YouTube creators are performing everyday tasks or taking on crafts and activities that people can do at home because everyone is stuck indoors right now. The genre has boomed as a result of social distancing.
Daily views of videos with “#withme” in the title have increased by 600 percent since March 15th compared to the rest of the year, according to YouTube. Uploads of videos from creators with “at home” in the title have also increased by more than 590 percent. Of those two types of videos, titles like “cook with me,” “work out at home” and “home office” have seen their average daily views grow by 100, 200, and 130 percent respectively.
YouTube has asked people to stay home (#StayHome) and encouraged creators to participate in a new “#WithMe” campaign that started today. A number of creators have already started asking viewers to stay home and continue to socially distance themselves as the world tries to curb the spread of the novel coronavirus. The company has also curated a number of “with me” playlists for people looking to exercise, cook, clean, study, and more through YouTube.
“It’s just me and you guys today,” Lauren Riihimaki of the popular LaurDIY channel says in a recent video where she makes tie-dye clothes using tools she found around the house while social distancing. “It’s just me, you, a monitor and two cameras — one wide, and a close up shot so you can see what I’m doing. It really does feel like old times.”
It’s unclear if these videos are seeing a surge in revenue. The Verge asked YouTube for more information, and will update if there is a response. Hank Green, one of the longest running YouTube creators on the platform, tweeted on March 22nd that while viewership across all channels has increased about five percent over the last week, advertising revenue is down 30 percent. Other creators are worried their advertising revenue will also fall, but are looking into doing other forms of videos to try and continue entertaining fans.
“With me” videos first started appearing on YouTube in 2007, but didn’t really become a genre unto its own until 2010. People getting ready for school or work would upload their routine, including choosing outfits to wear or making breakfast. The idea was that people at home could do their own morning routine while watching their favorite creators. By 2014, “with me” videos focusing on productivity started to emerge, including “study with me” and “journal with me.” By last year, “paint with me” became the most popular creative-focused version of the format.
The 2015 decision by the state’s Unemployment Insurance Appeals Board originally found that a terminated Postmates courier, Luis Vega, should be classified as an employee and therefore eligible for unemployment benefits when he was kicked off the platform. That decision also required the company to pay into New York’s Unemployment Insurance Fund for that employee and for “all other persons similarly employed.”
The ruling could be significant for Postmates couriers, as shelter-in-place restrictions or the need to self-quarantine has led to mass layoffs and significantly reduced on-demand work. For those still able to work for on-demand delivery apps like Postmates, there is a risk of getting infected. Typically, gig workers are classified as independent contractors, which means they are ineligible for unemployment benefits or healthcare.
Postmates has tried to address this by launching a fund that couriers can take advantage of to pay back medical expenses related to COVID-19, the disease caused by the novel coronavirus. And DoorDash and Instacart now offer up to 14 days of sick pay if they’re affected by coronavirus. But workers for these companies and others are still especially vulnerable while more and more Americans are relying on their services. For that reason, Instacart shoppers are organizing a work stoppage on Monday to fight for better sick leave and company-provided protective gear such as hand sanitizer and disinfectant wipes.
In yesterday’s ruling, a majority of the judges supported the original decision’s determination that “Postmates exercised control over its couriers sufficient to render them employees rather than independent contractors operating their own businesses.” If those workers were classified as independent contractors, Postmates would not be obligated to pay into unemployment insurance for them.
“Today’s decision is a huge victory for thousands of gig workers across New York,” said New York Attorney General Letitia James in a statement. “The courts have solidified what we all have known for a while — delivery drivers are employees and are entitled to the same unemployment benefits other employees can obtain.”
“While we do not agree with the majority opinion from the New York Court of Appeals in the matter of Vega v. Postmates, the court’s conclusions support a position for which Postmates has long advocated: we need a modern worker classification framework that is relevant to the autonomy and flexibility made possible by app-enabled work,” Postmates said in a statement provided to The Verge.
“We fully support designing a responsible framework that allows New Yorkers to choose if, when, where, and for how long they work, while also providing them access to the benefits and services they deserve. As stated in the dissenting opinion, ‘Our current framework, as inconsistently applied, fails to provide clarity to anyone involved.’ We want to work with New York to change that.”
In addition to its medical fund, Postmates has also followed other on-demand delivery apps in introducing “non-contact” meal deliveries to help encourage social distancing, which can help prevent the spread of COVID-19.
