- Angelo Mascia is an emergency room doctor in New York City.
- Mascia says if you are experiencing coronavirus symptoms but are doing well otherwise, you should assume you are positive for coronavirus and self-quarantine at home for 14 days.
- If you have a somewhat mild injury or have an illness unrelated to coronavirus, he said, you should try to find an alternative to visiting the emergency room, such as a video or phone consultation with a doctor or urgent care office.
- Mascia says the best thing you can do to help healthcare workers is to keep people out of the hospitals. He adds, “The more people that are in the hospital, the higher chance that something goes wrong. So we want to keep everybody at home and safe with their families where they should be.”
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Dr. Angelo Mascia is the chief resident at a hospital in New York City where he works in the emergency room overnight. Following is a transcript of the video.
Sara Silverstein: Angelo, thank you so much for joining us and thank you so much for showing up to work every day. Most of us are thinking about you and all the healthcare workers that are out there, but for those of us that are locked inside, it is impossible for us to imagine what you’re going through. You just came off your overnight shift. Can you give us an idea of what your night looked like tonight?Angelo Mascia: Sure. So a typical night in the emergency department before coronavirus was filled with a multitude of different cases, people with varying complaints. And now, the vast majority of what we’re seeing in the past couple of weeks is people with respiratory problems, people with difficulty breathing, people with cold or flu-like symptoms. And then on the severe end of the spectrum for that is you have a high percentage of these patients that have severe respiratory problems where they can’t breathe and they need assistance with a machine to help them breathe. And in normal times we’d see a fair bit of that, but the amount we’re seeing now is just way above and beyond what we see typically, the amount of patients that require these specialised machines to help them breathe.
Silverstein: Do you have any idea of how many patients you were seeing before versus how many patients you’re seeing now?
Mascia: Yeah, so that’s an interesting point. So I feel like we were actually seeing a higher number of patients previously before coronavirus. So the change now is that even though the number of patients is a little bit lower than what we typically see, the acuity or the severity of illness for these patients is just markedly higher than what we typically see. So every now and then you have some sprinkles of very sick people, but now most of the people we see are just extremely sick and they require a lot of attention and a lot of support from us.
Silverstein: And how much death are you seeing? What is the survival rate of people who are coming into the emergency room?
Mascia: So I don’t know if the exact survivor rate is worked out. That’s a difficult number to obtain because unfortunately we don’t have the ability to test everybody that has it. So getting an actual true survival rate of people that are actually infected is difficult.
I can tell you that from experience, the people that progress to requiring a ventilator seem to have a lot more poorer outcomes than typical patients that require a ventilator before coronavirus. So the people who unfortunately succumb to the coronavirus that require the ventilator, we are seeing that they typically have a worse outcome than other people.
Silverstein: And we have a lot of questions from the Business Insider audience who we would love to have a chance to ask an actual doctor, for example, what is the difference when you’re looking at a patient, how do you distinguish between COVID-19 and flu or pneumonia?
Mascia: So that’s a great question. So the coronavirus is actually kind of put the whole paradigm of how we evaluate patients on its head. What we call putting somebody on a ventilator requires something called intubation. And that’s kind of where we take a tube and we put it into the lung and we put them on a machine so they can breathe.
There’s a set of criteria which we follow that we look for for the patient that kind of assesses how they’re breathing to see if they require the machine. What we’re seeing now is just a set of patients that kind of put this criteria into question. You have all these patients with low oxygen levels. These patients that are working really hard to breathe and they just seem to require a ventilator a lot more frequently than we would expect.
And then with regard to the pneumonia, this is a pneumonia-causing illness. So there are viruses and bacteria that can cause pneumonia and the coronavirus – people that get it in a severe form do have a viral pneumonia. And sometimes if they’re immunocompromised they can get a bacterial pneumonia on top of that, which further complicates it.
Silverstein: And one of our people from our audience want to know, if they have asthma and they contract coronavirus, how likely is it that they will die from the coronavirus. And I understand that this is an impossible question to answer, but if you could shed some light for people that have that preexisting condition.
Mascia: Yeah, sure. So that’s a terrifying thing to have to deal with. We have a lot of people, especially here in New York City, that have to deal with asthma and we have the highest prevalence in the country of coronavirus. So like you said, it’s really hard to put an exact number on how likely you are to become severely ill if you have asthma. But those people who do have underlying respiratory problems, should just pay very close attention to their symptoms. So if they start developing fever, cough, shortness of breath, they should really acutely aware of what their breathing is like.
