By GWEN OREL
Five years after his residency, Dr. Alexander Sinofsky never expected to work again with the doctors who trained him to be an anesthesiologist.
Then COVID-19 happened.
He flew to New York City from Louisville, Ky., on April 15 to be an extra hand at Bellevue Hospital when his former residency program director asked him.
Sinofsky, a 2001 MHS graduate and son of the late filmmaker Bruce Sinofsky, had been considering flying to New York to help out in late March.
Then he got a call from the program director at NYU Langone (which operates Bellevue): Former residents were being asked to pitch in.
He will leave on May 8.
“There have been a lot of affected patients,” Sinofsky said. “There has been a big expansion of intensive care units. As anesthesiologists, a lot of what we do is intensive care.” Sinofsky is double board-certified, in interventional pain and anesthesiology.
“We do a lot of airway management, management of ventilator settings, line placements,” he said. “A lot of patients in the intensive care units are sedated, and are getting anesthetic things. Even though I’m not in the operating room, the things I’m doing are within my wheelhouse.”
Although Montclair is only 12 miles away, he hasn’t made it home to visit his mother and stepfather: It’s too risky. He has been in the intensive care unit and would not want to risk infecting his family.
Instead, he’s been going back and forth from his hotel to the hospital, where he works 12-hour shifts.
In the hospital, he’s seen something he hardly ever sees: patients passing.
It’s rare for him to have a mortality in the operating room, he said. As an anesthesiologist, he mostly works on neurologic cases and in orthopedics. At the interventional pain clinic, he works on chronic back pain, neck pain, and with implanted devices like spinal cord stimulators. Patients usually recover.
“Here, the mortality rate is up to 90 percent,” Sinofsky said.
And dying patients are often without family at hand.
“A lot of these patients are extremely sick. When they’re that sick they’re very contagious. I have seen family members around, but generally it’s the policy to limit to one compassionate visit,” he explained.
That means one compassionate visit the whole time the patient is there, usually reserved for someone not doing well who was likely not going to make it out of the ICU.
Most of the patients were not alert when they passed, Sinofsky added.
By the time he arrived in New York, personal protective equipment was not an issue at the hospital. He hasn’t seen any shortage of surgical masks, face shields, or gloves, though they are guarded more closely than they used to be.
When he arrived in mid-April, protocol treatments were in place. “I think that these hospitals have figured out how to manage the disease for the best outcomes, and to keep other people from being infected,” he said. “People were overwhelmed in the beginning. It’s a totally new disease. There’s nothing like it. It’s being compared to ARDS, acute respiratory distress syndrome, but it’s a totally different animal. It’s like nothing compared to what we’ve seen before.”
‘A FAVORABLE DIRECTION’
In the unusually full ICU, he saw that everyone was there with COVID-19. Many of the patients were over 65, with a trio of comorbidity factors that included diabetes, hypertension and obesity.
Sinofsky did see someone age 48, with no documented medical problems. “He was a bit chubby, but nothing that would make you blink. You remember when you see [younger patients], because you don’t expect them to be there,” he said.
The mortality rate for patients who have been intubated is 89 percent, according to announcements from the state of New York.
Paradigms for treatment have shifted a bit since mid-March. Where a patient having trouble ventilating would be immediately intubated, “with this viral disease, we have learned that that is not really the best approach for these patients.
“The hardest part is that with these patients in the ICU, while there’s some recovery, it’s the realization that most of them will probably never be taken off the ventilator,” Sinofsky said.
But, in the last few weeks, there has been a remarkable turnaround: “Things are going in a favorable direction,” he said.
While the ICU still has more people in it than it would normally have, he’s been seeing fewer admissions and more releases. Sinofsky suggested that it could be the natural course of the virus, or it could be a result of social distancing.
“When they brought in extra anesthesiologists and some specialty surgeons, they didn’t know when the peak would hit. The strategy was to flood the hospital with skilled hands,” he said.
And while there will likely be a second wave, Sinofsky does not think it will be worse than the first.
For one thing, there are better strategies in place for treatment, isolation, and contact tracing. But another thing Sinosky suggested is that we may be closer to herd immunity than realized, because many people may have been exposed and do not know it.
“I think this is as close to airborne as any virus I’ve ever read about,” Sinofsky said. “That’s why this has been so contagious. There are so many patients who are asymptomatic or have a mild case walking around.” He advises people to wear surgical masks — it need not be an n95 mask; even a cloth mask is better than nothing — when outside, whether or not they think they’ll run into anyone. Particles can hang in the air, he said, although they don’t hang in the air forever.
“It’s possible that 50 percent of people affected have no symptoms whatsoever. Some suggest even higher. I think that most people who would get very ill have already been exposed,” he said.
New York and New Jersey, because of their high population density, will be affected the longest, but in Manhattan, doctors have begun doing elective surgeries again, he said.
He has heard the 7 p.m. cheer in New York, and it makes him feel great. “It’s almost like military service,” he said. People thank him on the street just because he’s in scrubs. “I’m so unused to it I don’t know how to react.”
On Friday, he returns to Louisville. His city has not been that hard-hit, and that’s one of the reasons he wanted to come: “I’ll have seen the best practices in the ICU in Bellevue.”