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CNN Special Reports
Inside the E.R.: The Incredible Fight Against the Coronavirus. Aired 9-10p ET
Aired April 05, 2020 - 21:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
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DR. ROBERT FORONJY, CHIEF OF PULMONARY AND CRITICAL CARE MEDICINE AT SUNY DOWNSTATE: And a lot of that, what that represents is calling for a team to put an individual, a patient on a breathing machine.
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WOLF BLITZER, CNN HOST: Wow. You're going to see much more of Miguel Marquez's CNN's Special Report. That's coming up next right here on CNN.
And I want to leave you tonight with this very, very somber fact. One month ago on March 5th, there were only 11 -- 11 confirmed coronavirus deaths here in the United States. Eleven. Today, April 5th, only a month later, there are more than 9,600 confirmed deaths here in the United States. And I fear what that number will be on May 5th, a month from now. It will be enormous.
As we try to deal with all of this, let's not forget these are the not just numbers. These are wonderful people -- mothers, fathers, sons and daughters -- who will be so severely missed by their loving families. May they all rest in peace and may their memories be a blessing.
And let's not also forget the fact, the doctors, the nurses, the other medical personnel who are risking their lives right now to save lives and all the other men and women who are also risking their lives to simply help all of us get through this coronavirus pandemic. I think I speak for all of our viewers here in the United States and around the world, we are so grateful to all of them."
"INSIDE THE E.R.: THE INCREDIBLE FIGHT AGAINST THE CORONAVIRUS" starts right now.
ANNOUNCER: This is a CNN Special Report.
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DR. ROBERT FORONJY, CHIEF OF PULMONARY AND CRITICAL CARE MEDICINE AT SUNY DOWNSTATE: It's a disaster of biblical proportions.
UNIDENTIFIED FEMALE: Code 99. Code 99. DR. LORENZO PALADINO, EMERGENCY ROOM PHYSICIAN, SUNY DOWNSTATE: The
moment that somebody codes and comes off the ventilator, it's cleaned. The tubing is changed. And it's given to the next person.
CHERYL ROLSTON, DIRECTOR OF EMERGENCY ROOM AND CRITICAL CARE SERVICES, SUNY DOWNSTATE: I fear that we will not have enough of anything to provide for our patients.
MIGUEL MARQUEZ, CNN NATIONAL CORRESPONDENT: What are you dealing with every day?
JULIE EASON, DIRECTOR, RESPIRATORY THERAPY, SUNY DOWNSTATE: People who can't breathe. It's as simple as that. They can't breathe.
DR, ROBERT GORE, EMERGENCY ROOM PHYSICIAN, SUNY DOWNSTATE: We've been prepping for this all our entire careers. We're either going to do this right now or die trying.
PALADINO: We don't want to make the decision between two viable patients by simply trying to decide who is more worthy or flipping a coin.
MICHAEL MCGILLICUDDY, MORGUE SUPERVISOR, SUNY DOWNSTATE: In our facility right now we have 68 that have passed.
FORONJY: The people I feel most for are the families. Especially the ones that never had an opportunity to say good-bye to their loved ones.
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MARQUEZ (on camera): I'm Miguel Marquez in Brooklyn, New York. You're about to get an up close, unprecedented look at just how intense the fight against coronavirus is inside America's hospitals. We recently spent several hours inside a New York hospital experiencing the growing wave of patients overwhelming the city's health care community.
It is disturbing and sometimes deadly. Almost impossible to imagine until you see it. And it's not always easy to watch.
This is INSIDE THE E.R.: THE INCREDIBLE FIGHT AGAINST CORONAVIRUS.
MARQUEZ (voice-over): The frontline in the fight against coronavirus. The Brooklyn emergency room of SUNY Downstate Health Sciences University. Patient after patient, struggling to breathe. This morning has been brutal.
DR. CYNTHIA BENSON, EMERGENCY ROOM PHYSICIAN AT SUNY DOWNSTATE: Today is pretty intense. We have had a bunch of people die in a very short period of time which we, you know, are prepared for, but when it happens so many times in one shift, it's pretty hard to tolerate.
MARQUEZ: As we arrive in the E.R., the latest victim of coronavirus at SUNY Downstate is being wrapped up in the emergency room bay where doctors tried to save them.
