Linda Ohler interview with Bruce Gelb MD to discuss his personal experience with COVID in New York March 2020 followed by his recovery

00:00 And today's date is March 29, 2024, a little more than four years since we first confronted Covid in New York City. I'm recording from the Washington, DC area, and my guest is Doctor Bruce Gelb, who's recording from his office at New York University Langone Health in Manhattan. Doctor Gelb is an abdominal transplant surgeon at NYU in Manhattan. His focus is on liver and kidney transplantation, but he is also very focused on ethics and quality. He received his medical degree from the University of Texas, San Antonio, and he did a two year surgical fellowship in abdominal surgery at UCSF in San Francisco. Doctor Gelb thank you for participating in this. Please describe your roles and responsibilities at NYU before the pandemic.

00:58 Sure. It's what I affectionately call BC because it's before COVID I'm a full time abdominal transplant surgeon. I do primarily liver and kidney transplants, but also pancreas transplants. And I'm also on the team at NYU that's performed a bunch of firsts in the VCA realm, which are face transplants and hand transplants. Clinically, very, very busy with that up until the pandemic, and then things very abruptly changed for at least a few months. And I think we're still feeling the repercussions of that now, even years later.

01:35 Interesting. So you were one of the first cases of COVID yourself in New York. Please describe your experience with COVID.

01:48 It's like being an accidental tourist, I guess you could say. Thought we were getting ready for the pandemic. Those of us who were infected early really didn't expect to be victims of the virus. We were preparing to help people. We were in New York. We were watching and learning as much as we could from northern Italy, particularly with the intensive care, because it was a new disease, we didn't know how to treat it. All we knew was that it was coming. So we used Facebook groups and WhatsApp. Really no real formal lines of communication as you would think of them. But we formed groups very quickly and learned as much as we could from each other. And in the US, we were really looking to the west coast because we expected the pandemic to hit the western part of the country first and then move east because that's where it was coming from. Asian. Unbeknownst to us, it had already settled into New York City probably about two weeks before the wave of cases started here. And that was in very late February. I was actually performing transplant surgery. I was doing a kidney transplant when I believe that I was infected. And it was probably from a patient's family member during this, we were having before surgery, and that patient got violently ill in the recovery room just after finishing a kidney transplant. And we're really kind of scratching our heads and trying to figure out why. And I was in the operating room the following day doing another kidney transplant, completely fine. To barely being able to stand, being that sick within the matter of about 25 minutes, just to say was finishing the surgery. And that that was the beginning of the pandemic for me. And it was just over four years ago. It was March 11. I remember the exact day, and it's the exact date and time it was that emotionally powerful and getting that sick all of a sudden. The scary part of this is we didn't have any testing yet. We didn't have a PCR test yet for Covid. It was. It didn't come out for another week or two. All I knew was that there's only a couple things that can make a transplant surgeon so quick. They have to abruptly hand off their duties and leave work. And that's swine flu from 2008, which I unfortunately experienced when I was training to be a transplant surgeon. And watching a sweep through the hospital population, very things and. And just not knowing, other than the fact that it was a potential lethal infection. So from a personal standpoint, it was very scary having to leave and to quarantine and also not knowing who else could be infected that I was around over the previous couple days.

04:46 Please describe your symptoms. What symptoms did you actually have.

04:56 The first couple days? It was like having the flu. Awful. It was exhausting. It was. Being so exhausted and so sore. Was hard to walk, even just walking to my car from the hospital. It's one of the rare times that I had actually driven to work the day before, which I only do a couple times a year. But I think by good fortune, I drove that day. But just getting to my cardinal took probably a half an hour walking through the hospital, which is usually a five minute walk. And then I actually took a nap in my car for about 45 minutes before I felt to drive. And then I drove home from there. So really, really bad flu for the first couple days, I was hypoxic, so I had low blood oxygen levels. And I only knew this because I had vital signs taken. My oxygen levels were low, but I actually felt fine from that. I didn't have a lot of chest complaints. It was a couple days later when the inflammation in the lungs from the virus happened. We called pneumonitis, that I really felt it in the chest and had a. Was really sore and had a really, really bad cough. So the first couple days was like the flu. And then I actually started to feel a little better and thought, maybe it's just the flu I'm getting out of it. And then the second wave where you get all the chest complaints and the difficulty breathing hit. And that lasted for a couple.

06:24 Did you see a primary care physician or any physician, or did you just kind of take care of yourself?

