Submitted Photo This photo from Dr. James Auran shows a refrigerated truck (temporary morgue) in New York City.

Editor’s note: Dr. James Auran, formerly of Minot, is professor of Ophthalmology at the Columbia University Irving Medical Center and chief of the Department of Ophthalmology, NYC Health and Hospitals/Harlem. He sent the following letter to The Minot Daily News, explaining the COVID-19 pandemic in New York.

I grew up in Minot, leaving my junior year of high school, ended up on the East Coast, got my medical degree, eventually becoming quite possibly the first and only North Dakota native to run a department in a New York City safety net hospital.

When the COVID-19 pandemic hit New York in early March, everyone was caught off guard. New York was slow in closing schools and nonessential businesses, and this is an exceptionally contagious virus: it lives on surfaces for days and lingers in the air for hours; it can be spread just by breathing and talking. It is as or more contagious than the flu or the common cold, although the disease it causes is exponentially more deadly. We were forced to write policy and protocols from scratch in response to a rapidly escalating situation. Each day brought stricter and more extreme measures at the hospitals.

Although media reports sounded bad, I was struck by how the media was actually lagging behind in reporting the scope of the problem. There was strict rationing of personal protective equipment due to severe shortages, and testing for COVID-19 was almost nonexistent … not that testing matters: the assumption was at one of my hospitals that everyone had the virus so testing was superfluous, and the current nasopharyngeal swab test has a 30% false positive rate, meaning that 30% of the time someone with a “negative” test result actually has the disease (take home lesson: if you have the symptoms, assume you have the virus).

The Chinese ophthalmologist who blew the whistle on COVID-19, Dr. Li Wenliang, had two negative COVID-19 tests before he eventually turned positive and died from the disease. I too had two negative COVID-19 tests, and like many of my colleagues, fell ill early on: shortness of breath, cough, fever, loss of smell and taste, and an inability to think straight. It was a frightening experience. At one point I tried running in place, after 15 seconds I became dizzy and the oxygen levels in by blood had plummeted (oxygen saturation 80%). I crashed at day 8, an immune system overreaction described as a“cytokine storm”, and came close to (but avoided) a trip to the emergency room, a trip I feared might be one way. I have largely recovered, although as so often happens, I still suffer from foggy thinking and shortness of breath. The effect on the brain is significant, COVID-19 is a virus that invades the nervous system, and my neuro-ophthalmologist colleagues are reporting odd side effects like vision loss due to inflammation of the optic nerves.

I was treated with best-guess therapies: we haven’t had time for the luxury of controlled clinical trials. I was put on hydroxychloroquine, azithromycin, and high dose vitamin C. Although all of these may help, and excessive attention has been paid to hydroychloroquine, these are just three medications in a broad range of therapies under investigation. To give you an idea of the present thinking on COVID treatment, the Massachusetts General Hospital posts continuously updated treatment guidelines:

https://www.massgeneral.org/assets/MGH/pdf/news/coronavirus/mass-general-COVID-19-treatment- guidance.pdf

There is also promising data coming from Spain that intense immunosuppressive treatment can blunt the cytokine storm.

Many health care professionals, for example 40% of the OBGYN residents in training in my daughter’s program in Manhattan came down with COVID-19 illness. Some colleagues have died, others intubated, but half have already returned to work. Health care workers are being stretched, and stressed, to the limit, something mentioned in the news, but the press can’t seem to capture how close to, or beyond, nurses and doctors are to the breaking point.

Things have gotten much better. The infection appears to have peaked in New York City, due in large part to social distancing. Every hospital dramatically expanded their intensive care unit capabilities. The outpouring of support from around the country has been miraculous. For example, one doctor in Los Angeles, Dan Donoho, is personally responsible for the donation of 25,000 NK95 and N95 masks to one of my hospitals. Field hospitals have been set up in the Javitt’s Convention Center, as well as Central Park and now the Columbia University football stadium.

One city hospital recently spoke with pride that only 9% of their admitted COVID-19 patients died; another hospital now finds that 30% of their admitted COVID-19 patient are on ventilators. Refrigerated trucks standing outside every hospital to handle the excess bodies are grim reminders that this is so much more than ‘the flu.’

COVID-19 testing remains very limited: There is still no widespread community testing, which would facilitate tracing contacts and limiting disease spread. We look forward to a blood test (for antibodies), although the thought is that blood testing may be as inaccurate as the nasal swabs. The ‘peak’ is actually a plateau which is expected to last two to three weeks. Then what?

Well, the virus will still be around, and, if social distancing is relaxed too quickly, the infection will bloom again. Until there is a vaccine, everything will be different. We’re planning on resuming some elective outpatient visits and elective surgery in June or July or August, and are presently triaging patients for visits and surgeries based on medical urgency. For example, a patient needing regular office treatments will be seen as soon as possible, but someone who wants a routine check-up might be put off until September. The general thinking in New York is that schools will reopen in September.

There are these lessons for Minot. Until there is a vaccine, things will not get back to normal. COVID-19 is as easy to get as the flu or the common cold, so there is reason to think that without social distancing, everyone is at risk. Low population density, social distancing, and other lessons learned – the hard way- in New York and elsewhere will work in your favor. Anticipate that COVID-19 will also get there. Social distancing, applied rationally to allow schools and businesses to function, will remain a necessity. Your medical community needs to be prepared for this and for the next inevitable pandemic. As a city, ask for help if you need it: we are all in this together. It’s is going to cost a lot of money, and I hope some of that oil money pouring into North Dakota was put away for times like this.

I envy you for being relatively untouched by the virus, but you are at risk, and I hope this letter might help you think this through.