How a Virus Triage Tent Became a Serene Oasis for Health Care Workers - The New York Times
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On a rare quiet evening in late May, Dr. Dahlia Rizk asked her staff to join her by a campfire. They sat together for more than an hour, sharing the overwhelming horrors and occasional triumphs they’d experienced while treating the coronavirus, as the sounds of burning logs crackled in the background and a bright orange glow filled the room.
“It was a moment to realize that this all happened, this is real,” said Dr. Kamana Pillay, one of those employees in the room. “And to try to get back to some level of normal as a person.”
But Dr. Rizk’s team hadn’t left the hospital. They were sitting on the floor of a former Covid-19 triage tent, right outside the doors of the emergency department at Mount Sinai Beth Israel in Manhattan. The fire wasn’t actually a fire; it was a video projected onto the wall.
A couple months before, this tent had been used for the overflow of patients who had come to the hospital during the worst weeks of the pandemic.
But with the number of virus patients in New York City dwindling down to levels not seen since March, the hospital has transformed the tent into a recovery unit for health care workers.
Where doctors and nurses once tested patients at sterile medical stations, they now lounge in leather recliners surrounded by plants, watching one of nine landscapes. They just need to say where they want to be, and the voice-activated system transports them to the scene. Dr. Rizk prefers the sun rising over the ocean, because it reminds her of her family home in Florida. Each scene has its own soundscape designed by music therapists, and diffusers fill the space with lavender, chamomile and other scents that decrease anxiety.
“You go from hearing beeps and vents and whistles and all the intensity on the ward, with the bright lights, to this serene space,” said Dr. Rizk. “Suddenly something happens that really allows you to decompress almost immediately.”
During the peak of the crisis, the tent was used for the overflow of patients waited to be tested for the coronavirus. Credit...Brittainy Newman for The New York Times
In a survey of about 500 visitors, hospital officials said self-reported stress dropped 60 percent after just 15 minutes in the rooms. Other forms of self-directed stress relief, such as meditation, generate about a 30 percent drop, said Dr. David Putrino, the director of rehabilitation innovation at Mount Sinai. “And that requires learning to meditate. This requires you to just sit down and chill,” he said.
In early March, Dr. Putrino asked Studio Elsewhere, a New York-based start-up, to design a space where hospital staff could recharge in the same ways they might if they had been able to spend time in nature.
Dr. Putrino and Mirelle Phillips, one of the founders of Studio Elsewhere, built the first room in a sub-basement of a Mount Sinai building on 98th Street. They’ve since opened more than 10 of these rooms at five Mount Sinai locations — the tent at Beth Israel opened on May 20 — and have numerous requests from other hospitals looking for ways to help their staff cope with the trauma of recent months.
When the pandemic reached Beth Israel, the doctors at the hospital feared for the physical and mental well-being of the staff. Physicians usually have a playbook to follow. With Covid-19, they were writing the rules as they went.
“There’s fear and there’s anxiety walking in knowing that you don’t have all the answers,” Dr. Pillay said. “And that people who are making decisions don’t have all the answers yet — decisions that involve your safety and your patient’s safety.”
The small teaching hospital treated more than 1,000 of the city’s 209,000 Covid-19 patients, according to hospital administrators.
There was the man in his 60s who walked in with slight trouble breathing and within 24 hours needed to be intubated.
“You know in your heart that the likelihood of him coming off of that was very low and you know to tell him that,” said Dr. Pillay, who treated her first confirmed-positive patient on March 19.
Health care workers in the tent can say where they want to be, and the voice-activated system transports them to the scene.Credit...Brittainy Newman for The New York Times
The man eventually decided against intubation. He was transported to the intensive care unit, where he died days later.
“We referred to patients who died as casualties, because we really felt like we were at war,” said Dr. Barbara Barnett, the hospital’s chief medical officer. “And we didn’t know when the end was coming.”
Members of the staff fell ill, and suddenly doctors were treating their friends and colleagues. There were young patients who looked fine one moment and then five minutes later needed to be intubated. Fathers and daughters and long-married couples came in together, and in many cases, one of them went home alone. “That was really, really hard to witness,” said Dr. Rizk.
Others came in alone, and because of strict visitor policies, could not see family again. Doctors frequently offered their cellphones so that patients could see loved ones via FaceTime or Zoom in their final moments.
The stress mounted. Were they wearing the personal protective equipment properly? Would it run out? Would their colleagues get sick? Dr. Pillay worried about her boyfriend, who had already contracted Covid-19 at his job and was quarantining in a different room of their apartment. Dr. Rizk’s husband and two young children are staying with relatives in Florida. She’s glad to know they’re safe, but that doesn’t fill the silence of an empty apartment.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Does asymptomatic transmission of Covid-19 happen?
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
How does blood type influence coronavirus?
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
How many people have lost their jobs due to coronavirus in the U.S.?
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Will protests set off a second viral wave of coronavirus?
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
How do we start exercising again without hurting ourselves after months of lockdown?
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
My state is reopening. Is it safe to go out?
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
What’s the risk of catching coronavirus from a surface?
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
What are the symptoms of coronavirus?
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
How can I protect myself while flying?
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
How do I take my temperature?
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
Should I wear a mask?
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
What should I do if I feel sick?
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
“You’re afraid to stop, because if you stop and look around it’s overwhelming,” said Dr. Pillay.
In late April, Dr. Barnett learned that her friend and former colleague, Dr. Lorna Breen, the medical director of the emergency room at NewYork-Presbyterian Allen Hospital, had died. Dr. Barnett knew that Dr. Breen had contracted Covid-19, and assumed her friend had succumbed to the virus. The next morning, Dr. Barnett learned that Dr. Breen, who had no history of mental illness, had died by suicide.
“None of us can understand why,” said Dr. Barnett. “She was such a strong, incredible individual. A beautiful person.”
“The amount of death and despair and emotion has been far more than anything we’ve ever experienced. This will have an impact,” one doctor said about the tent. Credit...Brittainy Newman for The New York Times
She added: “But no one can prepare you for this.”
She hopes the relief tent can help the hospital’s physicians, doctors, nurses, security guards and all other employees make it through another day.
“Never in my wildest dreams could I have imagined they’d transform it into this little oasis,” she said. “From the minute you walk in you feel a release.”
Initially Ms. Phillips’s team at Studio Elsewhere and Dr. Putrino were in the process of installing this type of room for the Brooklyn Nets. But then the pandemic reached New York. They quickly redirected their effort to focus on the health of front-line workers.
New York City’s Covid-19 cases are now at their lowest point since March 17. The stress of treating patients with a mystery virus has been replaced with that of uncertainty; public health experts warn that a second wave is likely to hit sometime this summer. As her team waits to see what happens, Dr. Rizk is encouraging them to take time to recharge.
“Everybody is human. Everybody has families. Everybody is also an individual with emotions and feelings. They put that aside and they took care of the patients,” said Dr. Rizk. “But the amount of death and despair and emotion has been far more than anything we’ve ever experienced. ”
She invited her team to sit by the campfire in the tent as a first step in what will likely be a long healing process.
“You go in there and you’re in a different place,” she said. “And then you feel like you’re ready to get out there and face what you need to face again.”
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