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U.S. Death Toll Surpasses 3,000 on Deadliest Day; WSJ: New York Hospital Asks Doctors to Think Critically About Who to Intubate. Aired 6-6:30a ET
Aired March 31, 2020 - 06:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
UNIDENTIFIED FEMALE; This needs to be federal guidance. It may look like two cases today that become 20, that become 200, that become 2,000.
GOV. ANDREW CUOMO (D-NY): Please come help us in New York now. We need relief for nurses who are working 12-hour shifts.
UNIDENTIFIED FEMALE: We are playing whack-a-mole. There are other places that are going to come up and be a problem.
UNIDENTIFIED FEMALE: I'm out there literally every day and all night, scouring the globe to try to find the necessary life-saving equipment that we need.
UNIDENTIFIED FEMALE: It feels like coronavirus is everywhere. We need everyone at home to hold the line. Stay at home. Buy us time.
ANNOUNCER: This is NEW DAY with Alisyn Camerota and John Berman.
JOHN BERMAN, CNN ANCHOR: Welcome to our viewers in the United States and all around the world. This is NEW DAY. It's Tuesday, March 31, 6 a.m. here in New York.
And as of this morning, coronavirus deaths in the United States have passed 3,000. And according to the country's leading health experts, it's just the beginning.
Yesterday was the deadliest day yet, with more than 550 deaths reported. There are now more than 160,000 reported cases in the country. More than 1,200 people in New York alone have died.
The governors of New York and California are making urgent appeals for help. Governor Cuomo of New York says that this state needs one million more workers to tackle the crisis.
ALISYN CAMEROTA, CNN ANCHOR: And John, the battle on the front lines is still desperate. There is still mounting frustration about equipment shortages. Healthcare workers are still getting sick, which means they cannot take care of the influx of patients.
A trauma physician in Miami tells someone, quote, "We are slowly descending into chaos," end quote.
This morning, "The Wall Street Journal" reports that one New York hospital is beginning to advise doctors to think more critically about which patients get ventilators. In other words, they're preparing for rationing.
Seventy-eight percent of Americans are under stay-at-home orders after Maryland, Virginia, and Arizona issued new directives on Monday. Some states like Florida have resisted statewide orders despite Miami becoming a new hot spot, along with Detroit and New Orleans.
So let's begin our coverage in New York with CNN's Brynn Gingras. She is live at a makeshift hospital that has been built in New York's Central Park. So just explain how this works, Brynn.
BRYNN GINGRAS, CNN CORRESPONDENT: Yes, Alisyn. Well, this area of Central Park is usually used for people who want to exercise, want to relax. There's baseball fields nearby. Coronavirus is literally changing the landscape of New York City.
I want to show you these tents here behind me. There are 68 beds -- 68 beds for coronavirus patients, overflow from a nearby hospital. It's held from a Christian group out of North Carolina. And this as governors, really, across the country are pleading for more supplies and more personnel.
GINGRAS (voice-over): New York Governor Andrew Cuomo sending a desperate plea.
CUOMO: I am asking healthcare professionals across the country, if you don't have a healthcare crisis in your community, please come help us in New York now. We need relief. And we will return the favor.
GINGRAS: Earlier some relief arriving to New York City in the form of the U.S. naval hospital ship Comfort. On board, 1,000 beds and more than 1,100 medical personnel, ready to treat patients who are not fighting the coronavirus. The vessel, the latest temporary hospital to deal with overcrowding in the city's medical centers.
MAYOR BILL DE BLASIO (D), NEW YORK CITY: But I want you to understand the sheer magnitude of the plan. We need to triple our hospital bed capacity in New York City by May.
GINGRAS: "The Wall Street Journal" reports that one city hospital is asking doctors to think more critically about which patients get ventilators.
Inside one of New York's intensive care units, a nurse practitioner showing the harsh reality.
UNIDENTIFIED FEMALE: It's as bad as I've ever seen anything before. These are patients that are the sickest I've ever seen.