We visited SUNY Downstate for about three hours midday Friday. In the short time we were there, in the emergency room alone, six patients coded. In other words, they suffered heart or respiratory failure. Four of them died. A devastating part of just one day.
BENSON: This is what we trained to do and this is what we signed up for. Just not in this volume. You know, you may have a code. Maybe on a bad shift you may have two codes where you carry that emotion and you wonder if you did everything that you could. I think it's emotionally hard to prepare for this level of sickness and suffering and morbidity and mortality in such a short period of time. I don't think any of us are well-prepared for it.
MARQUEZ (on camera): Have you ever seen this E.R. jammed like this?
PALADINO: Not quite like these days, no.
MARQUEZ: You're not at max yet, but you're pushing it.
PALADINO: Yes. We're pushing it. So at times the emergency room here there's no room to move. But we have a system of where we decompress them out behind here in the hallways. Our other room is the fast pack. Not many people have been bringing in their children so we've taken over part of pediatrics. There's also clinics back here that we can turn into beds and they wait there once they're stabilized from here, and then go upstairs.
MARQUEZ (voice-over): The corridors in the E.R. here lined with those suffering from coronavirus. Patients unresponsive, struggling to breathe.
It is the hard reality of this virus. For some patients it attacks the lungs depriving them of oxygen, slowly suffocating them.
PALADINO: With COVID, the pneumonia is not just in one lung, but rather in both lungs, leaving the patient with no good lung. And it's also widespread throughout both lungs with a massive inflammatory reaction that's damaging the lungs.
MARQUEZ: Keep the most critically ill patients suffering from coronavirus breathing, it is as simple as it gets in medicine. But still a mystery as coronavirus resists treatments, confounds doctors and kills patients.
PALADINO: Here in terms of the airway, we have to manage their airway once they become so altered from the lack of oxygen that they're unable to keep it open themselves.
MARQUEZ (on camera): And what is the mortality rate? Once they go on a vent, what happens to mortality?
PALADINO: It increases exponentially.
MARQUEZ: More patients die in other words?
PALADINO: They do. The numbers are not exactly the same from country to country. And there are various factors for that. But we all agree that it skyrockets.
MARQUEZ (voice-over): Dr. Lorenzo Paladino is an E.R. doctor who has done groundbreaking work on putting more than one person on a single ventilator. It's research he hopes that will never have to be used here.
PALADINO: What keeps us up at night is precisely what motivates us to do that kind of research here at SUNY Downstate is that we want an alternative to give to these patients. And not just the ventilators, but also for CPAP and isolation, oxygenation high flow. We try all sorts of maneuvers in order to keep them breathing and keeping them from suffocating or having a cardiac arrest.
UNIDENTIFIED FEMALE: Code 99. Code 99.
MARQUEZ: And it's not just in the emergency room where patients struggle to breathe and code.
UNIDENTIFIED FEMALE: Code 99.
MARQUEZ: While interviewing doctors in other parts of the hospital --
UNIDENTIFIED FEMALE: Code 99.
MARQUEZ: -- nearly constant overhead announcements.
UNIDENTIFIED FEMALE: Code 99. Code 99.
MARQUEZ: That another patient has coded.
UNIDENTIFIED FEMALE: Room 815.
MARQUEZ: Those announcements for patients already admitted, not those in the E.R.
(On camera): Can I just stop you for a second? This --
UNIDENTIFIED FEMALE: Code 99.
MARQUEZ: This is the fifth or sixth code 99.
FORONJY: Code 99 is typically a rare event. We're having I would say 10 code 99s every 12 hours at least.
MARQUEZ: Well, we've been here for about 30, 40 minutes and that's the fifth or sixth one.
FORONJY: And a lot of that -- what that represents is calling for a team to put an individual -- a patient on a breathing machine.
MARQUEZ (voice-over): What is most jarring about seeing the inside of an E.R. and hospital making the transition to being one of three in New York state that will only treat patients suffering from coronavirus, outside it is quiet and feels like an early spring day.
(On camera): It's slow moving. And it's damn boring for a lot of people. But this is a disaster.
GORE: This is definitely a disaster. It's kind of difficult to -- for people from the general public who don't work in the hospitals because when you walk -- when you drive down Clarkson Avenue, you're driving on New York Avenue, on Nostrand Avenue, which are pretty busy thoroughfares, it's almost crickets. But then here in the Emergency Department it's a level of intensity that you only see in disaster zones that have been televised around the world.
