How are the New Yorkers who have been fighting the coronavirus for weeks now, coping with the crisis? We’re talking about the doctors and nurses who are in close contact in the hospitals, with those infected with Covid-19. Are they afraid? After almost 3 weeks and more than 10,000 deaths just in NYC, are they discouraged or optimistic? And what are their lives like when not on duty? Where do they sleep and eat? And how are they hoping not to get ill? Are they afraid to infect their loved ones?
To try to understand the state of mind of those heroes who are daily risking their lives in order to care for the gravely ill, we interviewed Dr. Lucia Daiana Voiculescu, anesthesiologist working at NYU Langone, and now caring for Covid-19 patients as a volunteer wherever there is the greatest need.
A graduate of “Carol Davila” Medical University in Bucharest, Romania, Dr. Voiculescu specialized in pain medicine at Vanderbilt University in Nashville, Tennessee. A practicing doctor, in the US since 1996 and in New York since 2008, Dr. Voiculescu is Associate Professor in the Department of Anesthesiology, Perioperative Care and Pain Medicine at NYU Langone Health, NYU School of Medicine. She is also Director of the Pain Medicine Center at Bellevue Hospital.
Daiana, a native of Romania, and like many of us, an adoptive New Yorker, is also one of our friends. Daiana is married to Renzo Cianfanelli, legendary war correspondent of the Corriere della Sera, whose articles you have frequently read in La Voce di New York. Daiana, a faithful reader of La Voce, has generously accepted to answer our questions.
Daiana, can we start by asking you in which hospital you’re currently working and since when? What exactly are you doing in this period?
“I want to start by specifying that all the following statements represent my experiences, opinions and ideas. They do not involve my institutions in any way. I am an Anesthesiologist specialized in Pain Medicine. Sometime at the beginning of March, I became involved in this crisis planning and decision making at my level. While globally the pandemic caught the world very unprepared and even reckless I would say that, here, at the institutional level, we tried to stay one step ahead. I am extremely respectful and humbled by the huge efforts made by all hospitals in New York. Everyone, at every level, in every role, has adapted rapidly and responded quickly to these tragic circumstances. The imminence of the crisis triggered a lot of inventive ideas and solutions. Nothing has been comfortable in the last month, but, with huge efforts and solidarity, so far we have managed to stay in control. As for myself, three weeks ago I delegated most of my clinical duties to Angela, my Nurse Practitioner, and requested to help my Anesthesiology colleagues who directly treat Covid-19 patients. We are divided into many small teams that provide care to critically ill patients in the intensive care unit and emergency room: airway care, central and peripheral lines, positioning, help with ventilation, hemodynamic support, etc.”
Where are you sleeping? You don’t go back home, do you?
“Indeed, two weeks ago, I decided to move to a hotel. My NYU department very generously offered hotel accommodation to those of us who might be potentially exposed to the virus on a daily basis and unable to isolate at home. Now I live in a small hotel room, 15 minutes away from my hospitals. It helps with walking time as well. In the beginning of March, I stopped using public transportation. Before moving to the hotel, I was walking to work. Back and forth, almost 14-15 Km every day.”
Where and what do you eat? Is it true that there are restaurants that send you free food each day?
“Yes, private citizens, organizations, or restaurants are sending food every day. There are rules that have to be respected, such as portioning, packing, and delivering the food. Most hospital units receive food generously sent every day by New Yorkers. As for me… For the last 6 weeks I have eaten only food prepared by myself. At the end of February, my husband and I quit eating in restaurants. At home it is very easy to cook. It becomes more challenging while living in the hotel. Fortunately, I love avocados, boiled eggs, canned sardines, kefir, imported bresaola and prosciutto and nuts. All types of nuts. In my previous life I must have been a squirrel.”
Compared to a week ago, would you say that the situation has deteriorated or do we see hopeful signs that it may be improving?
“I follow the situation in New York City very closely. According to the data made available every day by the New York City Department of Health, the number of positive cases (reported by the date when the test was performed) and hospitalizations, seem to have reached the plateau. We are still seeing a high number of deaths, reflecting the volume of diagnoses and admissions from days ago. I am hopeful that we are doing the right thing. I am hopeful that social distancing and face covering are helping. In terms of medical care, I know for sure that we are doing everything in our knowledge and power to save as many lives as possible.”
Is it true that the most serious cases of Covid-19 are the elderly? What is the average age of those being treated?
“The correct answers will be known only after all this is over, when we’ll be able to analyze large volumes of data from all over the world. Most of the critically ill patients whom I see are middle aged men (40-60 years old). This observation, of course, should not be extrapolated. Each medical setting is dealing with different patient populations, with different characteristics and levels of severity.”
We really seem to know so little about Covid-19. Has any new knowledge come to light in the last days that you could share with us in lay terms?
