Special Report: In COVID-19 ‘Hotspots’ New York, New Jersey, Indian-American medics try new drugs, officials tighten protocols

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“All my days are a blur because I (sic) been working nonstop.” says Dr. Pooja Shah, an infectious disease specialist at John F. Kennedy Medical Center in Edison, New Jersey.

She is among hundreds of Indian-American physicians on the front lines of COVID-19 in New York and New Jersey, states with the dubious distinction of being hardest hit by the pandemic,

The new strain hits close to home for virtually every Indian-origin family in the country, either because they know someone or have someone in their own family, serving as healthcare workers.

As of April 6, 2020, total confirmed COVID-19 cases worldwide were close to 1.3 million and fatalities at 70,798. The United States led with 338,995 cases and more than 10,000 deaths. In the country, New York led with 130,689 cases and more than 4,000 deaths. A thin silver lining was Gov. Andrew Cuomo’s announcement that total hospitalizations were down, and there may be a possible flattening of the curve going by the last two days, but it was not certain if the trend would continue.

In the White House press conference on April 5, 2020, President Trump zeroed in on the two states leading in pandemic cases, “Today, every patriotic American heart beats in solidarity with the incredible people of New York and New Jersey. They’ve really become a very hot zone, but some very good things are happening.” Some 3,000 National Guard medical personnel were being sent to New York City, announced Vice President Mike Pence in his April 6 press briefing. Some 600,000 N95 masks were to be delivered to New York City April 7, and more to other parts of the state.

The Federal Emergency Management Agency, FEMA was delivering an additional 500 ventilators to New Jersey.

Plus rapid testing kits produced by Abbott labs were being distributed around the country, and according to Governor Cuomo a return to normalcy would be evident when his state receives the approved rapid testing kits. “That is going to be the answer, I believe.”

New Jersey recorded 41,090 cases and more than 1000 deaths as of April 6, 2020 afternoon, Gov. Phil Murphy revealed. He also tweeted that data, science, medicine and facts were “Our North Star” in the fight against the virus, and gave the good news that several drive-by testing sites in the state had begun operations.

New Drugs

Meanwhile, physicians and health workers like Dr. Pooja Shah and her father Dr. Pradip Shah, are focused on treating patients in their emergency rooms and intensive care units with barely time to catch their breath, bravely trying the new solutions allowed under the law, in this national emergency.

Shah’s institution just got the go-ahead to use Remdesivir, an anti-viral drug that appears promising, being manufactured by Gilead Sciences Inc., and which is undergoing clinical trials in China.  The Expanded Access Site, under which Dr. Shah can use Remdesivir,  Gilead gives the medication with a strict criteria laid down for usage. She has to put down the patient’s status with the request on EAS, which then has to be either cleared or rejected by Gilead.

“It’s a very strict criteria such as the patient has to be intubated,” with certain indications in the lab work etc., Dr. Shah said. “Over the last week, I have had 8 patients,” to whom Remdesivir was given, but only for those in the Intensive Care Unit.

“We don’t know how long it (Remdesivir) will take to show any effect. We don’t know the outcome because its too early,” she added. Prior to its use, the patient and/or family members have to give the consent. The patient gets the drug daily and doctors input the data every day.

“Other hospitals are part of the clinical trial, but we are getting the actual drug – we are doing the clinical observation,” Dr. Shah explained. A clinical trial would have meant a random sample study where some of the patients would be given a placebo. That is different from Dr. Shah’s situation. She and others at JFK Medical Center are giving the real thing to each patient at a certain stage of their illness from COVID-19.

This is not the only drug Dr. Shah is using for her patients. “We are trying various drugs”. They are also giving Hydroxychloroquine and Azythromycin combination which every Emergency Room patient is put on — but, and it is a big but, Dr. Pooja Shah emphasizes, giving the drug is dependent on their underlying heart condition and several factors. “It is not straightforward. A lot of thinking is involved and it (Hydroxychloroquine/azythromycin) cannot be given every time,” she said. If a patient comes in without heart complications, “I do put them on it,” she said.

Gov. Cuomo in his April 6 briefing also addressed the state-wide use of Hydroxychloroquine adding that there was “anecdotal” evidence but no scientific study yet, on its effectiveness.

President Trump has repeatedly endorsed Hydroxychloroquine treatment over the past weeks, and he did so again on April 5. “… if you don’t have a problem, a heart problem, we would say: Let your doctor think about it.  But as a combination, I think they’re going to be — I think they’re two things that should be looked at very strongly,” President Trump said, announcing that 29 million pills had been stockpiled and being sent to hospitals.

“… if you don’t have a problem, a heart problem, we would say: Let your doctor think about it.  But as a combination, I think they’re going to be — I think they’re two things that should be looked at very strongly,” the President added.

Meanwhile, the Center for Disease Control and Prevention, CDC, estimates that 45 percent of adults (108 million) in the U.S., are living with high blood pressure.

Public Is The Frontline

Dr. Maulik Trivedi has been an ER physician in New York and New Jersey for the last 20 years, and is seeing a lot of COVID-19 patients. “In New York and New Jersey area, we are telling people not to come to hospital if the symptoms are mild. So everyone we see in ER are COVID patients,” Dr. Trivedi noted.