MARQUEZ (voice-over): It is a similar situation at Brookdale Hospital just a few miles away. An emergency room inundated with patients suffering from coronavirus. Every hallway, every space filled with those suffering from the disease. The magnitude of the disaster captured in two emergency rooms rapidly filling to capacity.
At SUNY Downstate, patient occupancy has gone up 50 percent in the last two weeks alone and the crest of the wave, the worst part hasn't even arrived.
(On camera): How quickly does a hospital get overwhelmed?
ROLSTON: Within hours you could become overwhelmed. I'll give you an example. We had to open up two additional units to create beds for patients. We had to take up space and create a fourth ICU to accommodate the patients that are coming through the door. So it can change very, very quickly.
MARQUEZ (voice-over): SUNY Downstate is ramping up, adding beds, staff and capacity as fast as possible. Still the worry, it won't be enough.
ROLSTON: I fear that we will not have enough of anything to provide for our patients. That's my biggest fear. We can mobilize staff, staff will triple up, double up, but the support things that we need like the respirators, the bed space, the bed capacity, those are my fears that we are not going to be able to truly meet our patient's needs.
MARQUEZ: The need already overwhelming. When we started our visit in the E.R., one person had just died and was being moved out. By the time we came back around, another victim of coronavirus was moved already into the same bed, struggling to breathe.
MARQUEZ (voice-over): Doctors on the frontline are confronting the mystery of this new coronavirus and the disease it causes COVID-19. It is part of a large family of viruses that have jumped from animals to people before.
Coronaviruses have caused everything from previous pandemic scares such as the SARS and MERS viruses. Coronaviruses are also sometimes simply the cause of the common cold. While most cases of this particular coronavirus see mild respiratory
illnesses, for some the virus invades the body threatening the life of the patient. It is those most extreme cases doctors here at SUNY Downstate are seeing in ever greater numbers.
(On camera): Has he been intubated? Is he on a vent now?
UNIDENTIFIED MALE: Here. He's intubated and he's on the ventilator.
FORONJY: It's a disaster of biblical proportions.
MARQUEZ (voice-over): At SUNY Downstate the barrage of emergency alarms.
UNIDENTIFIED FEMALE: Code 99. Code 99. Emergency stations 1. Code 99.
MARQUEZ (on camera): This is the fifth or sixth code 99.
(Voice-over): A constant and chilling reminder of the urgent need to figure out exactly how to treat coronavirus.
UNIDENTIFIED FEMALE: Code 99. Nursing station 73.
FORONJY: Code 99 could mean someone that still has a pulse, a blood pressure, but is struggling to breathe.
MARQUEZ: Breathing, the number one concern.
(On camera): When somebody comes in here presenting with either COVID symptoms or is positive for COVID, how often is breathing the thing that might kill them?
PALADINO: Almost every time. We always have to do some kind of oxygenation, ventilation and airing maneuver on almost every COVID patient that we keep in the hospital.
MARQUEZ: At the end of the day, this is about people suffocating.
FORONJY: This virus causes tremendous injury to the lungs. Literally causing them to fill with fluid, which makes it difficult for your lungs to grab oxygen.
MARQUEZ (voice-over): A typical virus could be treated with antiviral drugs. So far, none very proven to be effective against coronavirus.
FORONJY: Imagine trying to treat severe bacterial pneumonia without antibiotics. We're basically relying on a machine and the patient's own immune system to recover. And that's not a position we want to be in.
MARQUEZ (on camera): And that's the same sort of ventilator that you can turn -- you can run two or maybe even four patients off of.
PALADINO: Absolutely. MARQUEZ (voice-over): The machine is a ventilator, which helps pumps
air in and out of their lungs.
PALADINO: There's some fluid in the lungs and (INAUDIBLE) areas in this part of the lungs a little bit.
MARQUEZ (on camera): So your suspicion is that's a COVID affected lung?
PALADINO: Yes. This is only one screenshot but as we finished looking at the rest of the lungs as we find multiple areas of this on both sides, it increases our suspicion that he's suffering from COVID.
MARQUEZ (voice-over): At SUNY Downstate, the numbers of hospitalized coronavirus cases show a sharp trajectory just over the last two weeks. And the rate of sheer infections nationwide even sharper.
Johns Hopkins University is tracking cases and so far only shows a sharp rise.