People with asthma are very, very good at detecting when their asthma is acting up and if they’re noticing that their symptoms aren’t getting any better with things that they do at home, they should probably come get checked out by us so we can evaluate them.
Silverstein: And I think a lot of people at home are wondering off and on whether or not they have coronavirus. What are you telling people to do in terms of when should you actually come in for treatment?
Mascia: Sure. So that’s another great question. So, like I alluded to before, it’s a little bit difficult of a situation because there’s not enough tests available right now and the turnaround is a couple of days at the moment to get a coronavirus test result. They’re actively studying different ways to test it and get a more rapid result that’s more widely available.
What we recommend right now, in New York at least, is that anybody with symptoms we assume are positive. Because the prevalence here is so high, people that come to the hospital if they’re doing well otherwise we say, “Assume you’re positive. Please go home and self-quarantine as best you can for 14 days. All the things you hear on the news, hand washing, good hygiene, not touching your face, all those things still apply.” So just more of a mass cautious statement to everybody with symptoms just to protect everybody.
Silverstein: And have any of your colleagues contracted coronavirus and have any of them become seriously ill.
Mascia: We had a few colleagues that contracted coronavirus. We did, unfortunately, have some that became seriously ill. It’s very scary. This disease, it is true that it affects disproportionately people that are older with underlying medical problems more severely. But we’re also seeing some young healthy people with no medical problems that are also becoming severely ill and there’s really no way to predict that. So that just makes it that much more terrifying.
Silverstein: And one of our people from our audience want to know, what has been the hardest moment of fighting this virus?
Mascia: The hardest. So the medicine we’re well trained for, we know what to do when people are very sick, we know how to handle them. The hardest part is actually the humanity component. Because this disease is so virulent and it spreads so easily to people, emergency departments across New York City and New York State are restricting visitors access to all the hospital.
So the hardest part is really just not being able to allow visitors in to see the relative when they’re severely ill and dying from coronavirus. And that’s just really hard to do over the phone and try and provide that support for the family and the patient when this is happening.
Silverstein: Someone from our audience wants to know how you have the courage to go in and work overnight in the emergency room department every night.
Mascia: We hear a lot of things about courage and heroes, and we’re very grateful let me tell you. That’s a wonderful thing to hear. But this is what we’re trained to do.
We do medicine to help people. We want people to be well. We want people to stay healthy and we just do our best to make that happen. In a pandemic time or not we show up every day and do the best we can to make everybody as safe as possible and this is no different. Whether it’s a pandemic or not, our job and our goals to treat people stay the same.
Silverstein: And how do you deal with and manage the stress?
Mascia: So everybody does that differently. Everybody has to have their own outlet, particularly people in medicine that are exposed to this daily. There’s a few different ways people manage. It’s really helpful and cathartic to kind of reach out to your colleagues and discuss, if you have a particularly bad case you want to talk over. Just having somebody that understands, that’s in the field to listen to you is really helpful.
But just really having something that you do on the outside, especially for people in medicine, that you have kind of your thing that is your stress reliever that you would do normally in any sort of stressful situation. Just it’s very easy to get consumed by these things, you just got to keep yourself grounded and try the best you can and just fall back to things that comfort you.
Silverstein: And for people who have other emergencies that are not coronavirus related, what advice do you have for them? If someone has a little cut or something that normally they would go in for stitches for, what should we be doing right now?
Mascia: Yeah. So people with minor emergencies that don’t require necessarily an emergency department, there are other great options. A lot of doctor’s offices and hospitals are opening telemedicine services where you can kind of call and get a phone consult and they will direct you further based on what’s going on with you particularly. There are also the options of urgent cares and things where you’re not as exposed to people as you would be in an emergency department with coronavirus. So it’s just seeking out these other outlets for care or further direction if you should need it. Really just trying limiting your time in the emergency department if you don’t have to be there.
Silverstein: And it seems like in the treatment of coronavirus there is a lot of misinformation and some information that may be true. We have a lot of questions about what of these things are true. One of them is that someone saw something about having patients lay face down on hospital beds is helping. Is there any truth to that?