GINGRAS; This, as officials brace for the days ahead in emerging hot spots across the country, like New Orleans, Detroit, and Miami. In California, the Los Angeles Convention Center will be used to help the sick.
But the governor says that, along with the equipment, the state also urgently needs more healthcare staff as coronavirus-related hospitalizations doubled there within the past four days.
GOV. GAVIN NEWSOM (D-CA): We're in the middle of this. We believe very strongly the stay-at-home order has helped advance our efforts in reducing the stress on the system.
GINGRAS: Three out of four Americans are under stay-at-home orders this morning. That's more than 250 million people. President Trump says it's unlikely he'll enact them nationwide.
DONALD TRUMP (R), PRESIDENT OF THE UNITED STATES: We've talked about it. It just was something that was very unwieldy, very tough to enforce and something we didn't want to do.
GINGRAS: State leaders once again asking the Trump administration for more critical supplies and test kits, saying it's unfair to compete with others domestically and internationally for what they need.
GOV. J.B. PRITZKER (D-IL): I can't stress enough how much we need the federal government to step up and amplify the size of their PPE deliveries to Illinois, and frankly, across the nation.
GINGRAS: And listen, the stress on hospitals isn't the only problem. There are officials on every level begging people to do their part and to social distance.
In New York City, there's fines that are being handed out for people who don't comply. That's happening in other cities, as well. In New Jersey -- get this, John and Alisyn -- there were arrests, because people were trying to hold weddings -- weddings -- and large parties, as well. Social distancing is certainly half the solution to this pandemic -- guys.
BERMAN: All right. Brynn Gingras in Central Park.
Brynn, I have to say, those tent hospitals behind you in the park where so many people usually run every day or sit in the sun, that is a remarkable sight to see.
Joining us now, CNN medical analyst Dr. James Phillips. He's a physician and assistant professor at George Washington University Hospital.
Also with us is Lynn Hughes. She's a critical care nurse at Staten Island University Hospital.
And Lynn, I know you've been working 12-hour shifts. We just heard Governor Cuomo say, if you're a healthcare worker anywhere else in the country, please come to New York and help now. Tell us what you're seeing in the hospital where you work.
LYNN HUGHES, CRITICAL CARE NURSE: Well, seeing things I've never seen before, 37 years in ICU. And every patient is ventilated. It's the entire hospital, for the most part, is COVID-positive patients. We have them separated. The ICU and CCU, we're pretty much isolated units for just COVID patients.
CAMEROTA: I mean, Lynn, I just want to stick with you for one second, because as you said, you've been an ICU nurse for 37 years. You've never seen anything like this. You've been at that hospital, I think, for 21 years.
And, I mean, you have, I think, been really candid and open about the emotional toll that it's taking in the ICU on the healthcare workers. I mean, one of the things I read is that you said we -- that there are days that we feel like this is never going to end.
I mean, the rest of us who are not the front lines even feel that way. And so what do you all do when you can't see the light at the end of the tunnel?
HUGHES: Well, we pick each other up. We have a great crew. We're like a family. When one of us is having a bad time, you know, we say we'll do this. We'll do this together. You know, it's the only way we can get through it. That and, you know, you sit and say you do this and hope that your family stays safe.
BERMAN: It's a special kind of courage that you're saying every day, Lynn, and again, we thank you for everything you're doing.
Dr. Phillips, I want to ask you about another piece of news we're reading this morning, this in "The Wall Street Journal," that an email went out to medical workers and physicians at NYU Langone, suggesting they think more critically about who gets intubated, who gets put on a ventilator.
Let me read you a little bit of the email. "For those patients who you feel intubation will not change their ultimate clinical outcome (for example, cardiac arrests, some chronic disease patients at end of life, et cetera), you will have support in your decision making at the department and institutional level to withhold futile intubations."
What do you make of this note? What does the fact of it tell you, Doctor?