(On camera): This gentleman is suffering COVID as well.
MARQUEZ (voice-over): So what exactly do we know about this virus? The answer still very little.
DR. RAMI NAKESHBANDI, INFECTIOUS DISEASE DIRECTOR, SUNY DOWNSTATE: We don't know that much a about it yet. Even though it's been around for five months. We've been learning about it from other places where it -- you know, it started.
DR. MAFUZUR RAHMAN, VICE CHAIRMAN, DEPARTMENT OF MEDICINE AT SUNY DOWNSTATE: Every single day, we are reassessing our situations, what we have done prior day, prior week, prior month, and try to make sense of it because this is unlike anything we have ever seen. 80 percent, 85 percent of the people stay out of the hospital. Have flu-like symptoms, fever, cough maybe and that's it. Then you've got into this other 15 percent of the patient that come to the hospital because they are ill. 5 percent of those end up in the ICU, intensive care units.
MARQUEZ: The possibility of a miracle cure like the anti-malarial drug hydroxychloroquine touted by the president --
DONALD TRUMP, PRESIDENT OF THE UNITED STATES: I think it could be a game changer, and maybe not. And maybe not, but I think it could be -- based on what I see, it could be a game changer.
MARQUEZ: -- is still far from proven.
RAHMAN: We don't know if those things are working entirely. We do get good responses sometimes. But I have to tell you honestly, the responses have been disheartening at times. We're doing everything we can. Our best we can. But we are not successful most of the times.
MARQUEZ (on camera): It will work on some and not at all on others? RAHMAN: Absolutely.
MARQUEZ (voice-over): SUNY Downstate's infectious disease specialist says the virus and how it acts still surprises him.
NAKESHBANDI: We are looking into a pattern for the virus right now. How it acts on people when people get infected. But every time there is like some kind of new information comes up. In terms of presentation, in terms of management, in terms of response to supportive management or different medications. So we're still having some surprises about it.
The most symptoms so far that we have is fever, shortness of breath and cough. And not every patient has a fever. Not every patient has shortness of breath. So it is ranging, but the combination of those three symptoms, those are the most common ones.
MARQUEZ (on camera): Does the assumption have to be that this virus is just everywhere?
NAKESHBANDI: It's definitely in the community. It's not like there is --
NAKESHBANDI: Nationwide. It is definitely in the community. We're seeing it from patients who have not traveled anywhere or being like just staying in their home on state. So it is definitely in the community. And that's why it's not just avoiding certain kind of patients, but like it should be avoiding going out of home unless if it is really essential and necessary.
MARQUEZ (voice-over): The biggest unknown is how easily this virus can spread.
(On camera): Can it spread through breath? Through somebody just breathing?
NAKESHBANDI: Potentially, possibly. The more symptom the patient has, the more spread and the risk for spreading will be higher for sure. But there are some cases where or there are some instance where the patient is still no symptoms and they start spreading the virus to other people.
MARQUEZ (voice-over): Dr. Foronjy says at this point, better to be safe than sorry.
FORONJY: What I would say to people is to be prepared. My life was pretty normal three weeks ago. And this happened almost overnight. And I think people have to have a high index of suspicion. If you're seeing a lot of flu-like illness now today, you have to suspect it.
Even abnormal symptoms like abdominal pain, nausea, diarrhea, GI symptoms are frequently one of the manifestations of COVID-19. And interestingly, that was not known early. And in fact, in Wuhan, China there were many a patients and doctors that got exposed because they weren't suspecting it.
MARQUEZ (on camera): Does it help you to have people tested rapidly and efficiently so that you know what you're dealing with on that front?
FORONJY: Certainly, testing is helpful. People with symptoms right now I would say you should assume you have it. And here's the other thing I would say. And one of the things that delayed the rollout in testing, this is a PCR test. It's not a simple test that you can do in a doctor's office. PCR actually takes some level of technical skill to do. And the original test had up to 47 percent false negative rate. So that's bad. You're telling people you don't have it and you actually do. If your suspicion is high enough and the test is negative, go with your clinical suspicion.
MARQUEZ: Is this the big one?
NAKESHBANDI: It's definitely one of the biggest ones I have seen. I mean, I have been in practice for almost 10 years now. And this is one of the most aggressive virus I have seen. In terms of the way it spreads, and it's also in terms of mortality rates that we have been seeing compared to other viruses.
