that we wouldn't normally use to see ER patients. we're just sort of taking over every spare bit of real estate in the hospital. And I think we're going to have to continue to do that. So it really changes by the day, and it's certainly not good.

It's wild to see something really unfold before your eyes, and you read about it in the paper, and it's happening right in front of you day by day. Doctor, as a New Yorker, as someone whose brother is an ER doctor, and just as a fellow human being, I thank you from the bottom of my heart, and I know all New Yorkers do. Thank you so much. Thank you. Yeah, thanks. Dr. Jessica Van Voorhees is an ER doctor at Methodist Hospital in Brooklyn, and I spoke with her this past Thursday.

Doctors and nurses caring for COVID patients are facing a situation they've just never seen before. With no specific treatment for the virus available yet, patients are mostly being offered supportive care with the hope that the illness will eventually subside. And that has represented a huge shift in how many doctors are used to practicing medicine. Santa Joffrey is a physician at the Providence Regional Medical Center, north of Seattle. And she's worked directly there with COVID patients. She spoke to the radio hour Stephen Valentino last week about how her day-to-day work life has changed. changed? So my typical days before all of this pandemic really became an issue, I would see anywhere

between 14 to 17 patients. And nowadays, I can see anywhere between 17 to you're told to be prepared to see up to 25 patients per day. So my day begins with me making a list of patients that I know are positive, patients that potential ruleouts and then some regular patients who don't have coronavirus. And I try to see my patients who don't have coronavirus first just so that there's less risk of exposure and also to get a little bit more upbeat, you know. I think I myself and probably a lot of my colleagues I can say, you know, one of the

best parts about being a doctor is that when you're taking care of these patients, you get to learn so much about them. Like I will sit in their room. I'm talking to them about what life was like before they came here. What events are they looking forward to? And so that when I know about their health care issues, I know about them, their family, in a broader, you know, context. Whereas after I, after this, I am I go see my COVID patients or COVID rule out patients. I will mask up like this.

I wear gloves. I wear a gown. and then I wear another set of gloves. I wear a mask and then protective eyewear. And so they don't get to see me basically at all because I'm just eyes behind a mask and this protective eyewear. So they don't get to see if I'm smiling at them. And you lose a lot.

You lose a lot in that I don't get to sit there and hear about, you know, their niece's wedding that's coming up or how they manage at home or what they like to eat and things like this. it's mostly just business. And I don't get to know about them, which means that they don't stick in my mind like other patients used to. It kind of sounds like being a COVID patient

is kind of a lonely experience. It's very lonely. You don't, you know, usually a typical patient will have a CNA, a nurse, some type of therapist who's coming to see them, and the doctor, if not multiple doctors. Whereas these patients will probably have all of these things but once a day, you know, and the bare minimum. They might not be seeing physical

therapist. They might not be seeing, you know, occupational therapist or all the specialists. Because, again, the goal is to minimize exposure, so it's whatever is necessary. And they're not allowed visitors. So they have no family who can come and see them. And I think that's one of the, it's difficult. It is very difficult to be isolated in that room for multiple days. Dr. Santa Joffrey works at Providence Everett Hospital in Everett, Washington. And she spoke with the radio hours, Stephen Valentino. This is the New Yorker Radio Hour. More to come. This is the New Yorker Radio Hour. I'm David Remnick.

We're in a time now of terrible uncertainty in just about every aspect of our national life, not least in our politics. Whether the pandemic brings us to a greater sense of common good really remains to be seen, some in the business community and on the right are now arguing that widespread death may be preferable to the economic depression that follows from containing the virus. And President Trump, meanwhile, is insisting

that the country be brought back to work by Easter. And all through this, there's a presidential primary race still going on and we have no idea how the pandemic will affect the November election. To get some insight on all of this, I called up the New Yorkers Washington Corresponding. correspondent Susan Glasser. Susan, hi. Hi, David. Now, you've called this crisis the most clarifying of Donald Trump's presidency. What do you mean by that? Well, look, I mean, all crises reveal. And what we're seeing is