Mascia: Yeah, absolutely. Absolutely. So let me address the first part of that real quick before I get to the face down component. There’s a lot of different sources and a lot of different information just solely based on the fact this is a brand new disease. Humans have been studying the disease for just a couple months, whereas we have things like the flu and different types of viruses where we’ve been studying it for decades. We know a lot more about it. So things change pretty rapidly in the world of medicine as we continue to study and learn more about the disease and new things will come to light as we continue to study it.
With regards to turning patients on their stomachs, that’s actually something called proning. It’s typically used in a patient population with something called ARDS, which is a severe form of lung disease and it helps alleviate some of the tension on the lungs and allows people to breathe easier.
What we’ve been doing with these patients actually is people – Classically this process of proning is done with a patient that requires a ventilator. So they have the tube in, the ventilators on, they’re in prone position, meaning they’re face down. We’ve been actually trying to put some patients that are not on a ventilator, just on oxygen mask or a nasal cannula, putting them face down on their stomachs and it seems to be helping them a little bit.
Silverstein: And what about this drug hydroxychloroquine, does that help with the virus at all? Do we have any idea?
Mascia: That goes back to what I was saying before. There’s a lot of conflicting data. Looks like every day the data changes and the science changes. What the hydroxychloroquine is based on is a study out of France. The study itself is kind of wrought with different difficulties and that just comes with the immaturity of the disease and our lack of understanding right now. It looks at the moment, based on what I recently read out of a meta-analysis or a grouping of all these different studies where they looked at a large number of patients, is that maybe it’s not so effective, but again, we’re still learning that can change every day.
Silverstein: Is there any specific misinformation that is out there that you particularly want to combat?
Mascia: Yeah. So I mean, I completely understand being a layperson, that’s not seeing this directly, how you can’t really understand how severe it is, especially in areas that are not New York where you’re not seeing this patient population getting very sick.
And then you have this particularly young healthy group of people where they feel fine, they’re going about their day and they don’t think anything’s going to happen to them. And even though it is true that the vast majority of people that do have coronavirus will probably be ok, the concerning thing is that they may have it, they may have mild symptoms or no symptoms at all, and they can still transmit it to other people. And those people that they transmit it to may not be ok.
So the biggest misconception that I’d like to address is just that, even though you’re ok, even though you may be ok or you’re young and healthy, there are people that aren’t so fortunate. And these social distancing guidelines are well-founded and well-based in, in good data. And it’s really important that we protect everybody, and it’s kind of a community sense and not just looking out for ourselves.
Silverstein: And another question from the audience that I’m not sure that there is an answer to yet but people really want to know, can you become reinfected with coronavirus once you’ve recovered?
Mascia: Oh, that’s a terrifying prospect. There’s some preliminary data out of China right now looking at a group of people that actually tested positive after they had tested negative. The data’s very, very early. We don’t have any solid science behind it yet. It is something that’s actively being looked at and the medical community is following closely. But there’s also reports that people that are infected that have turned negative have a strong antibody support, meaning that their immune system is able to fight it well after they have it. So we’re just waiting to see what’s actually going to shake out once the science comes out.
Silverstein: And someone is asking, what is that the happiest moment that you have experienced as a part of this crisis?
Mascia: Happiest moment, we put a lot of people on ventilators, a lot of people we typically wouldn’t put on ventilators that don’t have coronavirus. So like I mentioned before, some young and healthy people. We actually had a young healthy person who was on a ventilator for quite a while who became very, very sick, come off the ventilator and actually got discharged home the other day. And that’s a huge win for us. It kind of makes everything we do worth it.
Silverstein: And what is your greatest fear about the coronavirus? Also from the audience.
Mascia: I mean, the greatest fear is just bringing it home to somebody you love. Me personally, I’m around it every day. I see a lot of patients. I’m highly exposed and I’m terrified, not only for myself, but just to bring it home to somebody I love and I would hate to be the person that infects somebody and they become sick seriously. Even if it’s not one of my family members, just even if I go to the grocery store and I’m the person that makes them sick, that’s just a tremendous amount of a burden and guilt to carry.
Silverstein: And the audience is asking, is there any signs that things are getting better in New York from your emergency room?