Microsoft says it will no longer invest in third-party facial recognition companies following a controversy around its funding of Israeli startup AnyVision, which critics and human rights activists say powered a surveillance program in the West Bank following an NBC News report about the company’s relationship with the Israeli government.
Microsoft now says an independent investigation led by former US Attorney General Eric Holder and his team at international law firm Covington & Burling found that “AnyVision’s technology has not previously and does not currently power a mass surveillance program in the West Bank that has been alleged in media reports.” Had it done so, Microsoft says it would have constituted a breach of the finance portfolio’s pledge on ethical facial recognition use.
Regardless, Microsoft says it is divesting from AnyVision and will no longer make minority investments in any facial recognition firms. “For Microsoft, the audit process reinforced the challenges of being a minority investor in a company that sells sensitive technology, since such investments do not generally allow for the level of oversight or control that Microsoft exercises over the use of its own technology,” reads an announcement on the website of the company’s M12 venture arm.
“By making a global change to its investment policies to end minority investments in companies that sell facial recognition technology, Microsoft’s focus has shifted to commercial relationships that afford Microsoft greater oversight and control over the use of sensitive technologies,” the announcement goes on to say.
While Microsoft is stepping away from funding facial recognition firms, it does still have a facial recognition technology of its own through its Azure cloud computing platform. The Face API, as it’s called, allows any developer to “embed facial recognition into your apps for a seamless and highly secured user experience.” However, the company’s chief legal officer, Brad Smith, said last year that Microsoft would never sell facial recognition for surveillance purposes, and Smith has gone on the record saying it’s denied law enforcement access to the technology over concerns it would contribute to civil and human rights abuses.
It’s unclear if Microsoft’s new investment stance means it can still acquire facial recognition firms or whether it is making any adjustments to its own use of internal facial recognition software as a result of the change in direction. Microsoft was not immediately available for comment.
Facial recognition, specifically the variety of the technology powered by advanced machine learning and other artificial intelligence tools, has come under a spotlight in recent years. At the same time, concern grows among politicians and activists that it could be used by law enforcement and governments to surveil citizens without their consent and in ways that violate privacy and human rights laws.
As a growing list of states order “nonessential” businesses closed to slow the spread of COVID-19, Amazon is giving warehouse and delivery workers letters to carry saying that they are engaged in essential work.
“This letter is provided as evidence that the carrier of this letter is an Amazon employee and, as such, an employee of an essential business,” reads a letter given to fulfillment center workers. “This employee is providing essential work to support Amazon’s delivery of critical supplies directly to the doorsteps of people who need them. In doing so, this employee enables members of the community to remain at home and reduce the risk of COVID-19 exposure and transmission, including the elderly and other vulnerable persons.”
The letter, written on Amazon letterhead, also includes a paragraph addressed to law enforcement with a phone number for verifying the carrier’s employment. The Verge confirmed that similar letters have been given to warehouse workers and delivery drivers around the country this week, with minor variations by role and region.
Though no states have required workers to carry documentation, Target and McDonald’s have told workers to carry similar letters. In Italy, France, and other countries hit hard by the coronavirus pandemic, residents are required to carry forms explaining why they’ve left the house. It’s possible the letters are a preemptive measure in case similar measures are taken in the US. Amazon did not immediately respond to a request for comment.
The Department of Homeland Security considers warehouses, logistics, food delivery, and other sectors Amazon could reasonably fall under to be essential services, and millions of Americans told to stay home have come to rely on the company’s distribution network for basic necessities. To meet surging demand, Amazon last week halted deliveries of nonessential items to its warehouses and announced plans to hire 100,000 additional workers.
But the company has a long history of injuries and grueling conditions at its warehouses and delivery network, and as COVID-19 has spread, workers across the country have called for better safety precautions. Amazon says it has intensified cleaning procedures, but workers say cleaning materials are often in short supply and the pace of work doesn’t leave time to use them. Amazon halted team meetings and altered schedules to avoid workers crowding together, but workers say their jobs still often require being in close proximity. There have now been confirmed cases of COVID-19 at 15 US warehouses. Amazon has closed only one, a returns-processing facility in Kentucky, and only after the governor ordered it shuttered. The company has also failed to notify workers when there has been a coronavirus case at their facility, leaving workers to rely on rumors and hearsay.
