When New York City became the epicenter of the global pandemic a month ago, a doctor at one New York hospital reached out to one of his Mayo Clinic colleagues.
New York-Presbyterian Lawrence Hospital, a hospital near New York City, was being overrun by COVID-19 patients. It needed help.
Where the New York hospital on a normal day might see a dozen ICU patients, there were now four times as many on ventilators. Doctors, surgeons and other medical professionals with little experience in an intensive care setting were being rushed to the ICU to handle the overflow of patients.
And they needed help in an area with which they were unfamiliar.
"Most of us couldn't travel there physically, and so we had to come up with a way to help out without actually being there physically," said Dr. Sean Caples, a Mayo Clinic critical care physician and an upstate New York native involved in the cross-country alliance.
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Over the next several weeks, as many as 60 Mayo intensive care staff would offer their expertise and assistance to the New York hospital nearly 1,200 miles away through tele-ICU capabilities.
'Stressful environment'
These were Mayo professionals who, in many cases, had a personal connection with New York-Presbyterian or the area. They had trained in New York or had family and friends there, and they wanted to help.
"It's a stressful environment," Caples said about working in an ICU setting. "If someone is uncomfortable there, it's hard to deliver the right care."
Through tele-ICU technology, Mayo staff were able to join their New York colleagues on their daily rounds.
It worked this way: A New York staff member carried a tablet from bed to bed, while a Mayo physician, using a tablet in Rochester, "joined" them, offering advice on the best way to manage the ventilator, medication or kidney issues of patients. The secure connection also allowed Mayo professionals access to health records, X-rays, lab data and notes.
Mayo has been using tele-medicine technology for several years now, Caples said. It usually takes six to nine months to set up a connection with another hospital. But the two hospitals were ready to go in four days.
"This was different. It's a little more simplified, not as complex," Caples said. "But it goes to show you that you can launch something like this quickly when people collaborate and think differently about it."
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There were not only technical hurdles but licensure issues to overcome. You need a New York license to practice medicine in the state. But Mayo was able to find a pathway through the regulatory thicket, thanks to the recently passed CARES Act, which offers Good Samaritan protection for volunteer providers.
Crystal ball
The experience also gave Mayo doctors an early glimpse into the pandemic's destructive potential and its ability to quickly overwhelm hospitals with sick patients.
New York has seen more than a quarter of a million confirmed cases of the infection and 21,000 deaths, with the vast majority in and around New York City. Minnesota, by contrast, has had 3,185 cases and 221 deaths.
"It was horrifying to know," Caples said. "You can put yourself in that situation. All of sudden, patients are coming faster than you can get them into a bed. That's chaotic, and it really makes care difficult."
The collaboration with New York-Presbyterian also provided Mayo staff with valuable lessons about the viral foe they were dealing with, as well fresh insights on the best way to treat COVID patients.
Mayo doctors saw features in the infection they had never seen in a virus before.
There was a tendency, for example, for COVID-19 patients to develop blood clots, which wasn't typical for a viral illness. They stayed on ventilators longer and often weren't removed from them "as soon as you would expect," Caples said. The rates of kidney failure were also higher than one would expect from a viral illness.
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"All these things we learned from the experience of our New York colleagues," Caples said.
While heartened by the drop in infections in New York as the curve flattens and bends downward, Caples said he remains wary of this virus.
"You feel like there's a little bit of room to breathe," Caples said. "But with talk about second waves and as testing goes up, we're probably going to learn more things that right now are not known. So I'm cautious in this optimism."
