On March 1, 2020, the first confirmed case of COVID-19 was announced. A health care worker who had visited Iran was now quarantined in her Manhattan home. On Monday March 2, 2020, NYU Langone Health and the NYU Grossman School of Medicine took the unprecedented action of banning out of state and out of country travel to meetings. I was scheduled to be the Jacobson Lecturer at the upcoming North American Neuro-Ophthalmology Society (NANOS) annual meeting that started on March 6, 2020, in Amelia Island, Florida. A great deal of controversy ensued during the next several days; many NANOS members thought that the NYU travel edict was an overreaction. People did not seem to understand that the Centers for Disease Control (CDC) had already fallen behind in this evolving pandemic, and that this ban was the right thing to do. Many colleagues were looking for guidance from the CDC, but the CDC itself was scrambling to find its footing regarding what to do. They had lost the opportunity to do early surveillance for the COVID virus because of the availability of testing. In the ensuing days, all the NY medical institutions enacted travel bans to meetings. The bans soon extended to other institutions throughout the country. The NANOS meeting was held, and approximately 500 attendees were able to make it. It was to be one of the last large scale medical meetings to be held. Zoom conferencing was installed for those of us who could not attend NANOS. I gave my first lecture by Zoom and apparently it went well. It was a bit strange to be talking to one’s computer without seeing the faces of your colleagues.
Over the next several days, it had become clear that the virus was rapidly spreading throughout NYC. We quickly converted to Webex and videoconferencing for virtually all of our conferences. I presented the last fully attended grand rounds on the topic of optic neuritis on March 10, 2020. I substituted for a speaker who was originally coming from California to give a talk on behavioral neurology. It has become clear in this crisis that face-to-face meetings are not always necessary, and it is likely that many of us will attend meetings virtually going forward.
We began the rapid deployment of video visits and telephone visits in lieu of face-to-face clinical visits whenever possible. This was an auspicious start to telemedicine in NYU neurology to say the least. We had just gone from zero to 100 miles per hour with our telemedicine effort. In many ways, the COVID-19 pandemic was similar to Superstorm Sandy in that new information systems were implemented: telemedicine with COVID-19 and Epic with Sandy. In early 2013, immediately after Sandy, Epic was initiated; in 2020, telemedicine quickly emerged at our institution. The downtime associated with Sandy allowed us to learn Epic; similarly, the downtime of this pandemic has allowed us to learn the nuances of video visits. Dr. Neil Busis, who had recently joined the NYU faculty, taught us about the platforms that we could use, including Haiku on the iPhone and Canto on the iPad. We had to learn a whole new set of codes for video visits and telephone visits. Over the ensuing days, we learned more about the virus and the potential therapies. However, there were largely untested remedies that were being touted. We went to skeleton crews to limit the attending and resident physician exposures. Despite social distancing techniques, the numbers of cases continued to increase in New York and the number of patients requiring ICU beds with acute respiratory distress syndrome (ARDS) exploded. It would take just a week for virtually every bed in our hospital to be converted to a COVID-19 bed. Neurological admissions became fewer as patients stayed away and the needs for infusing patients with steroids and monoclonal antibodies declined during this period. Soon, our neurology residents were redeployed to the medical services given patient volumes in the ICU and on the medicine service. Novel ideas emerged to preserve and refurbish the much needed N95 masks. Institutions were desperate for personal protective equipment (PPE) and ventilators. Although some of these requests were largely out of our control, our supply chain was greatly augmented by Mr. Ken Langone’s connections to industry and the government. The ingenuity of the staff to convert operating room ventilators to support medically ill patients was also important. During this period, I would frequently look out my NY window at the many tall apartments in NY and wonder if we were all locked down in our own cruise ships, on which the virus could spread.
Although there were many differences in these two major natural disasters, the most significant similarity was the heroic response of our physicians, nurses and staff. Although fear was appropriately profound in both cases, we were impressed with how these periods of uncertainty inspired courage, hope and resilience in our colleagues. Even in times of social distancing, the value of teamwork and leadership were never more important. No one really achieves anything alone, and it would be no fun if we did.