Last week, a group of senators wrote a letter to Amazon CEO Jeff Bezos expressing concern for the safety of Amazon workers during the pandemic and asking what precautions are being taken. Bezos published a memo the following day listing several safety measures, including the ordering of millions of masks for workers, though he acknowledged that the masks are in short supply and many of the orders have yet to be filled. Bezos’ memo, like the letters given to workers, also made clear that the company is positioning itself as an essential service during the pandemic, referring to “essential work” that cannot be done from home. “We’re providing a vital service to people everywhere, especially to those, like the elderly, who are most vulnerable,” he wrote.
But it’s unclear how long Amazon can continue providing this service if workers don’t feel safe. Many warehouse workers say they have begun staying home rather than risk infection, and drivers report bottlenecks at their delivery stations. Delivery times for some items already stretch to a month or more and threaten to get worse if Amazon can’t staff up.
Last week, the company raised pay by $2 per hour and increased overtime pay, but for many workers, it wasn’t enough. “At the end of the day, it’s just about being safe,” said a worker at a North Carolina fulfillment center. “At the end of the day, it’s not about making the dollar.”
He walked out after hearing rumors, which Amazon denied, that a co-worker had tested positive for COVID-19. He’s not sure whether he’ll come back.
Tesla has already paused some nonessential operations at the factory and is encouraging employees to work from home if possible, which has “significantly” reduced the number of people showing up to work every day, according to an email obtained by the Reno Gazette-Journal. The company expects to be down to only essential “supply chain” work by next week, as well as roles like security, facility maintenance, limited critical production, and IT support.
Tesla is taking a number of steps to reduce the chance of spreading the novel coronavirus among the employees who will keep coming into work, according to the email. The company will close some entrances and will perform temperature checks at the entrances that remain open. Hand sanitizer will be required upon entry. Workers will have to stay six feet apart, including in the cafeteria, where the company will only have one chair per table. Work stations will be disinfected twice per shift, too.
On Thursday, Tesla confirmed two office employees had tested positive for COVID-19, but did not specify where those workers were located. The company said in an internal email that the employees “had been working from home for nearly two weeks” before they tested positive for COVID-19.
“Our companies at TRIC [the industrial park where Tesla operates] are taking the COVID-19 matter seriously, and regularly report to us the measures they are taking to adhere to the established guidelines while maintaining essential operations,” Osborne wrote. “Checking employee temperatures, creating central access, allowing remote work, maintaining workstation distance, and others are occurring.” Osborne declined to offer more information in a follow-up email.
The COVID-19 pandemic is on the verge of colliding with another public health threat: extreme heat, which kills more people in the US each year than any other weather-related event. Public health officials usually recommend that people without air conditioning head to places like malls and libraries where they can cool off, but that’s not an option for a lot of people sheltering at home.
The problem could soon begin to affect India, where temperatures begin to climb in April and have reached as high as 45 degrees Celsius (113 degrees Fahrenheit). India’s 1.3 billion residents have been ordered to stay indoors until April 14th to stop the spread of disease, and only about 5 percent of the population has air conditioning.
Heat-related illness can begin with mild symptoms like a headache and muscle cramps, and they can progress to confusion, dizziness, vomiting, and losing consciousness. Once the body reaches a point where it can no longer cool itself down by sweating, heat stroke can lead to organ failure and eventually death. Those most at risk are often the poor and elderly, groups that are similarly hard-hit by the novel coronavirus. Heat-related deaths can be prevented by checking in on people who might be isolated indoors and providing public places for them to get out and cool down. But those strategies contradict efforts to stop the spread of COVID-19, which mostly focus on keeping people apart.
“We’re in between a rock and a hard place if it were to become a heatwave during the time when we’re enacting physical distancing measures,” says David Eisenman, a professor at the University of California Los Angeles’ department of community health sciences.
In developing countries, the migration to cities from rural areas has posed new problems when it comes to preventing deaths from heat. Traditionally built homes in less densely packed areas often included designs that naturally kept the structure cool, like inner courtyards and windows aligned to allow prevailing winds to pass through. But poorer newcomers to cities have packed into informal settlements where homes may be little more than brick or metal walls with a corrugated metal roof. “That’s literally an oven,” says Kurt Shickman, executive director of the Global Cool Cities Alliance, which partners with governments to plan more heat-resilient cities. It’s estimated that 40 percent of the world’s urban expansion takes place in slums, and more than two-thirds of the world’s population is expected to live in cities by 2050, according to the United Nations Development Programme.