MARQUEZ (voice-over): Health care workers here are ready for whatever coronavirus brings.
GORE: We have been prepping for this all our entire careers. And, you know, we're either going to do this right now or die trying.
MARQUEZ (on camera): Let's hope not the latter.
MARQUEZ (on camera): What are you dealing with every day?
EASON: People who can't breathe. It's just as simple as that. They can't breathe.
MARQUEZ (voice-over): Struggling to breathe. Their lungs no longer able to deliver enough oxygen to keep their bodies going. This is the reality for the most extreme coronavirus patients. They need a ventilator to pump in and out of their lungs.
EASON: They are that sick. They are talking to you and then a few minutes later, you're putting a tube down their throat, and you're hoping that you can set the ventilator in such a way it actually helps them.
MARQUEZ: Eason is a respiratory therapist at SUNY Downstate. She manages the ventilators that can help keep patients alive.
EASON: It's not just this machine that they talk about on TV that we don't have enough of. It's very complex. And if you don't set it up right, that patient outcome is different. You need skilled people who have lots of experience doing this to have good outcomes with these patients. And these patients are so different from any patients we have ever seen before. We normally have a couple patients that are this level sick. Our ICUs are filled with them. Filled with them. And none of them can breathe.
MARQUEZ (on camera): Are they unconscious the entire time they are on a ventilator or can they be conscious?
EASON: It's a bit of both. It depends on how critical the patient is. The more critical they are, the more we need to keep them sedated. These aren't basic just push air in and out kind of settings. These are very aggressive and it doesn't feel normal. So the patients are uncomfortable. They have all these tubes on them. If we lose an airway, we can lose them right then.
MARQUEZ (voice-over): Doctors and therapists using ventilators on the frontlines say that being hooked up to one doesn't mean you're in the clear.
(On camera): If you are hooked up to a ventilator, it's as serious as it gets for that patient.
EASON: Yes, it's as serious as it gets.
MARQUEZ: And we spend a lot of time talking about how more ventilators are needed. More ventilators. But if you go on a ventilator, that's not good news.
PALADINO: No, it's not. And you stay on the ventilator for a long time. The average patient who's placed on the vent prior to this pandemic for whatever reason stayed on the vent for only three, four days, perhaps even a week. But with COVID, they are staying on the vent for 21 days, three weeks. So when they take up one of the vents, they also don't give it back to us any time soon. So that vent is taken out of circulation for an extraordinarily long time, longer than we're used to seeing. And that contributes to the shortage.
MARQUEZ (voice-over): When it comes to the number of ventilators needed here in Brooklyn and around the country, health care workers are fearing the worst.
PALADINO: We don't want to make the decision between two viable patients by simply trying to decide who is more worthy or flipping a coin. We want to be able to offer a solution to everybody.
MARQUEZ: For multiple patients to use one machine, Dr. Lorenzo Paladino, who has done extensive research on ventilators, says the practice of splitting a single ventilator only works for some patients.
PALADINO: So right here at SUNY Downstate, we did the experiment of co-ventilation where we ventilated four subjects on a single ventilator. We recommend two, but for proof of concept we did four because we didn't want to try one with three and four. So if we knew if we did four, that two would be easier and possible. You can use it with most ventilators around the country as long as they have the power to generate enough air flow for the two subjects.
MARQUEZ (on camera): And that's the same sort of ventilator that you can turn -- you can run two or maybe even four patients off of if need be.
PALADINO: Absolutely. In fact by coincidence because it was done here, this is the exact model ventilator that we did the research on.
MARQUEZ (voice-over): Some hospitals are already treating more than one patient at a time on a single ventilator. But Paladino says this is a band-aid and not meant for long-term use.
(On camera): You can use literally double the number of vents you have here?
PALADINO: So it's not as simple as that. It's not for every patient. Some patients, we're unable to put them on a vent because of other core morbidities and diseases that they have. It would preclude them for it. For example, if you're having an active asthma attack on top of the COVID, we couldn't share your vent because it would be too complicated for the other patient we're sharing it with you because you need different respiratory parameters.
It's not a solution to not having more vents. It was always meant to be a temporary bridge for hours, 12 hours, until an area hospital can deliver us more vents, or until the stockpile can come. It's not a long-term solution for days or weeks.