“Unfortunately, nothing new that could change the course and severity of this disease in critically ill patients has emerged in the last few days. Now we understand the disease better, but we do not have radical solutions. The very sick patients are still treated symptomatically, providing respiratory and hemodynamic support. Many of these patients are dialyzed and some are placed on extracorporeal membrane oxygenation (ECMO).”
Have you noticed any common traits among the fortunate who are extubated and recover? Is it perhaps their age?
“We see numerous successful stories. Many patients are extubated, leave the intensive care units, and gradually recover well. Age and severity of co-morbidities probably play a significant role. But it is too early to draw firm conclusions.”
What advice do you have for anyone who might be experiencing symptoms at home, who perhaps is having difficulty in breathing but who hasn’t decided yet to go to the hospital? What point would you say, is too late?
“There are multiple possible symptoms associated with the mild-moderate forms of this infection. Many patients complain of extreme fatigue, muscle aches and fever. For them it is important to stay well hydrated, eat, rest and, of course, normalize the body temperature. Some patients experience diarrhea and nausea. Again, hydration, and symptom control are essential. As for those with persistent cough and gradual respiratory difficulties, in the mild cases, breathing exercises and spending time in prone position (face down, lying on the belly) help. Ideally, one should be able to monitor his/her own oxygen saturation, but there is a shortage of these small portable devices, which until recently were sold in pharmacies. Regardless of the symptoms, once becoming sick, one should stay in contact with their primary care doctor.”
At your hospital, are they treating some patients with ozone therapy and hydroxychloroquine as elsewhere? What is your opinion about these experimental therapies? Do you agree with Trump that when there’s nothing to lose they should be tried?
“I know that the FDA prohibits the use of ozone “in any medical condition for which there is no proof of safety and effectiveness”. I am not aware of this requirement being currently waived for Covid-19. As for hydroxychloroquine, its effectiveness and safety profile for the treatment of coronavirus infection is yet to be scientifically demonstrated. So far, the indication to use it is based on anecdotal reports only. In the age of evidence-based medicine this is not enough. Currently, there are multiple trials going on in major US medical institutions. Let science speak!”
How are you doing with ventilators? Governor Cuomo has been sounding the alarm for days, that we would not have them in sufficient numbers. Is that the case at your hospital?
“Ventilators are essential in the fight against this disease. I am amazed by the number and diversity of ventilators that I see while attending patients in various areas of the hospital. In my entire life, I have never seen so many, and so different types of ventilators, under the same roof. We have received many portable ventilators, not so sophisticated as the performant critical care ones, but good enough to keep people alive and help them get better. These days, no hospital in New York is comfortable with the number of ventilators they have, but so far, in my hospital, no patient in need has been denied a ventilator. Medical and administrative personnel are making huge efforts and coming up with very innovative ideas to make sure that we have ventilators for all those who need them.”
What has been the most difficult situation that you have faced thus far in your battle to save lives against the coronavirus?
“Every day is difficult, because every day I take care of intubated critically ill patients. I hold their heads in my hands, I touch their faces, their eyes, their hair. Men or women, Hispanic, Caucasian, black, young or old, all are innocent, precious people struggling for their lives. I tell them that everything will be OK, but I am not sure they can hear me.”
In your opinion, what has made NYC the epicenter of the disease? Who made a mistake, or was it just inevitable?
“Good or bad times, New York is the Novum Caput Mundi. I don’t think the crisis could have been avoided given the role New York plays on the world stage, its intricate connections, population density and variety. I think the magnitude of the crisis could have been mitigated, but I do not have the knowledge and expertise to say what mistakes were made, when or by whom.”
Are you afraid of getting sick?
“Do you remember Dr. Rieux from Camus’s The Plague? At a certain point he was saying: “I have no idea what’s awaiting me, or what will happen when this all ends. For the moment I know this: there are sick people and they need taking care of”. No, I am not afraid of getting ill. This is not the kind of illness that scares me. It is a very nasty disease that forces people to suffer and even die in solitude. But, eventually, most of the infected people will get better. Still, given my job as a doctor, I must be prepared as a soldier in combat, for any alternative that I may have to face: personal suffering, loneliness – or even death. Last week I signed my will. I did it at work, witnessed by two colleagues. Business as usual in the time of coronavirus.”
When you decided, years ago in Romania, to become a doctor, did you ever imagine that you might be in the front line of such a dangerous pandemic?
“In those years, in supposedly socialist Romania, we were desperately dealing with the catastrophic effects of the ‘multilaterally developed socialist society’. Except that the slogan was a fraud. We were constantly subjected to the stifling heavy breathing from Moscow, our overpowering Soviet neighbor from the East. I was reading a lot during those years. It is when I discovered Camus and his The Plague. A book that everyone, doctor or not, should revisit nowadays. I hope you don’t mind if I finish with another quote from Camus. ‘There’s no question of heroism in all this. It’s a matter of common decency. That’s an idea that may make some people smile, but the only means of fighting a plague is common decency’”.
