On Wednesday, The Daily Wire spoke with Dr. Zachary Blankenship, DO, a fourth year Emergency Medicine resident physician working at St. Barnabas Hospital in The Bronx, New York City, the heart of the COVID-19 pandemic in the United States.
As of publication, New York City has just over 19% of total confirmed COVID-19 cases in the United States, and nearly 32% of deaths, according to data from Johns Hopkins Center for Systems Science and Engineering (CSSE) Global Cases map.
[NOTE: The observations/opinions expressed below are that of one doctor in one hospital, and while indicative of what this physician is seeing on the ground in the hospital in which he works, nothing in this interview should be taken as necessarily representative of the experiences of other doctors in other hospitals in New York City and throughout the nation.]
DW: What did you see before on a normal day versus a day during this pandemic?
BLANKENSHIP: The emergency room is always a grab bag. Our specialty consists of really anything and everything that could come through the door. You have a mix of the sickest people you’ve ever seen in your life, and sometimes you have people who are not so sick, or have more minor ailments, and our job is to figure out which is which, who’s who, and where people need to go. Do they need to go to surgery? Do they need to be admitted to the hospital? Can they go home? So, it was just much more of a mix of highs and lows.
Now, what we’re seeing is everybody is sick. Our ER still has a small area that’s dedicated to right now treating people who are coming for non-coronavirus related issues. That section may be a little bit more of business as usual, but that’s a small fraction of the patients who are coming in.
What I’m seeing now is people who are much, much, much sicker. And every once in a while, I have somebody who is well enough to go home and self-quarantine. Then of course, we give those people what we call “return precautions,” saying, “If this happens, come back to the hospital,” or “If this happens, call 911.”
DW: When you’re seeing COVID-19 cases on the floor now, what is that like? What’s the procedure when a suspected COVID case comes in?
BLANKENSHIP: Everybody who is suspected COVID is placed in our section for COVID patients because the test doesn’t come back immediately, and we presume that they have it. One thing that we’re doing is we’re getting a chest X-ray on people as soon as they come in the door. These people all have viral pneumonia, and so we’re basically judging off of that chest X-ray.
The main thing in resuscitation, the first thing is always airway, breathing, circulation – and pretty much all of these people have difficulty breathing. So then we have to decide how we are going to take care of that. Some people can use what’s called a nasal cannula, which is the two prongs that go in your nose. Some people require a mask, which is called a non-rebreather. It’s the clear mask that has a bag attached to it. Then the sickest of the sickest actually get intubated and put on a ventilator.
DW: What’s the intubation process like?
BLANKENSHIP: The intubation process involves a lot of setup, getting all your equipment ready all around the bedside – doctors and nurses, a respiratory therapist, all of the bedside ready to go. You administer medication. Typically, you’ll do one medication for sedation and one medication for paralysis. Then you insert the endotracheal tube and confirm that with your physical exam and with a chest X-ray. Then you attach the ventilator to the endotracheal tube.
We’ve been doing a lot of what’s called video-assisted intubation. We have a machine where the blade that you’re putting in someone’s mouth to look at their airway actually has a fiber optic camera attached to it so you can better visualize what you’re doing.
DW: From a patient perspective, once one has been intubated, are you kept under after the process is completed?
BLANKENSHIP: You are kept sedated because the procedure can be pretty uncomfortable. On TV, they use the term “medically-induced coma.” So, you’re giving people a combination of pain medication and sedating medication so that they are out of it, that they’re unaware of what’s going on, and they’re not responsive to the interventions that you’re doing. We don’t say “medically-induced coma,” we just say the patient is sedated.
DW: What are you seeing as it pertains to intubated patients? Are a majority of your intubated patients recovering?
BLANKENSHIP: I would say the majority, as far as I can tell – and keep in mind this is not epidemiologic data, these are the observations of one doctor at one hospital. What I have seen is typically the patients who are so sick that they require intubation don’t end up doing well, and I’ve had many patients die on the ventilator. It seems to me that the patients who are able to get by without being intubated are the ones who are going to make it. That being said, I just heard this morning on one of our conference calls that we’ve had five patients recently who were able to be extubated and discharged, which is good to hear.
DW: How is this different than the flu, and why should it be taken more seriously?
BLANKENSHIP: What’s frustrating about it is that the flu happens every year, it kills thousands of people, and nobody seems to take it seriously. We can’t convince people to get flu shots. We can’t convince people to self-medicate as far as getting rest and hydration, and taking Tylenol or Motrin for their fever.
This, though, is not the flu. The flu’s course is much more predictable. You get sick people over a much longer time period, so that the capacity for our hospitals, our resource limits, are not strained in the way that they are now.
The other thing about the flu is that even though it can affect people in different ways as far as having respiratory symptoms, as far as having GI symptoms, the severity is just not as bad. Whereas the patients that I’ve been seeing here in the ER, I was really surprised at just how sick these patients are. And it’s not simply people with a little cough, a little fever. It’s people who are really, critically ill.
These patients have respiratory failure requiring oxygen. Most of the flu patients I see do not require oxygen. I’ve seen a lot of heart failure. I’ve seen a lot of heart attacks. And I believe there’s some evidence that the virus directly affects your heart rather than the heart failure being secondary to respiratory failure. All of my patients have deranged laboratory values, like abnormal electrolytes, kidney failure, liver failure.