“The problem is way worse in the developing world, but we shouldn’t take that and say that we’re out of the woods here [in the US],” Shickman says. The US sees upward of 600 heat-related deaths each year. Heat waves, which are becoming more frequent and more intense because of climate change, took a heavy toll in Europe last year, too, killing almost 1,500 in France last June and July.
“[Extreme heat] is even more of a pressing issue with the pandemic than it was beforehand, and this need for staying at home is only bringing out issues that already existed,” says Sonal Jessel, a policy and advocacy coordinator for the Harlem-based nonprofit WE ACT for Environmental Justice. Even though New York City has just stepped into spring, Jessel is already scrambling to figure out strategies to keep people safe in case hotter temperatures arrive earlier this year.
Temperatures can be several degrees hotter in cities like New York compared to surrounding areas, because all the asphalt and concrete absorb and trap heat. It can be even hotter in industrial neighborhoods with fewer trees and parks, which means some communities are more vulnerable than others. Almost half of all people who lost their lives to heat in New York City between 2000 and 2012 were African American, although they’re just under 25 percent of the city’s population.
“Now that we’re all instructed globally not to gather in close proximity, it’s going to really call for creativity and quick pivoting among public health systems around the world,” says Kim Knowlton, a senior scientist at the National Resources Defense Council, who has worked with Jessel’s organization in New York and other groups in India to prevent heat-related illness and death. She and other public health experts are beginning to put their heads together to figure out how they may need to tackle two crises — coming heat waves and the ongoing pandemic — in tandem. But they don’t have answers just yet.
Cities might have to figure out how to create publicly accessible places where people can cool down while also maintaining enough physical space between each other to prevent the spread of COVID-19, Eisenman at UCLA says. “It just seems like a really hard thing to pull off,” he says.
If beating the heat by going to a public place is out of the question, then more needs to be done to help people cool down at home, says Jessel. That means getting air conditioners into more homes, and helping people pay their utility bills so that they don’t need to choose between running their air conditioning and paying for other necessities. With lots of people losing their jobs during the pandemic, making air conditioning affordable is even more pressing. Jessel’s organization is advocating for more funding for the Low Income Home Energy Assistance Program, a federally funded program that provides assistance with home energy bills. Beyond that, Jessel and other advocates are pushing for ways to retrofit homes to keep them cooler. Installing better insulation, painting roofs white to reflect the sun, and planting rooftop gardens can keep homes and buildings cool.
Temperatures in parts of California, where there’s a state-wide shelter-in-place order, are going to rise above 80 degrees Fahrenheit (about 27 degrees Celsius) next week. While Eisenman doesn’t think those numbers will begin to pose a threat just yet, he warns that the first really hot days of the season can be particularly dangerous because people are still adjusting to the change in temperatures. And while California and New York are current hotspots for COVID-19 in the US, he worries that other states with fewer coronavirus cases now but hotter climates, like Arizona, might see their number of cases peak closer to the start of summer. That potential scenario could be deadly, which is why Eisenman and others are encouraging groups to take early measures to address the combination of threats — before the case counts and temperatures start to rise.
Paul announced that he tested positive for the novel coronavirus on Sunday as senators continued to negotiate provisions in their relief package on Capitol Hill. Both Sens. Mike Lee (R-UT) and Mitt Romney (R-UT) were advised to self-quarantine for 14 days by the Capitol’s attending physician after they had interacted with Paul. Other members like Sens. Cory Gardner (R-CO) and Rick Scott (R-FL) have also gone home after potential exposure to the virus.
The COVID-19 pandemic has renewed calls from some lawmakers for congressional leadership to allow remote voting. According to FiveThirtyEight, the Constitution does require a majority of members to establish a quorum to vote, but it’s the House and Senate’s own rules that require lawmakers to be physically present to cast their votes. So far, congressional leaders like Senate Majority Leader Mitch McConnell (R-KY) and House Speaker Nancy Pelosi (D-CA) have opposed total remote voting. The Senate already allows members to vote on behalf of others in committee, known as proxy voting, and Pelosi has entertained changes to the rules that may allow proxy votes on the House floor in the future. But none of those rules were in effect when the House voted on Friday’s relief package.
Still, many lawmakers stayed home to protect themselves from infection as congressional leaders nailed down the specifics of the deal on which the House planned to vote on Friday morning. House leaders sought to pass the measure by voice vote, a seldom-used procedure that doesn’t require the entire chamber to be present for passage.