the man in full with all of his limitations, his character quirks, and the strengths and weaknesses of his administration. And by sort of waging war on the institutions of government, as we know it for the last few years, creating and constructing a White House that runs or doesn't run, unlike any other of any Republican or Democratic president, those are the tools that he brings to this most unusual battle. And you couldn't imagine a president personalizing a crisis with a virus. But somehow that's That's where we are. That's where we are. The Trump show applies even to the pandemic. What do you mean by personalizing this crisis? Well, look at one of these daily press conferences that he's now been holding in the White House briefing room. And what do you hear? You hear

the word I, an awful lot. And you hear a president who's dramatizing this as if it's something that is affecting him and him alone. He talks over and over again about how awful the corrupt. coronavirus test was that he had to take, which is literally consists of a swab that was shoved up his nose. And, you know, same thing with the economy. I had the best economy. It was a growing grade. It was the best in world history. Can you believe this happened? Nobody, nobody expected this to happen. And on and on and on it goes. And it's this sort of very narcissistic kind of stream of consciousness approach to a crisis. It's really well documented. The president played down the seriousness of this pandemic for a long time. And do we have any sense of why that is?

You know, this week was the one month anniversary of the president's first substantive tweet about the coronavirus. On February 24th, he said, essentially, this is not coming to the USA in a big way. And we're all going to be fine. And it's not going to really happen here. February 24th, that was more than a month after his... his own government had been warning him that steps needed to be taken that weren't taken. So there might be in the future some sort of a 9-11-style commission to look at why that was. But I think, you know, with Trump, sometimes the answer is pretty transparent. And in this case, I think the answer is pretty transparent.

He didn't want anything to interrupt his reelection campaign plan, which entirely hinged on the strength of the U.S. economy and also the strength of the U.S. economy. and also the strength of the U.S. stock market, which had hit its highest point in February. And that's the risk of personalizing government, where his overwhelming need for a personal political resurrection after his impeachment and trial absolutely overrode the increasingly dire warnings that it seems he was getting from inside his government as well as outside. This kind of reaction, which may be understandable for an ordinary citizen, at least temporarily, seems to me inexcusable for the leader of a country, that he, rather than face the facts of a growing hurricane of cases,

illnesses, death, shortages, and hospitals, reacts the way he is by saying we're going. to be back by Easter and this has to be enormously confusing to so many people in the United States and is likely to cause behavior that leads to tragic consequences. David, that's the essence of it that's so striking is that in the end when the catastrophe came and hit Trump, it was one that had to do with public health and where his flimflammary and narcissism and insistence upon creating, constructing, and projecting, and projecting alternate realities would collide with, you know, empirical reality in such a stark way. You know, the math is the math.

Look at those charts. Look at those numbers. X number of people are sick. Two weeks from now, three weeks from now, X number of people are going to be suffering and dying. We have X number of ventilators. And so I think that really hit home for many people this Tuesday when the president, in the face of that overwhelming scientific and empirical reality, was simply declaring willfully, well, I insist that, you know, I would like to reopen the country by Easter and how people packed into pews. And it's painful to watch it because it gets to the essence of Trump and why he's different

than all other presidents of yours in my lifetime. It's not about ideology. It's about the unique flaws in his character. And for me, that's what makes him so potentially dangerous in this particular kind of a crisis. We've got truth tellers, whatever flaws you may. ascribe to them over time, but you have truth-tellers like Anthony Fauci and Andrew Cuomo, who are speaking straight to the president. How is, from your understanding of what's going on inside, how are their conversations with the

president going? Are they reaching him at any level? Does he just ignore them? Does he push back? How are those conversations going? Well, it seems to be almost erratic in the extreme based on the accounts that you've heard from Fauci and Cuomo in various interviews, they both claim that the president does listen at times that, you know, the sort of abrasive attacking personality that you and I observe in his public

performances is not always the case in private. And you see that with Trump, who has a sort of love, hate relationship with Cuomo, right? He often speaks of the fact that, oh, well, we get along really well, and then 10 minutes later, he'll attack him publicly and suggest that New York, state is going to suffer in terms of federal aid because they're not being, quote, nice to him. And again, they have the problem of needing to speak the truth, maintaining their own credibility with the public and with their own teams. But at the same time, we all know that if you alienate Trump too much, you know, that is a real risk. He'll throw you out the door.