There seems to be some effect on your blood’s ability to clot and break down clots, which is at a constant balance. And so I’ve seen a ton of people who have blood clots. They’re getting blood clots in the brain, which we call a stroke, blood clots in the heart, or a heart attack. I’ve seen people with blood clots in the leg, too. I’ve also seen patients with bleeding, gastrointestinal bleeding, blood in the urine.
DW: And these are all COVID cases?
BLANKENSHIP: These are all COVID cases. So, these people are being affected almost from head to toe. Multiple organ systems are all being affected by COVID. And don’t get me wrong, there are plenty of people who are getting it, staying at home for 14 days, they’re sick for a few days, and then they feel just fine and they do okay – but the ones who are truly sick are much sicker than any flu patient I’ve ever seen.
DW: Do you have enough PPE, or are you struggling with supplies?
BLANKENSHIP: We’re good. Our hospital has taken good care of us. I think we’ve also received some private donations. We’re not worried about that at all.
DW: How’s the situation with capacity, specifically as it pertains to ventilator access?
BLANKENSHIP: We did have an influx of ventilators. We were able to increase our supply, and we have used most of them. But capacity has been actually improving. This week I worked five nights in a row, and it definitely got better as I went on through the nights as far as number of patients.
DW: What is your stress level like? How has this impacted you as a physician?
BLANKENSHIP: It goes back and forth because as an emergency medicine physician, this is what we were trained for, and we’ve always seen the sickest of the sick. So there are times when I’m in the middle of a shift and I’m just working, working, working, I don’t really have time to think about the bigger picture, and then maybe you get a little lull and you start to think, “Wow, this is really crazy.” Sometimes I’m more negative and feeling extremely stressed, and then other times I feel more positive and think, “At least I’m doing something.” And the camaraderie between staff has been very good, very high, really supporting each other. So, it’s good to know you’ve got other people, and that other people have your back.
DW: How is this impacting your colleagues? How do you see this impacting their behavior or their stress levels?
BLANKENSHIP: It varies from person to person. I think the stress level is definitely higher than baseline. That’s hard to say. I think we’ll know when this is over really just how much people have been affected. But right now, it’s almost like we don’t have time to be stressed because there’s so much to be done.
DW: What would you say to those who are downplaying the impact of COVID?
BLANKENSHIP: Please don’t. Please don’t. That has been one of my big frustrations. Maybe this is some sort of denial. Maybe people are trying to protect themselves because they don’t want to face that. Downplaying it doesn’t just hurt you, it hurts everybody you’ve come into contact with. It hurts people who are older than you. It hurts people who are baseline sicker than you. I think it’s selfish.
DW: We just saw a predicted drop in deaths on the IHME model to approximately 60,400 on the low end, and ICU bed need down to 19,400 or so. Do you think we are effectively flattening the curve?
BLANKENSHIP: That is really hard to say. So much of that depends on where you are because I think there are places that still haven’t been fully impacted yet. Are we effectively flattening the curve? For starters, we definitely weren’t at the beginning of this, right? We had months to prepare for this, and we pretty much did nothing. We were told over and over again, “Don’t worry about it.” So I think at the beginning, no, we did not effectively flatten the curve. However, our interventions, our social interventions, made a difference. Now, I think time will tell.
DW: To those who say that if the curve is flattening, it’s because COVID-19 wasn’t a big deal to begin with, what would you say?
BLANKENSHIP: I would say you’re wrong. The people who are going to say that are not the ones who have just lost a parent or lost a grandparent. Because for those people, it was as bad as we said it was going to be. With something like this, if you over-prepare and things do end up being “not as bad as they said it was going to be,” that’s a good thing. That’s a good thing to take precautions and save lives. What’s not good is a sense of complacency or not doing anything, and then having the alternative happen, where far too many people die.
DW: Is there something that we haven’t touched on in this interview that you would want our readership to know about this whole situation?
BLANKENSHIP: I would just say to please think about others. Please think about how your individual actions are affecting others. Think about what you can do to make the situation better. And I know everyone’s heard it a million times, but please stay home, if you can limit the number of times you leave your home. I’ve just seen and heard from far too many people who are still going everywhere they want to go and doing everything they want to do, and think of this whole situation as some big inconvenience to them personally. So, please stay home. And if you have to go out for any reason – hopefully it’s a good reason – take precautions. Do the things that you know you’re supposed to do.
I don’t want to be too negative, but I have just seen so many people die in the last week. I’ve seen people who are so sick, and we’re doing everything we possibly can, and they still die. And so even though I know I’m helping a lot of people, I still felt like I needed to do something else, which is why I made that video when I came home the other morning because my family back in Oklahoma, and my friends in Oklahoma, they just don’t get it. I think that, I don’t know, maybe the news somehow isn’t real enough to people. So maybe if they see my face and hear my voice, then maybe it’ll become real for them.
[The above reference: Dr. Blankenship posted a video to his Facebook on April 7 in which he asked that people stay home, and explained what he is seeing in a daily basis in the emergency room as it relates to COVID-19.]
And I think that if it never really makes it out to certain places, or they end up having a much lower death toll than predicted, then that’s wonderful. It means we’ve done something right. After the fact, they shouldn’t then turn around and say, “Oh look, this whole thing was some big hoax.” Because for 1.4 million people, it has not been a hoax.
The Daily Wire would like to thank Dr. Blankenship for taking the time to speak about this important issue in this critical time. For information pertaining to the current COVID-19 numbers in the United States, as well as the rest of the world, check out the Johns Hopkins Center for Systems Science and Engineering (CSSE) Global Cases map here.