Those plans changed after Rep. Thomas Massie (R-KY) told a local radio station on Thursday that he planned to object that vote and request a recorded tally, meaning 216 members need to be present, threatening to delay an already-delayed stimulus package.
“We have notified our Members of the possibility that the bill may not pass by voice vote,” House Majority Leader Steny Hoyer’s (D-MD) press office wrote in a statement on Thursday. “The Majority Leader’s Office has sent a notice to Members that if they are able and willing to be in Washington, DC by 10:00 a.m. tomorrow, they are encouraged to do so, while exercising all due caution.”
By Friday morning, enough House lawmakers had raced back to Washington by car and plane to override Massie’s objections.
Earlier this week, the House Sergeant at Arms Paul Irving and Congress’ attending physician, Brian Monahan, issued guidance advising lawmakers to stay in their offices until the vote was called and required them to use hand sanitizer as they entered and left the chamber. According to The Washington Post, the galleries that hang above the House floor were opened up so more members could filter in while maintaining the Centers for Disease Control and Prevention’s guidance of six feet of distance between one another.
Still, not every lawmaker was able to make remarks on the House floor on Friday either lauding or critiquing provisions in the titanic relief package. The Wall Street Journal reported on Thursday that Hoyer’s office told lawmakers outside of DC that they could record their own video statements that would be aired on C-SPAN during primetime hours next week. They will also be shared on social media.
The pandemic has upturned political life. Aside from threatening congressional business, presidential candidates like Joe Biden, Bernie Sanders, and Donald Trump have all started to host rallies and campaign events online. No one knows exactly how long the pandemic will last, but it could force lawmakers to reimagine political business entirely as much of it moves online.
Disney originally aimed to reopen its various theme parks by April 1st, but in light of the rapid spread of the novel coronavirus and recommendations from both local authorities and health experts, Disneyland and Disney World will remain closed until further notice.
“While there is still much uncertainty with respect to the impacts of COVID-19, the safety and well-being of our guests and employees remains The Walt Disney Company’s top priority,” a tweet from an official Disney Parks account reads.
The company will continue paying its hourly parks and resorts employees through April 18th, the statement added. It’s unclear if this also applies to parks around the world, including in Paris, Tokyo, Shanghai, and Hong Kong, but The Verge has reached out for more information.
Disneyland and Disney World began closing on Sunday, March 15th. They were initially going to say closed through March 31st. Part of the resorts will remain open, including retail and dining experiences at Disney World Resort. Disney’s parks in the United States joined Paris, Shanghai, Hong Kong, and Tokyo in closing, marking the first time in history that all seven resorts, including their various parks, were all closed at one time. Disneyland has only closed twice before: on November 23rd, 1963 in a day of national mourning for President John F. Kennedy, and on September 11th, 2001 because of the attacks in New York and Washington, DC.
Disney’s parks business generates approximately $20 billion a year in revenue for the House of Mouse. Continuing to keep the parks closed will have a strong impact on the company’s financial situation. Executives at Disney outlined as much in a recent SEC filing for investors, noting that “the impact of the novel coronavirus and measures to prevent its spread are affecting our businesses in a number of ways.” Disney’s parks have closed, cruises are suspended, and theatrical movies have been delayed. Production delays and sports leagues hitting pause have also affected content creation for both film and television and left ESPN in a bind.
“We expect the ultimate significance of the impact of these disruptions, including the extent of their adverse impact on our financial and operational results, will be dictated by the length of time that such disruptions continue,” the filing reads.
Those disruptions will also depend on the “currently unknowable duration of the COVID-19 pandemic.” Disney’s SEC filing also notes that “the impact of governmental regulations that might be imposed” is something they’ll have to keep in mind. For example, Florida and California governments could impose bans on large gatherings for an extended period of time, meaning that Disney World and Disneyland may have to operate within those guidelines.
While many entertainment companies are taking a hit, Disney is feeling it extra hard. Unlike NBCUniversal and WarnerMedia, owned by major telecom companies Comcast and AT&T respectively, Disney doesn’t have a larger conglomerate it can rest on. Analytical firm MoffettNathanson issued a research note last week explaining just how hard extended park closures, production delays, and other forces could hit Disney in the months to come.