GOV. ANDREW CUOMO (D), NEW YORK: Theoretically splitting means every ventilator can help two people. Splitting is not ideal by any stretch of the imagination.
MARQUEZ: As we're moving toward the crest, what goes through your mind?
PALADINO: So every day we look at what the ventilator count is at, at our hospital. We have a robust disaster division here. And so we've been preparing for a long time. My ventilator research dates back over a decade ago. It's the reason is, is that we were worried about SARS, h5n1, the anthrax attack, so we have been preparing for this for a long time. But I think my research might be more applicable to the smaller hospitals that don't have enough ventilators, don't have the preparation, don't have a disaster committee nor the budget for it.
MARQUEZ (voice-over): While SUNY Downstate still hasn't run out of ventilators, the many parts that had to be replaced every time a new patient is put on one, they are in short supply.
PALADINO: The moment that somebody codes and comes off the ventilator, it's cleaned, the tubing is changed and is given to the next person.
FORONJY: The machine itself is the same. But the tubing has to be changed out. The circuits, the filters, and you can imagine ventilator use that we would do in a month we're doing in a day here. This is using up supplies at a rate that no one could have anticipated.
EASON: I call vendors all day long, are my vent tubing coming? My ventilator is no good if I can't connect it to the patient. So I change ventilators, we're using alternate supplies every single day because this one can give me two cases today. That one can give me two cases tomorrow. It's continual to keep those supplies coming in. We're helpless without them.
MARQUEZ: Despite the focus on ventilators, coronavirus patients that do need them still face an uphill battle.
FORONJY: If you're on a ventilator, statistics show that the odds are against you. We're fighting for every single life.
MARQUEZ: New York Governor Andrew Cuomo warned that 80 percent of patients put on a ventilator in the state never recover.
CUOMO: If you go on a ventilator, there's roughly only a 20 percent chance that you will come off the ventilator. The longer you're on the ventilator, the lower the chance you come off.
EASON: It is going to get worse.
MARQUEZ (on camera): Are you ready for it?
EASON: I'm as ready as I can be. You know, I've been preparing. You read about it. You don't think about it. You take it one moment at a time. As the director of the department, I spend hours with logistics making sure that my staff have the tools that they need and that they have the supplies. That they have ventilators. That we have filters that we have -- our armor. We have it right now, but we know we can't take that for granted.
MARQUEZ: You must be incredibly stressed.
EASON: Yes, I'm incredibly stressed. But this is what we do. We'll be doing it every single day. My staff is here. We're ready for this fight.
MARQUEZ: And what do you say is to therapists, doctors, nurses, hospitals across the country where this is coming?
EASON: Get ready. Because whatever you've imagined as your worst day ever, you have not seen it yet.
MARQUEZ (voice-over): Inside and out, SUNY Downstate Health Sciences University is dealing with a massive health crisis. At the same time it is transitioning to becoming a coronavirus-only hospital designated one of three in New York state. DR. WAYNE RILEY, PRESIDENT. SUNY DOWNSTATE HEALTH SCIENCES UNIVERSITY:
We're in high phase. We're turning areas of the hospital that are normally not used for patient care into patient care settings.
MARQUEZ: The ambulance bay being transformed into a war zone like triage area for victims of coronavirus.
(On camera): It has the feel of a field hospital in a warzone.
RILEY: Yes, it does. Yes, it does. We're really taking a lot of tactics from military medicine here to do this. Disaster medicine is you make it up, you improvise, you get creative in times of disaster and epidemic.
MARQUEZ: And you guys have how many beds now and how many do you expect to have?
RILEY: We have about 220 staff members. We're going to plus up to over 350 at two locations.
MARQUEZ (voice-over): SUNY Downstate Bay Ridge, a few miles away was an unused hospital. It's being called back into service.
Back at the main hospital, the tents outside will soon be the first place new patients are assessed.
(On camera): In a week, in two weeks, what will this look like?
RILEY: I think it will be jam-packed. That's what we're ready for.
MARQUEZ (voice-over): The tents, state of the art. Negative pressure chambers to keep the virus at bay and those working around it safe. A regular E.R. has a few negative pressure bays, but nothing like this.
(On camera): Why does negative pressure help?
RILEY: Because if you don't have a negative pressure clinical care setting, the respiratory droplets in the air sort of emitted from a COVID patient would hang around, whereas with negative pressure, it's vented out into the atmosphere where obviously once it gets out into the atmosphere it just disintegrates.