06:31 A combination of everything. I went to my local urgent care center and had a chest x ray done in vital science tick. And I was on the phone a lot with a lot of my colleagues in the hospital, fortunately for me, and very blessed because of the profession and the place they work in. I have very personal contacts with some of the best of the best, including infectious disease doctors, lung doctors, and cardiologists. And at the same time, I had the plague, so I didn't want anyone near me and nobody wanted to come near me. So even when we. When the, the hospital actually developed a PCR COVID test right around the same time, some of the big labs were around the country, but I didn't, no one thought that it was safe for me to come to the hospital for a test, and nobody was going to walk into my home and do that test for me. So they actually, someone, they sent someone to my apartment building to drop it off with my dorm in. And then I had someone else bring the test kit up to my apartment, left in my dark board. Then I picked it up and went and did all the testing myself with the swabs deep in the nose. And then I basically had to quarantine myself because I certainly didn't want to get anyone else sick, particularly people who were going to be having to take care of what was about to hit New York. Within the first few days of the first patients starting to hit the hospitals, we knew we were really on the brink of something extreme in New York City.

08:13 Do you have any residual effects?

08:17 Yeah. So it took me almost a month to start to feel well enough to at least be able to go back to work. And then I actually left transplant surgery for the next couple of months and just worked in the icus taking care of COVID patients because I had some level of immunity at that point. And then about six months after initially being infected, I started to get symptoms from long Covid, a lot of fatigue and aches and all the different long Covid symptoms you hear about. Prior to that, I was an avid runner and would run multiple times a week frequently go on a five mile run in the afternoon just to decompress from work. And there were many days over the next few years where I could barely walk a block in the city without being fatigued. And that's actually just recently getting better. I'm just back to running. We're four years later, I'm just back to running two or 3 miles sometimes.

09:19 Since we weren't doing any elective surgeries at NYU, we stopped doing elective surgeries and we stopped doing transplants. Many of us were put to deployed to other areas. Where were you deployed to?

09:35 So we, the, all of the transplant surgeons met because, you know, that we couldn't do transplants for a couple reasons. One, the hospitals were full. The hospital has basically five icus across the different types of icus you have. And we very rapidly converted 85% to the hospital, to ICU rooms. So there was just no space for patients for any kind of elective or non emergent surgery. And then the other side of things, where Covid was so deadly to transplant patients, if they got infected, many of them died, if they were in the hospital, especially in the first wave. And then because everyone who was in the hospital was dying from COVID they weren't candidates to be organ donors. So there was no organ donor supply in the country for a while. So the transplant surgeons met and we kind of divvied up and decided who was going to help take care of who, because we have a lot of patients, both before and after transplant, that we have to get through this period, and then who's going to be redeployed on both the inpatient and outpatient side and taking care of COVID patients. I quickly volunteered to do the COVID units because having just been infected, we didn't know much about the virus. But most viruses, if you catch, you can't get again for at least a couple weeks or a couple months. So I presume that I was certainly the safest and I had some sort of antibodies at that point. So I was actually recredential in pulmonary and critical care for that period. And just because of my background and experience of being able to take care of critical care patients, I was one of the physicians in the hospital that could run an ICU. And we composed teams of everyone else based on what they could do. The chairman of plastic surgery came back into the hospital as an intern. Level work and medical charting on the inpatient units because that's where the need and that's where the place was. But everyone, titles didn't matter. It didn't matter what your level of experience and who you are, it was really what could you do to help? Everyone in the hospital really kind of reconfigured for that first couple months.

11:51 Interestingly, I was deployed to infectious disease, so I was collecting data, which was really interesting because you could look at the zip code and see where Covid was hitting really hard in areas in the city. Can you describe the work you were doing in the ICU?

12:13 Sure. So I was basically an intensivist. I was an intensive care doctor. I had several teams, but the first team, we all. And these are all people who don't really know each other because the hospital is a big place, and all of a sudden this team is thrown together. And the people on my team were an EMT, a pediatrician, a neurology resident, a pathologist, and I had a pulmonary fellow fellow was able to do the fine tuning of the ventilators. And we really put all of our knowledge base together to take care of all of these patients. So it was really a ragtag team, and I've never experienced war firsthand, but it really felt like how society reacts in the battlefield to the best of their ability to do what they can. And the team really just performed remarkably, especially in those circumstances.

13:19 I remember when we had zoom rounds in the morning, you coming off nights and saying you felt like you had worked in a war zone.

13:29 So, yeah, yeah, we had. You know, the shifts were from seven to seven, and you either work the daytime shift to the nighttime shift, and there were periods where we worked for 24 at a time. And it was that period of the pandemic when nobody in New York could do anything, everyone was sheltering in place and staying at home. So except for essential workers, which were going into the hospitals or working in the EMS system, which I think it was very difficult for people who couldn't go out anywhere too. And at the same time that people going into the COVID hospitals, there were no visitors. It was completely sealed off. You were there working, you were not in the hospital. So it was very separated. And the level of support that the community provided was really astounding. 07:00 at night, randomly, people started cheering in the city one night, and fire engines all honk their horns, and that became a thing the whole entire city came out for. And there were nights in the hospital that that was really, really profound because there was a lot of suffering, there was a lot of death, there was a lot of fear. It was very, very emotionally charged, and it was very, very hard on the staff and about 645 people who could get outside would go, leave the hospital and go out on First Avenue, and all of the fire trucks and ambassadors would light up and you'd hear the cheering through the city, and it was exceptionally emotional.