Despite the worsening coronavirus pandemic in the US, NASA is still looking ahead to its long-term goal of sending humans back to the lunar surface and is now asking SpaceX to start doing cargo runs to the Moon in the near future. NASA awarded the aerospace company with a new contract this afternoon, tasking SpaceX with sending cargo and supplies to a space station that NASA wants to build in the Moon’s orbit.
The new partnership is a big piece of NASA’s Artemis program, an initiative to land the first woman on the lunar surface by 2024. As part of the program, NASA has proposed building a space station in orbit around the Moon called the Gateway, where astronauts can work and train before heading down to the lunar soil. Just like the International Space Station, the Gateway is going to need supplies and science experiments from time to time, and now SpaceX is the first company charged with making that happen.
SpaceX has been supplying cargo to the International Space Station for almost a decade now, packing supplies inside the company’s Dragon capsule and launching them on top of a Falcon 9 rocket. To get supplies to the future Gateway, SpaceX is going to use some upgraded vehicles. The company is developing a new cargo vehicle called the Dragon XL, a cylindrical white spacecraft that can “carry more than 5 metric tons of cargo to Gateway in lunar orbit,” according to SpaceX. The supersized Dragon will launch on top of SpaceX’s Falcon Heavy rocket, the much more powerful variant of the Falcon 9 that consists of three rocket cores strapped together.
Thanks to a fixed-price contract, SpaceX is on the hook to send multiple supply missions to the Gateway once the station is up and running. During each trip, the Dragon XL will stay docked to the Gateway for six to 12 months a time. The capsule will carry things like “sample collection materials and other items the crew may need on the Gateway and during their expeditions on the lunar surface,” according to NASA.
“Returning to the Moon and supporting future space exploration requires affordable delivery of significant amounts of cargo,” Gwynne Shotwell, SpaceX’s president and COO, said in a statement. “Through our partnership with NASA, SpaceX has been delivering scientific research and critical supplies to the International Space Station since 2012, and we are honored to continue the work beyond Earth’s orbit and carry Artemis cargo to Gateway.”
SpaceX likely won’t be the only company tasked with sending supplies to the Gateway. Ultimately, NASA has the option to add multiple cargo suppliers and has allotted up to $7 billion to spend on cargo contracts for Artemis. Each contract guarantees that NASA will order at least two cargo missions per provider and NASA can request missions for up to 12 years.
While the contract is a big step for SpaceX and NASA, a lot of questions remain about the future of the Artemis program. For one, it’s unclear when the Gateway will actually be built. For the last few years, NASA officials have argued that building the Gateway is a crucial part of the Artemis program as it will help the space agency establish a sustainable presence around the Moon, rather than just send astronauts to the lunar surface to leave “flags and footprints.” But the administration challenged NASA to land its first Artemis astronauts by 2024, and with that deadline quickly approaching, the space agency may not have enough time to build the Gateway if it wants to get humans back to the Moon in the next four years. In fact, NASA’s newly appointed associate administrator for human exploration said that the Gateway is no longer critical for getting humans back to the Moon by 2024, according to Space News. That doesn’t mean it won’t get built, but it may not happen until after the first lunar landing deadline.
Meanwhile, it’s becoming increasingly unlikely that NASA will be able to meet its 2024 deadline at all, as the coronavirus pandemic has forced the agency to suspend production on some key programs. Notably, NASA shut down development of its next big rocket, the Space Launch System, which the agency plans to use to fly the first Artemis astronauts to the Moon.
As for SpaceX, the company is still operating during the pandemic as the company has been deemed mission essential by the state of California, due to its work with the Department of Defense. So it’s possible the company could still get a jump-start on the development of this new capsule. But it’s unclear when the Gateway will be ready to receive its first shipment.
In the midst of the outbreak, people will still have heart attacks and strokes. Babies will still be born. Appendixes will still burst. And so hospitals are figuring out how to juggle the patients who require ordinary urgent care with those who are sick from the new coronavirus.
At first, Long Island Jewish Medical Center’s emergency department tried to keep people with suspected COVID-19 separate from patients with other complaints. But since the volume of patients exploded, every patient is now treated as a possible COVID-19 patient and given a mask, says Adam Berman, associate chair of emergency medicine at the Queens hospital.
The same thing is happening at Zuckerberg San Francisco General Hospital and Trauma Center; even if a patient comes in with a different complaint, they are treated as though they may be infected. Keeping likely COVID-19 patients separate from those who don’t have the illness becomes difficult as the virus spreads, and virtually everyone is “COVID-possible.” “A woman came in with vaginal bleeding, but she was COVID-positive,” says Chris Colwell, the chief of emergency surgery at SF General. Her complaint wasn’t the disease; it was the bleeding. “It’s very hard to cohort in a situation like this.”