“I know colleagues that are sick and some Indian-American physicians are in ICUs,” he says with stark frankness. He urgently appealed for the public including Indian-Americans, to stay home unless symptoms are bad.

“Actually, you guys are on the frontline. You do your job and you protect us (healthcare workers),” by staying home and maintaining the protocols, Dr. Trivedi said. “We are in the backlines taking care of the patients.” Physicians also have family both here and in India, an added worry, he noted.

Currently, in-house at the New Jersey hospital where he works and which he did not want identified, Dr. Trivedi estimates there are 160 COVID or potentially-COVID patients. He is loathe to discuss the new meds that are being tried as the results so far are not definitive, mirroring what Dr. Shah said.

“People are saying to try this or try that and maybe there’s no risk. But that kind of information can lead to death,” he cautioned. “What’s really important is we need to give accurate information and no false hope.”

As ER physician, he says, doctors are starting patients on some of the recommended new medications, and “depending on the clinical picture of the patient we do give some. But this is a fast moving situation.” And when patients recover, he said, “I’m not prepared to say it is the result of some new medication.”

The CDC, he says could be behind the curve compared to ER physicians who are seeing the illness in real time and are coping with it on the spot, on the ground. In fact he recalls seeing the symptoms now identified as COVID-19, as long ago as late December 2019 and early January this year, but it did not have the name.

Several Indian-American doctors have appeared on national and local television stations, speaking to issues surrounding COVID, and to potential cures. The television station, ITV Gold, which is part of Parikh Worldwide Media that brings out Desi Talk, interviewed several including Dr. Binod Sinha,  president of the American Association of Physicians of Indian Origin New Jersey Chapter, Dr. Purvi Parikh, of New York, expert in asthma, allergy and immunology, Dr. Bhudev Sharma of the JFK Medical Center, alerting people to the dangers and giving the details and the precautions for individuals.

“To earn our name and respect as an AAPI doctor, we need to get involved in our local community as much as possible,” Dr. Sinha said.

“Please stay home,” urged Dr. Purvi Parikh, calling it a “very, very dangerous’ situation especially in New York, New Jersey, and tristate area. Hospital are full and her colleagues in emergency rooms are telling her they have no places left. “So we’re already making decisions to let some people live and some people not live based on that,” she added.

The NYU Langone Medical School, where Dr. Parikh also works, is currently conducting a random trial on Hydroxychloroquine use on patients with a $9.5 million grant from the Bill & Melinda Gates Foundation, the New York Post reported April 6. The paper also sourced state health officials not named in the piece had said that some 4,000 of New York COVID patients were being treated with Hydroxychloroquine and that 56 hospitals had been shipped the medication.

Lawmakers & Law-enforcers

Indian-American administrators and elected officials in New York, but particularly in New Jersey where they occupy several critical positions, and are at the helm of their districts and the state, are enforcing the regulations that are helping drive down the incidence of the deadly virus.

New Jersey State Sen. Vin Gopal is working from home to coordinate additional supplies for healthcare workers, he told Desi Talk. Plus encouraging social distancing on a continuing basis. “If we all continue … we can all get out of this together,” he said. He has been in touch with Indian-American physicians and nurses as well as other medical personnel listening to their priorities. “And we are also educating the Indian-American community on related health concerns like diabetes and heart disease,” which are underlying conditions proving to be very negative for those testing positive for corona virus.

New Jersey Attorney General Gurbir Grewal has been in constant touch with the public on Twitter, with law enforcement steps being taken. “Some officers spent the weekend cracking down on more social-distancing violators, including disrespectful partiers in Rumson, … This isn’t about you, it’s about all of us. Do the smart thing, the right thing, & STAY HOME,” he said on Sunday April 5.

In the shadow of the Big Apple, Hoboken, New Jersey Mayor Ravinder Bhalla, displayed an even greater closeness to his constituents than usual, mourning the loss of any resident of his city, and sending out updates on closures and stricter regulations. On April 3, he posted a video thanking Dr. Gaurang Brahmbhatt of Riverside Medical, for offering to test COVID-19 patients, which began April 4. “Any resident with symptoms now has peace of mind that testing is available,” the Mayor said.

On April 5, Bhalla tweeted a photo of his wife Navneet and him wearing homemade scarves as masks saying. “Do I want to cover my face? No. Do I look a bit silly? Yes. Do I want to help my community & medical professionals, who are sacrificing their own safety for us? ABSOLUTELY. Hob, please use face cover (ie bandanas) when in essential businesses including supermarkets and pharmacies.”

New York’s only Indian-American State Senator, Kevin Thomas of Levittown, has also been posting guidelines and working from home with his staff on Zoom, and even visiting his office in Albany, and voting online on the state budget just passed.

Even as New York’s COVID numbers indicate some levelling, Sen. Thomas posted a tweet on the status of a fellow Senator, who was in an induced coma. He also sent out a warning April 6. “#SocialDistancing is important. If you see instances where social distancing isn’t being practiced, you can report it to the NYS PAUSE Enforcement Assistance Task Force,” he said. The 24/7 hotline for those complaints is 1-833-789-0470. Sen. Thomas also has a COVID-19 Community Resource Page at nysenate.gov/coronavirusresources.