Dara Kass is an emergency medicine physician at New York–Presbyterian Hospital and Columbia University Irving Medical Center in New York City, the epicenter of the U.S. coronavirus outbreak. She usually works the weekend shift, but she’s not going to the ER right now—she’s quarantined at home after having tested positive for COVID-19. In just a matter of time, she went from doctor to patient. And she’s wondering when she’ll be able to get back to the ER and help others suffering from the disease.
Kass spoke to me remotely from her home for Thursday’s episode of What Next. We talked about life with COVID-19, what it’s like to be a provider with the disease, and the strain on the NYC medical system. Our conversation has been edited and condensed for clarity.
Mary Harris: Who do you think your first patient with COVID-19 was?
Dara Kass: I don’t know. I had taken care of a patient in late February who I thought had a very weird presentation of a fever and a cough. I went through this thing in my mind: She had no travel history, showed no risk factors, met none of the CDC criteria. But then she coughed on me, and it was the first time I thought I should protect myself from patients.
That weekend felt the way I think a lot of other hospitals are going to feel as this happens. There is a calm before the storm. That is really scary because you wind up discharging a bunch of patients who most likely don’t need to be there.
So you discharge patients to make room for a surge—
Yeah, the system does that. And then the next day you start seeing patients coming in a little sicker, a little more short of breath, their oxygen levels a little lower. Now we’re intubating not just a 90-year-old or a 50-year-old—we’re admitting two patients at the same time.
You’ve said your bosses did all they could to prevent getting to the place they are in now.
I am proud of how Columbia has addressed this from the beginning. Working in one of the major medical centers in New York City, we always knew we would be overrun with patients when the coronavirus came to New York. And they have been incredibly honest and consistent with their desire to help and be leaders in this field.
Is there a bar here?
You can only do what you do, right? They’re not testing nearly enough people because they can’t. They’re not testing nearly enough health care workers because they can’t. It is a really difficult thing to tell people who probably have the virus: “You probably have it. I wish I could test you. I wish I could give you closure.” It’s uncharted territory for us as doctors to watch patients who look like us get really sick without preparation.
With COVID-19, are you seeing lots of patients who are young, who look like they could be working alongside you in the ER?
It is still overwhelmingly the case that the patients who come in sick are going to be over the age of 60. This disease does have a prevalence among older people. But that has nothing to do with it sparing younger people. So for the first time ever, we are intubating patients who look like us. It’s not just one random person who has a lung disease or somebody who has a really extraordinary case of cancer. It is the consistency that every day, on every shift, there will be one patient under the age of 50, at least, who will lose the ability to breathe on their own.
It sounds like what you’re doing is both talking to other physicians who have found themselves suddenly ill and also talking to physicians who are slogging through it every day but seeing themselves in their patients and feeling helpless.
That’s exactly right. And that’s where the cycle of anxiety and fear for the health care workforce is coming in. We are helpers first and foremost. We rearrange our lives for this. We are ready to take care of patients. But now we have these other experiences. If I come home to my family, what happens when I get infected? Am I going to become one of those patients who’s not going to make it?
We have seen patients after five or six days, especially young patients, take a turn for the worse and lose the ability to breathe. It makes it super existential: For me, as long as I can breathe today, I’m going to use my breath for a purpose.
How many health care workers do you know who are now positive?
It’s more and more each day. Every day I get multiple texts from friends who find out they’re positive, or they’re waiting for tests. There are many friends who are exposed at work in different health systems who still cannot get tested. In New York City right now, if you’re not sick, even as a health care worker, you still can’t get tested.
You sent your kids to stay with family. One them has an underlying condition.
You make a decision that feels dramatic. But you do it because you want to protect your family from you. I mean, my husband stayed with me and I think he probably has it. I think he just started showing symptoms a couple days ago. So that’s a whole new wave of anxiety for me. I’m going to watch him closely, and he’s going to take deep breaths. As long as he can breathe, we’ll be fine.
You said on Twitter that in quarantine, the nights are the worst. What are you thinking about?
I’m thinking, am I still breathing? Is my breathing weird? Am I having chest pain? What’s going on here? And then I’m thinking, the president said to he’s going to consider getting rid of social distancing because he’s tired of this and wants to get the economy working again. What does that mean? We haven’t even gotten ahead of what’s going on in the world. Scientists are being sidelined for what really amounts to propaganda. It’s not getting better. There are no magic medicines. There are no cures. This is going to be hard work for a lot of people and it’s going to take a long time. And if we’re the ones going on the front lines, seeing patients, taking care of them, making sure everybody is safe, how is it that the person who’s supposed to take care of us is saying it’s not that big of a deal?
How do you imagine your first day back in the ER?
Every day, I’ve been getting reports from friends: “I’m mentally exhausted,” “I didn’t eat,” “I snapped today,” “This is so hard and I’m so nervous.” I told a friend it’s going to be a rough few months for New York. She’s said, “New York is already at a rough time.” And that was on Saturday.
So things have gotten worse since then.
I mean, they’re going to get worse every day. There was a paper in the New England Journal about the responsible and moral choices we’ll have to make about whom to ventilate and whom not to ventilate.
I saw that paper and it broke my heart because it was saying in the wonkiest way that we’re going to have to make hard choices, and here’s how we’re going to make them. I think it recommended some kind of panel to decide who gets taken off life support.
We are going to have to make decisions that none of us are prepared to make for our families, for our patients, and for ourselves. Deciding what the algorithm looks like, whom to intubate, what to do with nursing home patients who get sick with this. Do we ventilate a 90-year-old with dementia or a 40-year-old with three kids?
This is why it’s different, right? It’s different because most of these days will end with people not being saved. Certainly not the majority of people, and certainly not all the ones you wanted to save or even could save.
Can I ask what you’re going to do for your husband? Because you’re saying he woke up feeling unwell.
He’s not having shortness of breath. But I’m going to do the same thing I did for me. I handed him a bottle of Tylenol, a pulse ox, an albuterol inhaler, a thermometer, and a bottle of water. And I’ve told him to lay down in bed.
Are you going to get him tested?
He doesn’t meet criteria to be tested.
Even though he’s been living in the same house with you?
That’s not the criteria right now. The criteria is people who are sick and have had known contact, or people who are sick and are health care workers. I got tested through a window of opportunity that I don’t think exists anymore.
We’ve been listening to your voicemails about how you’re dealing with the outbreak and the lockdowns. These messages are helping us feel connected during a very solitary time. So keep calling us. The number is 202-888-2588. Or you can find me on Twitter @marysdesk. Stay well.