Mascia: From my emergency room, it seems like we’re kind of at a flattening of the curve. I think for the past three days, what I’ve seen is about, it’s a pretty steady rate of 7,000 new positive cases a day with about 700 deaths or so daily. And I mean, that number is very large and very concerning and terrifying, but the good news is that that number is not raising up every day. It’s kind of seemed to plateau at that and hopefully the next step is continuing downward as we, continuing all of our efforts with social distancing and all of that.
Silverstein: Is dealing with the dead bodies as traumatic and severe as we are seeing in some areas in New York City at your hospital?
Mascia:Yeah. So I’m sure everybody’s seen reports of mobile morgues or trucks that are used and it’s a very real prospect across many hospitals in New York City just because the rate of death is much higher than city’s used to accommodating. And it’s hard for everybody involved, there’s no easy way around it.
Silverstein: Another question that may be impossible to answer from the audience. Do we have any information on whether or not this is seasonal?
Mascia: We don’t yet. That is something that’s also being looked at. We’re at the turn of the flu season roughly where it would start to end now.
And interestingly enough, once we started all the social distancing our flu rates have kind of plummeted. Our flu basically ended two months early around the New York area. So we’re watching it closely to see if there’s a recurrence, but I don’t think we’d know that for at least a couple of months from now.
Silverstein: And we’re seeing so many people on social media who want to be able to help healthcare workers. What have you been experiencing at your hospital and beyond that, what can other people do to help?
Mascia: So the biggest thing you can do to help is just to follow the guidelines of the governmental agencies that are giving us advice on what to do. Your best thing you can do for us is keeping people out of the hospital. The more people that are in the hospital, the higher chance that something goes wrong. So we want to keep everybody at home and safe with their families where they should be.
And on the other side of that, in New York City, I’m sure some people have seen, every night at 7 p.m. there’s citywide clapping. And the people in my – my colleagues specifically, we talk about it daily. People send videos across our various group chats and it’s really uplifting.
We’ve received a lot of donations from the community, not just material items but hand-written notes or drawing from people’s children. And stuff like that is really nice to see. Just reaching out, showing your support for us is all we need.
Silverstein: And that is wonderful to hear and it’s so nice to hear that the healthcare community is inspired by everyone coming out at seven o’clock because I know that it’s uplifting for the rest of us.
Mascia: Yeah. Absolutely.
Silverstein: A lot of people are asking about why it takes so long for a cure. And again, not a fair question to ask you, as you’re battling the disease day by day and not necessarily working on that part of the fight. But, people have a lot of questions about that, about the vaccine and when we expect it.
Mascia: Sure. So that kind of falls into the same theme I’ve been talking about. This is just such a new disease that finding these answers takes a little bit of time. There’s a lot of intense science that goes into it. Particularly looking for a vaccine, there’s a multitude of different factors that have to go into developing a vaccine, especially for a brand new disease we never encountered before.
If you look at diseases that have existed in our history for centuries, you have HIV, you have tuberculosis, and those things don’t have vaccines yet. I’m not saying that coronavirus is similar to that, but it’s not something that can take just a couple of months, and unfortunately it’s going to take some time before that happens. But with these type of vaccines it is very likely that it will happen in relatively a short time.
Silverstein: And how worried are you about getting people to take the vaccine once we have it?
Mascia: So that just goes back into the misinformation and misconception of what we actually do. There’s a lot of people who don’t believe in vaccines and don’t believe they’re effective for whatever various reasons. And that will definitely put a damper on putting the coronavirus out and kind of delaying it’s spread throughout the community.
Because once we have a vaccine we rely on a group of people having the vaccine in a community to develop something called herd immunity where the virus really can’t spread from person to person because the people that it encounters are immune, so it stops that spread. So it is a concerning factor for all of us in healthcare, not just for COVID, but just for any virus that we have a vaccine for.
Silverstein: And before I let you go, I want to end with one final audience question. What is a healthcare law or some change to our healthcare system that you hope to see in the future before we have to face something like this again?
Mascia: So there’s a lot of healthcare issues in the United States. A lot we won’t be able to touch on here. But I think allowing people to have access to healthcare that normally don’t have great access to healthcare, in terms of giving them the ability to see doctors when they need to see doctors and help them with preventative measures and all of those different types of health needs, I think will be tremendously important moving forward and just keeping our nation healthy as a whole.
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