Responding to the COVID pandemic: a lesson in coalescence


On March 13, 2020, almost exactly one year ago, hospitals in New York City shared an uneasy feeling that the enemy was all around us, growing in force and stealthily approaching, but still invisible. Then, over the next three weeks, the COVID tidal wave washed over us in full fury, as desperately ill patients flooded our emergency rooms. So as not to drown in that wave, Bellevue Hospital needed to rapidly expand inpatient capacity. And we did.

Our facilities team opened up 100 new floor beds by repurposing old spaces. Our tradespeople hurriedly converted every one of our 56 ICU cubicles into a negative pressure room – employing a makeshift construction to exhaust filtered air through the outside window. Our surgeons canceled their operative schedules, joining the medical teams in the care of COVID patients. Our anesthesiologists became full-time proceduralists, supporting the ICU teams 24/7. Our orthopedists formed a proning team, turning ventilator patients from face-up to face-down positions on schedule, to support their respiratory status. Our nurses took on extra patients, worked in hot zones, and redesigned their workflow. Within two weeks, our hospital was completely transformed. Every space had a new purpose and every staff member had a new role. No one was overlooked.

By early April, Bellevue had taken its hit, had filled all our newly designed ICU beds, and was struggling to breathe. But when we looked around us, we saw that hospitals in the outer boroughs were even worse off. They had been completely buried in an avalanche of COVID with dozens of patients still backed up in their emergency departments. At that point, we decided to do something that seemed contrary to our self-interest, practically suicidal for an overwhelmed hospital. We began bringing in transfers. By the dozens.

Under the direction of our public hospital system leadership, up to 40 COVID patients per day were transferred to Bellevue from packed emergency departments in Brooklyn and Queens. Through the peak of the surge, we imported more than 600 COVID patients from other hospitals, filling every repurposed space with a new patient until Easter Sunday when, creaking and groaning, our great historic hospital began to come apart at the seams. Fortunately, after that point, the tidal wave subsided and the COVID census rapidly receded.

I would like to think that our hospital was exceptional in its COVID response. But it was not. Truthfully, our performance was no different than the responses of hospitals everywhere. All across the nation, hospital administrators obsessed about N95 mask deliveries, construction workers puzzled over airflow, and pharmacies coped with critical shortages. Emergency physicians worked in full PPE for 12-hour stretches, surgeons gave up their bread-and-butter operative cases, and doctors of all stripes assumed unfamiliar roles to help the greater good. Nurses agonized over PPE and stretched their coverage models, wondering if they could hug their children at night. Housekeepers scrubbed sinks and wiped down bedside tables, pondering whether COVID can penetrate latex gloves and cloth gowns, like radiation. Through it all, these selfless professionals came to work every day. They showed up. Why? In a word, coalescence.

Hospitals are, by nature, mission-driven institutions, and in every hospital’s mission is some version of this phrase: “to provide high quality, safe care to all our patients, regardless of need.”  Underneath all our differences, we have the same objective and, as professional staff, we put that aim above our own fears, concerns, and selfish interests. Because of that driving mission, our nation’s health care providers put all differences aside, aligned their forces, and joined as a mighty army to defeat a common enemy – all together. All as one. Coalescence.

Can the same be said of America’s leaders in our federal response? In a word, no. From the very start, our national leaders retreated along party lines and began pointing fingers. Our commander-in-chief denied the truth, downplayed the danger, and then immediately launched into the blame game. It was the CDC. It was the state governors. It was China! Each state began to look out for itself, fighting over PPE, competing for staff, shifting blame. National leaders lined up by party, and pretty soon, the entire public health approach became a familiar sad story: red states vs. blue states.

When faced with an existential crisis, any organization, as large as a nation or as small as a marriage, will go one of two ways. Either it will bond together, coalesced in a common purpose, or it will collapse in a spasm of blame and shame. While our health care institutions displayed the inestimable value of coalescence, our political leaders demonstrated the catastrophic impact of divisiveness. And our national statistics confirm the result. More than a half million deaths to date from a preventable pandemic.

Is there any hope for our nation? Can we learn an important lesson from the health care industry? Can we find the will to coalesce as health professionals have done? I believe we can. We have done so many times in our history, and the current administration is already displaying a penchant for facing the truth, learning from science, and promoting the collaboration needed to overcome our common foe. Coalescence. Let’s support our leaders in this welcome change.

Nate Link is chief medical officer, Bellevue Hospital, New York City, NY, and author of  The Ailing Nation: Lessons from the Bedside for America’s Leaders.

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