When the 2019 coronavirus disease (COVID-19) pandemic began to overwhelm New York City hospitals in March, NYU Langone called for physicians and advanced practice professionals from across the medical center—and across the country—to help manage the flood of critical patients. Many members of the Division of Endocrinology, Diabetes, and Metabolism volunteered for the effort, bringing skills and experience that proved to be crucial for treating this complex disease.
A Coordinated Response to an Unprecedented Crisis
More than 850 clinicians joined what came to be known as the “COVID Army” at NYU Langone, redeploying to SARS-CoV-2 floors that were rapidly established at the hospital system’s inpatient facilities, including Tisch Hospital, Kimmel Pavilion, NYU Langone Hospital—Brooklyn, NYU Winthrop Hospital, and NYU Langone Orthopedic Hospital, as well as the affiliated NYC Health + Hospitals/Bellevue. A multidisciplinary leadership group organized clinical structure and workflow to maximize efficiency and optimize patient outcomes. On each unit, medical teams consisting of a hospitalist, 2 or 3 attending physicians, several interns, and 2 nurse practitioners or physician assistants cared for 20 to 30 patients; they worked in 12-hour shifts, 3 or 4 days in a row.
New recruits received training in COVID-19–related protocols and procedures from the hospitalists, and through NYU Langone’s online training system. “Learning to deal with a new virus was anxiety-producing, and many doctors were working outside their field of specialty. My team included amazing reproductive endocrinologists as well as plastic surgeons,” says Melissa Sum, MD, assistant professor of medicine and medical director of NYU Langone Diabetes and Endocrine Associates, who served on Tisch Hospital’s COVID floor for two weeks in April. “But we had excellent instruction and support, and the institution always prioritized safety for both patients and staff.”
Crucially, NYU Langone was highly committed to ensuring personal protective equipment. “We always had N95 masks available,” Dr. Sum recalls, “and we reused them to conserve resources.”
Leveraging Well-Honed Skills for a New Disease
In the early days of the pandemic, COVID-19 was a baffling puzzle to virtually everyone who encountered it. By the time it hit New York, however, endocrinologists were learning that certain aspects of the disease made their training invaluable to effective treatment. Evidence suggested that diabetes and hyperglycemia were risk factors for severe illness. In addition, high-dose steroids had emerged as a medication of choice for the sickest patients—which often exacerbated existing diabetes or tipped borderline cases into frank diabetes. Careful selection of steroid formulation and dosage was crucial in such instances. “Many patients’ sugars got very erratic when they decompensated clinically,” Dr. Sum notes. “We had to keep an eye on their insulin and electrolytes and drug regimens while monitoring their respiratory status and heart status.”
The demand for such management grew so high that NYU Langone’s inpatient glycemic consult service recruited two nurse practitioners from the outpatient endocrinology practice, the Center for Diabetes and Metabolic Health, to assist remotely with challenging cases of hyperglycemia. Each morning, they reported to the Advanced Practice office, where they and other colleagues (masked and seated at desks spaced at least 6 feet apart) spent the day overseeing care of severely ill patients.
“We would review glycemic patterns, recent labs, and the primary team’s plan of care, and adjust orders accordingly—mostly via chat messages,” explains Courtney Albert, NP, who served on the team. “The arrangement enabled us to answer urgent questions and offer detailed advice while avoiding the exposures that would have occurred if we’d been going in and out of patient rooms. It felt good to be able to contribute to the fight, even if I wasn’t out on the floor myself.”
Putting Patients’ Lives Before Personal Comfort
For NYU Langone’s frontline clinicians and support staff, caring for the onslaught of gravely ill and highly contagious patients was extraordinarily grueling. Nidhi Agrawal, MD, clinical assistant professor of medicine and director of pituitary diseases at NYU Langone Diabetes and Endocrine Associates, is married to another NYU Langone faculty member—Vikramjit Mukherjee, MD, assistant professor of medicine and director of the medical intensive care unit at Bellevue. The couple have two young children.
“Between his shifts and mine, we barely got to see each other once or twice a week during the peak of the crisis,” says Dr. Agrawal, who spent two weeks in the COVID Army. “We also had to be very mindful not to bring the infection home. We thought about staying in a hotel or a rented room, but we decided against it because the kids are so little. Luckily, our wonderful nanny stepped in whenever both of us had to be at work.”
Another source of stress was the multisystem nature of the illness, and its alarming rate of mortality. Although teams of medical students were assigned to update patients’ families through daily phone calls and videoconferences, physicians were responsible for informing loved ones of an imminent or actual death. Several COVID-19 patients died during Dr. Agrawal’s tour of duty. “Talking to families about these patients passing away was very, very hard,” she recalls.
Yet the struggle to save lives was also intensely uplifting. In part, says Dr. Agrawal, the inspiration came from her colleagues. “It was an extremely well-coordinated effort, and the team spirit was amazing. I was working with specialists I’d never met before—cardiologists, rheumatologists, radiologists—but we bonded very tightly.”
Most important, she adds, was the opportunity to help turn the tide. “I’m thankful that I had the privilege to take care of these patients. If I had to do it again, I would do it in a heartbeat.”