Hospitals around the country are closing some services to make sure that people who have medical emergencies can still get help — even with an influx of people sick with COVID-19. In many hospitals, any surgery that could reasonably wait is canceled. That frees up surgeons, internal medicine doctors, and others to help in the emergency department. Some hospitals have stopped offering outpatient care to conserve resources. Visitors are being limited or banned.
“The issue here is one of crowding out,” says Stephen Shortell, a professor of health policy and management at the University of California Berkeley, where he is also a dean emeritus. “The concern here is that COVID-19 will crowd out other people who need hospital care, which puts a premium on hospitals’ ability to set priorities.”
Hospitals have to figure out how to distribute available rooms or beds, staff, and equipment to ensure all patients get care. The way they allocate resources in a global pandemic must necessarily change, says Lisa Eckenwiler, a bioethicist and associate professor of philosophy at George Mason University. There’s a duty to care for patients, while also trying to preserve the maximum number of lives. Hospitals must make sure that all patients are treated fairly, and that the public understands how these decisions are being made, she says. And it’s important for patients to show solidarity for each other — for instance, by understanding why your own surgery has been rescheduled in light of the crisis.
At most hospitals, figuring out how to provide the best care starts with emergency planning documents. At the University of North Carolina Medical Center, for instance, those documents include hurricane plans, floods, electrical outages, and two kinds of plans for highly communicable disease, says David Weber, the medical director of infection prevention there. That hospital has limited visitors and developed guidelines for what counts as a truly urgent surgery, he says.
Both LIJMC and SF General have pandemic planning documents — as well as documents for other kinds of emergencies, such as mass shootings — but even with a plan, it can be difficult to predict in advance what course a pandemic will take. Both hospitals began monitoring the outbreak in China in January.
LIJMC had kept a particularly close eye on the new coronavirus, since the hospital is near John F. Kennedy airport in New York, and there was a direct flight from Wuhan, the city hardest hit by the virus, to JFK three times a week. COVID-19 patients require special rooms and special precautions, so LIJMC began tweaking its emergency plans immediately, Berman says. No one has stopped tweaking them. “It’s literally every day being revised and changed and updated based on new information and the capacity of our hospital,” he says.
Ordinarily, the hospital’s emergency department is staffed based on the amount of demand the hospital sees historically. But the volume of patients has gone up, so LIJMC has brought in extra providers, mostly emergency physicians. Elective surgeries were canceled and visitors aren’t allowed. The hospital’s lobby is now used for screening.
At first, COVID-19 patients were sent exclusively to the intensive care unit, but it was filling up — so other floors of the hospital were equipped as makeshift ICUs. Just about every floor has a COVID-19 patient on it. “Most of our hospital now is a COVID wing,” Berman says. But if a patient comes in with another emergency — a heart attack, a stroke, or trauma — they will still get the same standard of care they would have before the pandemic, he says.
One benefit of the shelter-in-place order effective March 17th in San Francisco has been a drop in moderate trauma cases, says SF General’s Colwell. When people don’t leave home much, they’re less likely to be exposed to COVID-19 — but also less likely to have an accident, resulting in an emergency room visit. Those people who do have other kinds of emergencies are still receiving normal care.
The biggest constraint on his emergency department now is the number of people with marginal, inadequate, or no housing, Colwell says. No shelter or skilled nursing facility will take them without a negative COVID-19 test, and they can’t be sent back to the streets where they might pass the virus on to others. Right now, he has 15 patients in beds who might have COVID-19, but who don’t have acute medical issues and have nowhere else to go. “As we sit here today, the problem is not ventilators,” Colwell says. It’s that he has nowhere to send these patients. That’s been an issue for a long time — but it’s particularly acute right now.
Both Colwell and Berman say that they are particularly grateful for community support. Colwell was particularly delighted by donations of N95 masks, but other gifts have also flooded in. “We have gotten such an outpouring of donations of food and equipment and things that help the mental state of the people working in the emergency department — because this is taking a toll on everyone,” Berman says.
Despite the stress, both of their departments were doing all they could to keep the pandemic from taking a toll on their ability to treat patients. The doctors said they want to continue giving usual care, even in these unusual times.