At the beginning of March, Dr. Neal Shipley unexpectedly found himself at the epicenter of the COVID-19 outbreak.
As medical director of 52 Northwell Health-GoHealth urgent care centers in the New York metropolitan region — including one in New Rochelle, a suburb where the first COVID-19 patients in the area arrived to be diagnosed and treated — Shipley began preparing for a fierce battle against a raging virus.
Urgent care centers were quickly becoming an integral part of Northwell’s response to COVID-19. As doctor’s offices closed their doors to help slow the spread and emergency departments were becoming overloaded with patients sickened by the novel coronavirus, people were increasingly turning to the types of clinics that Shipley oversees.
“At the start of the pandemic, patients were showing up with upper respiratory illness, coughs, fevers, body aches and fatigue,” says Shipley, 58, who is a board-certified emergency medicine physician. “And urgent care centers were convenient places for sick people to find help with little or no wait times to see a primary care physician.”
[Read: Mother-Daughter Nurse Team Both Treating Coronavirus Pandemic.]
During those early weeks, the Centers for Disease Control and Prevention and the New York State Department of Health guidelines changed quickly, as did the clinical understanding of how the virus presented. That, Shipley says, created an urgent need to effectively communicate with his team — about how the virus spread, how to identify patients at risk, how to properly use personal protective equipment and how the testing process worked.
Staff had to decide which patients to send home to recover and which to send to hospital emergency departments that were already overloaded. “From the minute we opened to the minute we closed, we were working at 150% of capacity,” Shipley says.
As the outbreak escalated in New York, the number of patients arriving at urgent care centers increased rapidly. Shipley and his colleagues were battling a difficult combination: a surge in patients who were sicker than those usually seen in an urgent care center — and workforce strain, as staff members also began to fall ill.
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By mid-April, almost every patient showing up across his 52 centers was either diagnosed with COVID-19 or had COVID-19-related symptoms. More than 20,000 patients were tested; a third were positive.
Shipley and his Northwell colleagues took quick action to avoid overcrowding and lines around the block. Patients were given appointments and didn’t enter the building until they received a text message telling them to do so. They were handed a mask at the door and escorted directly into an exam room. “Success meant making it through the day without having to send more than two or three patients to the ED in an ambulance,” Shipley says.
As COVID-19 began impacting the urgent-care workforce, greater demand was placed on staff who weren’t sick or under quarantine. There was little time to pause: The staff kept going, and going; when possible, someone would be given a day off. Team members were laser-focused on making sure proper PPE was available, and there were weekly calls to check on staffers’ well-being.
“We heard about the physical and emotional costs of working more than 12-hour shifts in full PPE, while caring for sick patients with an illness we had no good treatments for,” Shipley says.
The staff regularly shared their successes and cried over relentless streams of heartbreak pouring through the clinic doors. Older patients were likely to end up in the ICU, on ventilators, unable to have visitors and with a terrible prognosis. “We all knew the toll this battle was taking, but we had to remain focused on the task at hand: to provide the best possible care for our patients despite the risk,” Shipley says.
At home, employees took precautions to keep their families safe by sleeping in separate bedrooms, using separate bathrooms, taking off their work clothes at the front door and showering before approaching their loved ones.
In the early days of the outbreak, Shipley self-quarantined at home for 14 days after learning he’d been in a meeting with someone who had tested positive for COVID-19. He set up his command center at the kitchen table, monitored his temperature daily and leaned on his wife, Nan, to whom he’s been married for 28 years.
“Luckily, I didn’t get the virus,” he says. “My family and I worked to keep safe by wearing masks outside, social distancing, washing hands, respecting the scientific evidence and honoring the efforts of those working to save lives by not adding to their burden.”
Shipley says that at the peak of the crisis, diagnostic testing became a high priority at his urgent care centers. While reliable testing was available because of the centers’ relationship to Northwell Health, it was challenging to meet the demand. Providers had to be in full PPE to perform a nasal swab, and protective equipment had to be changed for each new patient. “As the stakes grew higher, every patient visit became more complex,” he says.
[Read: Doctor Treats COVID-19 Overnight, From His Living Room.]
Now, because New York has turned the corner, the demand for antibody testing exceeds that for diagnostic testing. While that’s a good thing, it’s not yet fully understood how long antibodies last and whether they confer immunity to COVID-19.
“One of the best things that’s happening now is that we’re starting to see non-COVID illnesses come back to our centers,” Shipley says. “I have never seen a group of providers so happy to suture up a laceration or prescribe antibiotics for a UTI.”
Shipley says that individually and collectively, health care workers have sacrificed so much and worked so hard on behalf of their communities, staff and patients to get to where we are now. “When there’s a second wave, if we don’t have a better strategy for testing and contact tracing, I worry that all of the sacrifice will be for naught and we will be right back where we started.”
As the pandemic begins to abate in New York, Shipley has had more time to reflect on his experience. He says Nan has been his touchstone for making sure he’s thinking clearly during the worst part of the crisis. He’s particularly proud of how his urgent care teams pulled together and rose to the challenge, despite extremely difficult circumstances.
“While it has been emotionally and physically exhausting,” he says, “the resilience, determination, grace and courage under pressure have been heroic.”
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