DR. JAMES PHILLIPS, CNN MEDICAL ANALYST: It's heartbreaking. So, good morning and thank you for having me on.
Lynn, thank you for the work you're doing. It's an honor to be on the air with you. What NYU is doing is supporting its physicians. We wrote a piece in
"The New England Journal of Medicine" last week. Ezekiel Emanuel and the rest of our great team put a piece together about resource allocation in the time of COVID-19. What that specifically gets to is how do we decide who gets a ventilator and how do we decide if someone doesn't?
What New York is doing is helping to alleviate the burden of the individual physician by trying to enact some measures, some -- some guidelines by which doctors don't have to make that decision on their own and then live with that decision the rest of their life.
I'm also recommending that from all hospitals, but I feel like we should be seeing that from our professional societies, as well as perhaps even from the federal government, from the CDC, so that we don't have to live with that burden alone.
CAMEROTA: Yes. I mean, Doc, just so that we understand, what NYU Langone says is that these guidelines already existed, OK? They are just reminding their doctors that they have their backs and that these conversations are starting.
And so do you see this as yet the next step in rationing? Or futile intubations, why are we doing futile intubations to begin with?
PHILLIPS: That's a great question. Well, we're not sure who's futile or not. So one of the -- one of the most difficult challenges of having a novel virus like this is that when patients get admitted and they get put on a breathing machine, there's a lot of tests that we run, everything from checking cardiac enzymes to inflammatory markers, looking at imagine like X-rays and CAT scans. But we have yet to find that one test that will tell us this person is going to survive or this person is going to die, no matter what we do.
In a situation where we're running out of ventilators, if we were able to find a marker that says this is futile care before we put someone on the ventilator, then instead of using that precious resource for someone who is going to die anyway, we can instead transition them to palliative care and allow them to be comfortable and, potentially, even share that time with their loved ones for what's left. And thereby free up that resource from someone who's got maybe a better chance of surviving.
BERMAN: It's a brutal decision. It's a brutal discussion to even be having, but it's one that we have to have and has to be had at every level, including families and individuals, who should have this discussion to help take the pressure off the medical workers for patients who end up there, as well.
Lynn, I want to go back to you, because yesterday was the deadliest day in America for COVID-19. More than 570 deaths. And we're told here in New York City that the peak might be not for another two weeks. So what does that mean for you? How will you be able to handle a surge even greater than where we are right now? HUGHES: Well, we have to take it one day at a time. The hospital is
constantly reviewing the strategies and working with the staff to try to, you know, have us do extra shifts if we can. Everybody's just pitching in together. You do what you have to do.
CAMEROTA: Hey, Lynn, when -- When Governor Cuomo says -- you know, makes that appeal for healthcare workers from other states to come in and have it be all-hands-on-deck, would that -- is that easy when -- when nurses show up from another state, let's say at your hospital? Do you have to train them or can they just dive in with their skills?
HUGHES: Well, we haven't had out-of-state nurses yet. Most of the time, though, when you do have people come in from a different area, I mean, critical-care nursing is critical-care nursing. The systems that we use as far as documentation may be different, but once a nurse, always a nurse.
BERMAN: Doc, let me get you to weigh in on another piece of news we've been hearing. Governors around the country have been pleading for more tests.
The president says, Well, he hasn't heard that testing's an issue anymore. I want to play an exchange that "The New York Times" posted from Gov. Steve Bullock of Montana and the president during this conference call yesterday. Listen.
(BEGIN VIDEO CLIP)
GOV. STEVE BULLOCK (D-MT) (via phone): Literally, we are one day away, if we don't get test kits from the CDC, that we wouldn't be able to do testing in Montana.
TRUMP (via phone): Tony, you can answer it if you want but I haven't heard about testing in weeks. We've tested more now than any nation in the world. We've got these great tests and we're coming out with another one tomorrow where, you know, it's almost instantaneous testing. But I haven't heard about testing being a problem.