15:08 They were cheering for the doctors and nurses, right, coming out of shift, and.

15:13 That was the few minutes every day, wherever the staff could just go out and cry.

15:21 Makes me get tearful thinking about it again. We had zoom like rounds every morning so that we could talk to one another and know what was going on. How were you or who from your team was communicating with the patients at home who had been transplanted in the past?

15:44 That's where I kind of left transplant for a few months and went back, and the rest of the team did a lot of that. But they sent it. They set up a very robust process, and it was very important not losing people, not letting people fall through the cracks. We realized very quickly that this is a very high risk time, and then also it's a time where human contact was broken. Fortunately, we're in an Internet speed era, and the number of people who have access to the Internet is extremely high, which allowed us to still have contact. I thought well and hard at the time. I said, if this pandemic happened 15 years before, we wouldn't be able to do this. It would have been by phone calls, maybe, and even just having team meetings. And that still happens today. I mean, that's the medium that we're interacting on right now, which seems so commonplace right now, really solidified out of the pandemic, and that's here to stay. It's something that changed the fabric of the way modern society works and how we stay connected as humans, because before that, it was by phone or in person. And this certainly isn't the same as doing an interview like this in person, but it's becoming really, really close. And we're very fortunate to have had this technology at that point. We still use it today. Our kidney transplant service is a very, very big service. And when we round in the morning, the number of different people involved in the team is very big. And if we walked around or in a conference room, we don't have a conference room big enough. If we walked around, it's too many people, it's not safe for the patients or we'd never finish. So on our kidney transplant service, we actually do rounds in the morning in the same format. All of the providers are at their computers. Some are in the same room, many are in their other offices, but spend about 80% of rounds that way, and talk about the complexities of everything that needs to be done. And then a small, focused part of the team will round in person, patient to patient after that.

17:57 And the patients at home. We had electronic medical records that allowed us to communicate with the patients through Mychart, and we could send them messages and tell them to stay put and not come in for appointments and things. Right. Yeah.

18:14 It changed how people go to see a doctor. In the past, if you didn't feel well, you went to your doctor. That's changed. If you are sick, you get on a video visit now so that you don't, even if you just have a cold or you may have the flu. We're just getting out of the respiratory viral season in New York, and it's a different paradigm now. If you're not feeling well, you need to be seen by the medical system. You need to see a doctor. But we do it. We start with a video and then figure out if you need to come in and be seen or if you should be going to a doctor's office versus an urgent care center or an emergency room. And people can be triaged before they come in to see, you know, should they see someone face to face right away, or they need to be isolated and screened before going in somewhere else. The other thing that's much more prevalent, especially in the northeastern part of the country, is if someone has a sniffle, they wear a mask now.

19:12 Mm hmm. Yeah. Interesting. Yeah.

19:16 People are sick. They don't go to work. They stay home. They work from home.

19:21 Yeah. We learned a lot from that, didn't we? With transportation shut down in New York, how were we able to monitor the patients? Were you able to do any monitoring? I know we sent nurses out and phlebotomists out to draw their blood.

19:40 Yeah. So transportation didn't shut down in the city. Non emergency personnel did not use transit. The subways and the buses were still running, but the only people on them were people in emergency services for critical government services or working in the healthcare system, and that was to limit exposures. But the. But the subways and everything were still working. The getting to care to patients, it was a lot of trial and error, a lot of assistance from private industry and well wishers. But one of the companies that's involved in the transplantation set up a whole home visit service where they would go to patients homes to draw blood, and then they would deliver the blood to the hospital laboratories so that those tests could be run on the same day or by the next morning. So a lot of adaptability and ingenuity and very quick thinking, a lot of trial and error.

20:55 So when did transplants actually begin again? At what point? Since we weren't doing them in March, the end of March. When did that start?

21:03 It started doing liver transplants again, I think about six weeks later. The life saving transplants, where you're going to, you're not going to survive unless you have an organ. We got those going as fast as we could, and that was really as soon as organ donors that weren't infected with COVID started to come around. And then we tried to learn as fast as we could. And we actually found out that a lot of patients that may have had Covid but not necessarily died from COVID illness, even if they were actively infected now we transplant those organs. We were very safe at first, and then as we got more information, and we were very robust about sharing this in the transplant industry, not just in the US, but across the world, so that we could adapt as fast as we could. But heart, lung, and liver transplantation resumed within about two months. Within six weeks to two months in New York City, which was by far the hardest hit in the US. Other parts of the country, some barely had to pause except for the lack of donors. Others had to pause for just a couple weeks. And the ramp ups. There were a lot of discussions about should you allow a living kidney transplant surgery to proceed, or should those patients stay on dialysis for a little bit longer? Because it was one, okay, we can physically do the operation now, but what if the donor or the recipient gets Covid right afterwards? How long is it safe to wait? And we just didn't know at first. And we also didn't have any medications. And as we started to get into and understand and be able to treat acute COVID infections better and understand them more, we were able to get a little more aggressive and push the limits more and more.