Well, and again, the public safety of New York State in the case of Cuomo and the country in the case of Fauci, to a certain extent, involves them not having some catastrophic rift with the president. And so that's a very, very delicate line that they have to tread. And it really is so worrisome. We've already seen the president publicly attacking numerous governors, mostly of heavily Democratic states. You know, he went after Governor Pritchker in Illinois. He's gone after Cuomo at various points. He's attacked many figures who are crucial to the actual on the ground response to the pandemic. But there's one result in terms of the pandemic. There's another in terms of public opinion. Gallup released a poll which found that the president had a 49% approval rating, which is high for him, with 60% approving of his handling of the crisis. What's driving? his number is so high, assuming that everything that you've said is true? Well, that's right. It is a remarkable phenomenon. So two things we've seen since the beginning of the Trump presidency. Number one,

views about Donald Trump are remarkably fixed and immune to almost any kind of external change or shock. And so no matter what Trump has said and done over the last few years, you know, he's had this core of a little bit more than 40 percent of the country in these opinion polls that have supported him. and then a small group of waiverers. And now what you're seeing in that Gallup survey is remarkable. Essentially, the people who have gone back and forth on Trump, that small number of people who remain undecided, have swung back to approving of his conduct in office for last years.

You don't see Democrats changing their mind about the president. And I think that's the other thing as far as the politics of this moment go that is notable, which is that you have essentially blue America and red America very partisan and divided country right now. They're at least initially experiencing the pandemic in a very different blue state, red state way. And so you have the big cities that are predominantly democratic on the two coasts are being hit first and hardest by this. And Trump seems to be exacerbating those divisions that already exist in the country. with how he's talking about this and some of his rhetoric about wanting to return to normalcy

and how it's not really that big of a deal essentially are playing almost overtly to small, less populated states in the middle of the country that so far have not been hard hit. He actually mentioned the other day Nebraska and Idaho. They can go back to work. And so you see the president playing off of those political divisional. in our country at a time when others would speak of national unity, he seems to be speaking and encouraging division. Are there any Republican senators who are breaking with the president?

We see Lindsey Graham, in a sense. Lindsay Graham, arguing with this approach that the cure can't be worse than the problem. Yes, but to me, what's striking, as it has been throughout the Trump presidency, is the deafening lack of public pushback from Republican senators, Republican House members. I think that's the most remarkable thing. Where you are hearing some rumblings and some pushback is among Republican governors and officials at the state and local level, whose job it is to actually protect the public safety.

So Governor Mike DeWine in Ohio, Governor Larry Hogan in Maryland, Those have been two of the loudest and most effective Republican state officials in terms of their clear-eyed response to the pandemic when implicitly their behavior and their public statements have been a rebuke to Trump almost every day. In fact, Larry Hogan the other day when Donald Trump said he wants to bring the country back to work by Easter Sunday, Larry Hogan just came out and said, this is fate. This is an imaginary timeline. And no, that's not going to happen. Yeah, that may be true. And it is. But the lieutenant governor of Texas, Dan Patrick, suggested on Fox News on Tucker Carlson's show that senior citizens shouldn't put their personal safety from coronavirus ahead of the health of the economy. You know, my message is that let's get back to work. Let's get back to living. Let's be smart about it. And those of us who are 70 plus,

We'll take care of ourselves, but don't sacrifice the country. Don't do that. Don't ruin this great American dream. You're basically saying that this disease could take your life, but that's not the scariest thing to you. There's something that would be worse than dying. Yeah. You know, it's amazing to hear that.