(END VIDEO CLIP)
BERMAN: So let's take Governor Bullock's word for it that there is a testing problem, notwithstanding the fact the president hasn't heard about it. We've had some million tests in the United States now. Why, from a medical perspective, isn't that enough? What more do we need from testing in the United States right now?
PHILLIPS: Right, that's a great question.
So we have, what? Three hundred and fifty million people in the United States, and just because you test positive or just because you test negative once doesn't mean that you're still negative a week later when you're still encountering people that could be giving you the virus.
What's important is that we're able to determine who has this disease for several reasons. First and foremost, for Lynn and I, when people come into the emergency department, and they're having respiratory difficulties, we need to know if that's because, is this a virus? Is this a cardiac problem or a simple pneumonia otherwise, so that not only do we know how to treat it appropriately but know where to place that patient. Because if they are positive, we want to keep others from getting sick.
We seem to have an adequate amount of testing in most parts of the country to do that for in-patients. But for patients that I'm sending home, that I see every day, I'm still sending them home and either telling them just, You have this. I have to diagnosis it clinically, and I need you to isolate at home, or, I can send them somewhere to get a test, but it's taking up to eight to nine days to get that back from a lab.
More importantly is the idea of surveillance, where we are testing the population randomly to determine if that disease is out there in an asymptomatic way. If we're talking about preventing second and third waves, that has to happen, and that requires tens of millions of tests, if not hundreds of millions of tests.
CAMEROTA: Dr. Phillips, Lynn Hughes, thank you so much for explaining all of this to us. I think that you really helped our understanding, and thank you for everything that you're doing in the hospitals. We are really grateful to you and your colleagues.
PHILLIPS: Thank you.
CAMEROTA: Should we all be wearing masks? Now, for weeks the guidance from the White House was no. But that guidance could be changing this morning, so we'll discuss next.
(BEGIN VIDEO CLIP)
TRUMP: We're not going to be wearing masks forever, but it could be for a short period of time after we get back into gear. People could -- I could see something like that happening for a period of time.
(END VIDEO CLIP)
CAMEROTA: OK, that was President Trump, saying he could see a scenario where all Americans should wear masks in public to prevent the spread of the virus.
This morning, "The Washington Post" reports that the CDC is considering changing the current guidelines that argue against using masks for everyone.
We are back, joined again by Dr. James Phillips, as well as ICU nurse Lynn Hughes.
Dr. Phillips, should we all be wearing masks? Would that help?
PHILLIPS: That's a tough question. So, I think an explanation's in order, and I'll keep it brief.
So the N-95 masks that we wear in health care should not be worn by the general public. There's not any great proof that that's going to make a big difference. Those are used to prevent getting the disease from healthcare workers that are in close proximity to patients with it.
Now surgical masks or the cloth masks that you often see people -- are different. Those are designed to keep the droplets that may be infected from coming out of your own mouth and nose onto other people, thus spreading the disease.
It makes logical sense that if everyone, including those who may be spreading the virus, was wearing that mask as sort of a shield over their face to prevent droplets from getting out into the air, that it would limit the transmission of the virus.
Now, cloth masks are not recommended to try to prevent you from getting disease. That's been shown to not work. That's why we don't wear cloth masks in the hospital.
I think the CDC and the federal government will end up coming out with a recommendation for people to wear masks, specifically to prevent droplet spread. I think that's coming.
BERMAN: It's not to keep you from getting it. It's to keep you from spreading it is really the issue.
And one problem with it, of course, is complacency. If everyone does wear them, people might think there's no way of getting it if they walk outside. That's simply not true.
Lynn, to you. How would you feel if you walked out of your shift and saw people on the streets on your way home wearing masks?
HUGHES: Well, as long as they're surgical masks. I do get a little aggravated when I'm out and I see people with N-95 masks on, knowing that, you know, we're trying to make sure that everybody in healthcare that comes in contact with these patients has the proper PPE.