22:54 What do you think? What lessons do you think we learned from this that we could apply if anything like this should happen again?

23:03 Oh, God, where do you start?

23:06 I mean, I know we had, in New York, we've had 911. We had Hurricane Sandy come into NYU. If I'm not mistaken. It actually flooded in NYU. So we've had trauma before, but this was different. This was different from.

23:25 This was different because it was sustained for much longer. And I think a lot of us were ready for acute illness and dying people to come around. Hurricane Sandy taught us the lesson of resiliency over a period of months. It's much more fatiguing when it occurs over months to years. So I think the tale of COVID people weren't ready for overall lesson learned. Remember everything you learned from the past. Ask for help. Rely on the fact that community will come together. A lot of people, I think, expected society to break down in the US and America. And although we didn't hear arguing and beliefs and differences about what to do, when it came down to it, at the local level, community was always there. You didn't see fighting in the streets. You didn't see it was much broader policy level and big picture things that didn't impact people in the moment, things that we have now that we think are useless, are never gonna ramp up. Those are the things that change in a big emergency like this. A lot of people thought there was no real good use for the QR code. Covid brought it back. It's here to stay. Telehealth and video visits. There were so many arguments that, no, to really practice medicine, you have to do it face to face. The patient needs to see the doctor, the doctor needs to be able to touch the patient. And this taught us that we can adapt, and there are ways to utilize the tools we have and to reimagine what we have and also what we need.

25:13 A lot of people were concerned about the n 95 masks and the protective equipment not being as available. But I think they didn't understand that everybody was wearing it. Usually it's just the clinicians that wear that, but this went to people in the cafeteria, people working in housekeeping, everybody. So it got spread so thin. Because of that.

25:44 I think we had a sense of urgency about the supply chain issues that would have. I think we miscalculated the magnitude. I think the federal government thought very smartly at first, save the protection for the healthcare workers. But then the immediate realization that not only does that completely change the amount of supply that's usually used, because it's a very small percentage of n 95s that are used day to day. But when everyone working in the hospital is essential needs all the time, and then the community, those market pressures, I don't think that anyone was prepared for. I think we adapted as quickly as we could, but the whole supply chain worldwide was interrupted, including transporting. You could manufacture them, but how do you get them places quickly? I think that's taught us how important redundancy is in supply chains and systems to be prepared and to be able to adapt. And then I know NYU Langone Health as a health system has really focused on that over the last couple of years of making sure there's always a backup plan and a backup to the backup plan and then the what ifs. I always try to think of the third what if down so that, you know, even. Even if it doesn't necessarily hit, you're used to going through that process to be able to adapt very quickly to whatever changes come along.

27:16 One thing that was also very interesting to me, considering New York, Manhattan, how populated it is in that area, was that all of the hospitals were. The transplant hospitals were working together every single Monday, Wednesday, and Friday. We met to talk about patient safety and staff safety issues. So it was 14 hospitals, transplant hospitals, and four organ procurement organizations working together for patient safety. And that just meant all competition was gone. It was not about nobody cared who was doing how many this or that or your outcomes. We were all worried about working together and sharing ideas. So it was pretty impressive. Like you said, the community really came together, and that is r1, good example of it, too, coming together. So is there anything else you wanted to share about the experience that I may not ask you?

28:24 I'm sure we'll have other experiences like this in life. As much as we don't want to, we don't. Living through Hurricane Sandy and evacuating the hospital and then dealing with the aftermath of rebuilding a hospital and also dealing with transplant patients who didn't have a home during that time, taking those lessons into the COVID pandemic were invaluable. I would be happy if I never had to deal with another pandemic, professionally or personally. Or personally. And we're a resilient population. We're a resilient species, and it's important to roll with what comes at you. And I always tell people, focus your energy and your aggravation on the things that you can control, and don't waste your stress and anxiety on the things you can't. Being able to focus that energy to what you can actually do something about has been a lifesaver.

29:31 That's really a good point. And it's what we had to do. Well, thank you very, very much. This was very interesting, especially talking with someone who actually had the disease recovered and then went to work to save more lives. So thank you very much.

29:49 My pleasure. I wish I never had to tell the story.

29:54 But I really am appreciative that you did do that. So thank you very much, Bruce.

29:59 My pleasure. Thanks so much for inviting me.

30:08 Okay.