As the coronavirus outbreak continues to intensify in the US, hospitals are already beginning to feel the strain, with fears that the healthcare system could end up being overloaded like Italy's was.
"We don't have the machines, we don't have the beds," said a New York City doctor who spoke on condition of anonymity to CNN. "To think that we're in New York City and this is happening. It's like a third-world country type of scenario. It's mind-blowing."
At first, most of the patients at the hospital were 70-years-old or older, but a number of patients younger than 50 have begun coming in as well.
"I don't think they understand the severity of this disease," said the doctor about the younger patients. "Two weeks ago, life was completely different."
Dr. Craig Spencer, director of global health in emergency medicine at New York-Presbyterian/Columbia University Medical Center, described the new reality in emergency rooms as "dire."
"In my shift yesterday, nearly every single patient that I took care of was coronavirus, and many of them extremely severe. Many were put on breathing tubes. Many decompensated quite quickly," said Spencer to CNN. A makeshift morgue is being set up at New York City's Bellevue Hospital in preparation for a possible surge in the need for autopsies.
In New Orleans, where 1 in 1,000 residents are infected, a respiratory therapist was shocked by the influx of COVID-19 patients.
"I have patients in their early 40s and, yeah, I was kind of shocked," said the therapist to ProPublica. "I’m seeing people who look relatively healthy with a minimal health history, and they are completely wiped out, like they’ve been hit by a truck. This is knocking out what should be perfectly fit, healthy people."
COVID-19 patients can be affected by acute respiratory distress syndrome (ARDS), explained the therapist. "That means the lungs are filled with fluid. And it’s notable for the way the X-ray looks: The entire lung is basically whited out from fluid. Patients with ARDS are extremely difficult to oxygenate," explained the therapist. "It has a really high mortality rate, about 40%. The way to manage it is to put a patient on a ventilator. The additional pressure helps the oxygen go into the bloodstream."
While ARDS usually happens over time, it happens a lot quicker with the coronavirus and is very severe.
"With our coronavirus patients, once they’re on ventilators, most need about the highest settings that we can do. About 90% oxygen, and 16 of PEEP, positive end-expiratory pressure, which keeps the lung inflated. This is nearly as high as I’ve ever seen. The level we’re at means we are running out of options," said the therapist. "I’ve never seen a microorganism or an infectious process cause such acute damage to the lungs so rapidly. That was what really shocked me.”
"With all the coronavirus patients, we’ve had to restrain them," added the therapist to ProPublica. "They really hyperventilate, really struggle to breathe. When you’re in that mindstate of struggling to breathe and delirious with fever, you don’t know when someone is trying to help you, so you’ll try to rip the breathing tube out because you feel it is choking you, but you are drowning."
"I worked a long stretch of days last week, and I watched it go from this novelty to a serious issue. We had one or two patients at our hospital, and then five to 10 patients, and then 20 patients. Every day, the intensity kept ratcheting up," he added.
While the hospital started out with more than enough equipment, they quickly started to run out.
"At first we were trying to use one mask per patient. Then it was just: You get one mask for positive patients, another mask for everyone else. And now it’s just: You get one mask," said the therapist, warning that there is a "very real possibility" that the hospital will run out of ICU beds.
"At that point I don’t know what happens if patients get sick and need to be intubated and put on a ventilator," said the therapist to ProPublica. "Is that person going to die because we don’t have the equipment to keep them alive? What if it goes on for months and dozens of people die because we don’t have the ventilators?"
New York state has over 6% of the world's confirmed cases and about half of all US cases, according to CNN. New York City is planning to build emergency hospitals and a hospital for non-coronavirus patients is being built in Javits Center. The state is also working to procure more ventilators.
Dr. Anthony Fauci, director of the NIH's National Institute of Allergy and Infectious Diseases, warned that the pandemic could "overwhelm any system in the world," adding that without enough ventilators "that's when you're going to have to make some very tough decisions," according to CNN.
A nurse in Virginia described her hospital as "exceptionally chaotic." Coronavirus patients are sitting next to other patients in the emergency department. "I think that's extremely reckless," said the nurse.
A nurse in Georgia was denied testing repeatedly, even as she showed worsening symptoms. She cared for several patients who died of pneumonia but were never tested for COVID-19 and was finally tested on Tuesday. "It is insane. And it's infuriating. You feel you have to scream to even be heard," she said to CNN.
Medical professionals throughout the country are trying to continue to provide care while not becoming sick themselves, but a lack of personal protective equipment (PPE) is leaving many vulnerable to infection.
If the virus takes health care workers out of service, "it's game over. It's lights out," said Dr. Peter Hotez, professor and dean of the National School of Tropical Medicine at Baylor College of Medicine, to CNN, adding that there's "nothing more destabilizing for the United States" than such a situation.
Spencer warned that while the US was too late to stop the virus, they could still slow its spread. "Hospitals are nearing capacity. We are running out of ventilators," he said to CNN. "Ambulance sirens don't stop."
These issues and fears are some of the main drives behind the effort to "flatten the curve" and spread out the number of infections over time.
While US President Donald Trump stated that he wanted the country to lift restrictions by Easter, most health experts see that as impossible. Measures such as quarantines, lock downs and social distancing guidelines are aimed at slowing the spread to give hospitals the time and ability to deal with the epidemic.