MARQUEZ (voice-over): PPE, or personal protective equipment, micro- resistant gowns, N-95 masks, face shields and gloves still a constant struggle to keep supply.
(On camera): How much do you have? How long can you hold out?
RILEY: Well, we're not OK for today. But we're not OK for next week. And that's the frustration that many of us feel here in New York City and that we only have six or seven days' supply in all of New York City. So my job is to think about next week.
MARQUEZ (voice-over): And ventilators and having enough of them for when the crest comes always a concern.
(On camera): How many do you have? How many do you need?
RILEY: Ventilators we have about 65 today. We have about 30 patients on the ventilators right now. So as you see, as the patients, number of patients continue to come, we're estimating that just about 25 percent of every patient we test will likely need ICU care and-or ventilation.
MARQUEZ: All ages?
RILEY: All ages. The youngest we had here is 3. The oldest is 95.
MARQUEZ: All COVID?
RILEY: All COVID.
MARQUEZ: Wow, 3?
RILEY: Three. A 3-year-old. Good news he went home.
RILEY: Yes. He did go home.
MARQUEZ (voice-over): And what was once the employee cafeteria will be transformed into a coronavirus ward.
JELANIE DESHONG, DIRECTOR, GOVERNMENT RELATIONS, SUNY DOWNSTATE: We're expecting a surge pretty soon. They said about three to six weeks when we reach the apex and that's what we're preparing for. Between hospital which is staffed for 225, we're looking to get probably another 50 to 60 beds in here. And then at our Bay Ridge facility, another 140 beds.
MARQUEZ: To accommodate all those new patients expected in new beds, it will take something in shortest supply. More staff.
DESHONG: We're at 2,000 now. That staffs about 225 beds. I think we need probably another, you know, 1,000 to 2,000 volunteers to come in.
MARQUEZ (on camera): To almost double your staff?
MARQUEZ (voice-over): Twelve volunteer doctors and nurses are already working. Another 30 or 40 want to.
RAHMAN: The group that is in my mind sacrificing the most are the providers. The doctors, the nurses, the respiratory therapists. Everybody who is donating their time. But donating their time is almost taking away from the bigger sacrifice they are making. They are putting themselves at risk, their families at risk, to care for our patients.
MARQUEZ: Rahman, responsible for making sure there is enough of everything, says medication to keep all those patients on ventilators sedated is in short supply.
(On camera): What medications are you running short of?
RAHMAN: We're talking about benzodiazepines, some Ativan, for example, Versed. We're talking about pain medications like morphine. We're talking about sedatives like fentanyl. Precedex, the medications that are required to keep patients on a ventilator sedated so they don't fight the machine and get into more trouble than they're already in.
MARQUEZ (voice-over): SUNY Downstate also ramping up testing. Just this week it is able to conduct rapid tests in house. Only a handful a day right now, but they'd like to be doing as many as 1,000 tests every day.
DR. CAITLIN OTTO, DIRECTOR, MICROBIOLOGY, SUNY DOWNSTATE: Right now, we have one instrument that we can do about 12 tests an hour. But we're quickly getting another instrument and actually a second platform where we're going to be able to do many more than that.
MARQUEZ: One bottleneck, finding enough of these reagents needed to conduct every single test, every part of SUNY Downstate pushing staff and supplies to the limit. The hospital even expanding its capacity to care for the dead.
MCGILLICUDDY: Right now, everyone is on a stretcher. No one is placed on the floor. We're doing it with most respect and dignity.
MARQUEZ: The hospital's regular morgue already full. Two refrigerated semitrailers now serve as a makeshift morgue, shelves will be added to increase capacity. And there is now a plan to close down a side street and move three more trailers into place.
UNIDENTIFIED MALE: They got triage. She adds them in the system, then they come in. They get assigned a bed. As you can see right now, we're basically at capacity full.
UNIDENTIFIED MALE: As E.R. doctors stress here is pretty intense.
MARQUEZ (voice-over): Already intense, stressful, but the coronavirus has yet to throw its most devastating punches at the resilient staff at SUNY Downstate.
(On camera): What you're dealing with is still not the crest of the wave?
GORE: No. This is not the crest of the wave. We need to be ready both mentally, physically.
MARQUEZ: Are you ready for what lies ahead?