It's really stunning. I, you know, personally, I'm not ready to sacrifice my parents for the, views of, you know, some Wall Street financiers, I have to tell you, it's just shocking that people say things like that out loud. They always joke that Trump is the one who says the part out loud. Well, you often have some of his followers now doing that. And by the way, David, it's not isolated to the Texas lieutenant governor. There are some senators who have said eerily similar things and who have been downplaying the public health risk of this from the very beginning. Senator Johnson from Wisconsin has said similar, if not quite so colorful, versions of the same thing.

And so, you know, again- Well, look at Rand Paul, who tested positive for coronavirus. His father, Ron Paul, wrote a column essentially saying the whole thing was a hoax. And then, of course, Senator Paul, himself, a medical doctor, an ophthalmologist, who ought to know better, went around the U.S. Capitol and put his colleagues' lives in danger, many of whom, as we know, are quite old and therefore at much higher risk from this particular disease. Rand Paul went around the Capitol for, I believe it was more than five days. Joe Biden has been not completely eliminated from the scene. We've heard from him here and there,

but it's almost as if the election is no longer going on, it seems. Isn't that remarkable? I mean, it's an aspect of our national life that's been put almost on hold. And on the one hand, you know, I see a lot of political professionals suggesting that, you know, Biden should just step out of the way and let, you know, Trump implode himself. You know, obviously, many of us look at the situation and say Donald Trump is sabotaging himself and his political fortunes better than any opposition candidate ever could. the stream of lies and mistruths, the incompetence, the failures, you would think that would be a very powerful record he's assembling of opposition research. You saw actually, though, that the Biden campaign clearly is worried that they're too far out of the news cycle. And they started to have to a Biden appearing this week in daily appearances from his confinement or whatever we're calling this,

this quarantine era movement. So he's appearing and giving his own sort of counter-brief. So, you know, do you attack Trump right now, or do you just sort of stand out of the way and let him shoot himself in the foot, metaphorically? Susan, finally, Ronald Reagan once remarked that the most terrifying words in the English language where I'm from the government and I'm here to help, how does that statement hold up these days? You know, it's remarkable when you see Republican senators and Democratic senators rushing together to pass a $2 trillion bailout package for the U.S. economy in a matter of hours and days, the same Republican senators who wouldn't do anything like that in any other circumstance. Politicians, regardless of their ideology, and that includes Ronald Reagan, are willing to throw money at a problem. when it's a problem like this one. But you do feel that the sustained Republican attack on the

institutions of our government, on the very idea that it can be an agent of health, has contributed to what appears to be the incompetence and disorganization of the Trump administration's response to this. There'll be plenty of time. We'll be hashing over what happened and what didn't happen in this national crisis for many years to come, I suspect. But the role of Republicans and specifically the Trump administration in how it handled this, you know, there's going to be some shocking stuff I imagine that we learn when it all comes out. Susan Glasser, thank you so much. David, thank you. Susan Glasser is a Washington correspondent for The New Yorker, and you can read her work at New Yorker.com. I'm David Remnick, and I want to thank you for

listening. However the COVID emergency is affecting you, I wish you and your families the very best. Good health to all of you. We'll be back next week with more of the New Yorker Radio Hour. The New Yorker Radio Hour is a co-production of WNYC Studios and The New Yorker. Our theme music was composed and performed by Merrill Garbus of Tune Arts, with additional music by Alexis Quadrado. This episode was produced by Alex Barron, Emily Boutin, Ave Carrillo, Riannon Corby, Cala Leah, David Krasnow, Gauphin and Putubuele, Louis Mitchell, Michelle Moses, and Stephen Valentino, with help from Alison McAdam, Morgan Flannery, Mengfe Chen, and Emily Mann. The New Yorker Radio Hour is supported in part by the Cherina Endowment Fund.