But, you know, if that makes people comfortable. It does do one thing. It keeps you from touching your face and your nose, which is part of the spread, as well.
But everybody just needs to wash their hands and stay home.
CAMEROTA: That would be the best guidance, yes.
But I hear you, that it does protect you, in that it keeps you from -- you know, we all touch our face, we now know, all the time. So it cuts down on that in terms of protecting you.
And, Doctor, as you say, it cuts down on you spreading the droplets. I don't have any masks, N-95 or the standard surgical, but I do have
some lovely silk scarves in my closet. Should I -- would those help? Do homemade masks like a scarf, Doc, would that help?
PHILLIPS: So in an important distinction, I'll say yes, and I'll explain why. The -- will they help keep you from getting the disease? The answer is no.
What happens, the way you get the disease is by inhaling particles that are, like, 5 microns in size -- very, very, very, very small -- that would go through any silk scarf or cloth mask.
But if you yourself are sick, even if you don't know it -- and those are the ones we're the most worried about -- by coughing into a -- or breathing into a scarf or a cloth mask, you're preventing that -- those droplets from getting out into the air around you, and that keeps someone else from inhaling it. Just like coughing in or sneezing into your elbow. It's the same concept. It's acting as a shield.
So in that case, if I walked out and I saw people wearing scarves around their faces everywhere they go, I'd be a very happy doctor.
BERMAN: Let me note that your scarves are beautiful, and I'm not diminishing them in any way, but there are all kinds of medically- approved sites that are now issuing guidelines and instructions on how to make cloth masks, if you want.
If you have a sewing machine, and if you know someone who has a sewing machine, there are guidelines now to make them as best you can. And I advise people to check some of those out.
Lynn, again, thank you for everything you're doing. We really appreciate it. We hope you get some rest sometime before you go in again.
BERMAN: Hang in there.
HUGHES: Stay safe.
BERMAN: And, Dr. Phillips, our thanks to you, as well.
PHILLIPS: Yes, thanks a lot. Take care, guys.
BERMAN: All right. So --
CAMEROTA: John, perhaps you can send me some of those links that you are suggesting.
BERMAN: You and I both know someone who can make stuff like this.
CAMEROTA: I know we do.
BERMAN: All right. Hundreds of passengers this morning in limbo on board a cruise ship stricken by coronavirus. The latest on this Holland America ship and reports from some emerging hot spots. That's next.
BERMAN: New this morning, the president of Holland America cruise line is pleading with Florida officials to allow one of its cruise ships that has passengers stricken with coronavirus to dock.
On Monday, Governor Ron DeSantis said that would be a mistake. Four people on the Zaandam cruise ship have died. Two passengers have tested positive, and nearly 200 others are exhibiting flu-like symptoms. Passengers, we are told, are getting desperate. A man whose parents are on board spoke with CNN's Anderson Cooper.
(BEGIN VIDEO CLIP)
UNIDENTIFIED MALE: It's heartbreaking. I mean, they never do things like take cruises. They never spent any money when we were growing up. And finally now, us kids are self-sufficient adults; they can do things like this.
And they get caught up in a global pandemic and stuck out at sea for a month and can't come home while they're not feeling well. It's truly a nightmare scenario. And, you know, if your own country won't take you in, where are you supposed to go?
(END VIDEO CLIP)
BERMAN: The son went on to say his father has been exhibiting minor symptoms now for a few days.
CAMEROTA: This morning the death toll in just New York from coronavirus tops more than 1,200. Deaths here are expected to peak within the next nine days.
But other states like Tennessee and Florida are not projected to peak for weeks. Health officials are warning that the crisis that you see in New York is a preview of what's to come across America. So we have reporters spanned out across the country with the latest.
ED LAVANDERA, CNN CORRESPONDENT: I'm Ed Lavandera in New Orleans. The number of coronavirus cases here in Louisiana has now topped more than 4,000, and nearly 200 people have died.
State and health officials are worried about two things. One, a shortage of ventilators.