FORONJY: We feel prepared.
MARQUEZ: Are you ready?
FORONJY: I feel prepared. And part of the reason I feel prepared is because I have a team behind me.
MARQUEZ (voice-over): And SUNY Downstate isn't alone. Brookdale Hospital just a few miles away is being overwhelmed with patients suffering from coronavirus. Unlike SUNY Downstate, doctors, nurses and staff when we visited a few days ago they didn't have proper protective gear for dealing with a viral outbreak.
DR. ARABIA MOLLETTE, ER DOCTOR, BROOKDALE HOSPITAL: We're doing our best we can here. And we're just asking everybody not only just your prayers and support, if you have donations, if you could send donations with gowns and gloves and masks and, you know, vents, we need it.
MARQUEZ: Look at the difference between SUNY Downstate now only receiving patients suffering from coronavirus. Their staff in proper jumpsuits made to protect from microbes compared to what the staff at Brookdale were wearing. Paper surgical scrubs and the emergency there every bit as intense.
MOLLETTE: Every corner, every part of the hallway, every room, every space has been filled up to capacity with patients. And we're just doing the best we can.
MARQUEZ: Dr. Arabia Mollette works at Brookdale University Hospital Medical Center in Brooklyn, New York.
MOLLETTE: The numbers keep rising. And that's the part that scares me. This is a war zone. It's a medical war zone. Every day I come in what I see on a daily basis is pain, despair, suffering and health care disparities.
MARQUEZ: And the coronavirus battle has only just begun.
(On camera): Do you expect it to get worse?
MOLLETTE: Yes, I do.
MARQUEZ (voice-over): Get worse at Brookdale. Worse at SUNY Downstate. And the rest of the United States.
(On camera): What people are seeing here will be in Columbus and in Chicago and in Miami, and in Los Angeles. This is the proverbial canary in the coal mine for what the rest of the country will see.
GORE: Right. I just did a talk with another emergency department in the Midwest.
[21:50:03] I trained at Cook County Hospital, and they're getting ready for what we're already experiencing right now. They believe that they're probably two weeks behind where we are right now.
PALADINO: What happens in rural America and the smaller community hospitals that have only a fraction of the vents we have, but are being overrun with patients.
MARQUEZ: In those places just a few patients in some cases might --
MARQUEZ: You worried?
MCGILLICUDDY: Extremely. I'm a volunteer fireman. I've run into burning buildings. I've seen accidents. This scares me. For myself, for my family. And for everyone else.
MARQUEZ (voice-over): Michael McGillicuddy is also the morgue supervisor, and these trucks are his new temporary morgue, prepping for what they believe is ahead.
MCGILLICUDDY: I've been a funeral director for over 16 years. I worked with FEMA. This is pretty much the worst that I've seen. Because with the disaster, we know what we're getting. Here it is nonstop.
MARQUEZ (on camera): How many bodies do you guys have right now?
MCGILLICUDDY: In our facility right now we have 68 that have passed.
MARQUEZ: Is either of these trailers full?
MCGILLICUDDY: No, they're not full at all.
MARQUEZ (voice-over): At SUNY Downstate, the workload overwhelming. Even doctors who see death every day have never seen it like this.
FORONJY: We are suffering psychological scars as is the community suffering psychological scars. It's tough on everyone.
MARQUEZ (on camera): Yes.
FORONJY: But I -- the people I feel most for are the families, especially the ones that never had an opportunity to say goodbye to their loved ones.
MARQUEZ: What you've seen is a small peek at what hospitals in New York City are dealing with right now. What's coming in the weeks ahead and a warning to the rest of the country.
(BEGIN VIDEO CLIP)
UNIDENTIFIED MALE: I'm a New Yorker. It's essential that I'm out here.
UNIDENTIFIED MALE: It's a little risky coming outside, but I kind of feel like a superhero saving the world.
MOLLETTE: This is a war zone. It's a medical war zone.
CUOMO: This is an extraordinary time where you need to see people at their best.
UNIDENTIFIED MALE: It is in our heart and it is in our soul to sacrifice, to serve, to fight for you.
UNIDENTIFIED FEMALE: I travel coast-to-coast, as long as we can haul food for the American people, you will have plenty of food on those shelves.
UNIDENTIFIED FEMALE: My heroes are all of the people that I work with who are showing up and helping us fight this pandemic.