In recent weeks, doctors, nurses, and other health workers—both paid and volunteer—have flooded into New York City from all over the country to help hospitals and other medical centers overwhelmed with COVID-19, which as of mid-May had put nearly 50,000 city residents in the hospital and claimed the lives of at least 15,000 people. One of those unpaid volunteers was Gal Mayer, M.D., medical director of the LGBTQ-serving New York City clinic Callen-Lorde from 2005 to 2013, and since then senior director of HIV prevention at Gilead Sciences.
Wanting to put his doctoring skills to use in a time of crisis, Mayer reached out to the New York City Medical Reserve Corps—and ended up spending five weeks COVID-screening health workers at Brooklyn’s Woodhull Hospital, part of the city’s public hospital network. As he shared with TheBodyPro, his experience there was both sobering and moving. [Editor's note: Gilead Sciences is an ad sponsor on TheBodyPro. However, the decision to interview Gal Mayer for this article was based entirely on his many years of experience as a highly respected HIV clinician and health care administrator. We maintain a strict separation between advertising and editorial.]
Tim Murphy: Gal, thanks for talking with us about your service to the city. So, tell us the story of how you ended up with a stethoscope around your neck for the first time in about seven years.
Gal Mayer: Sure. In early March, I was scheduled to attend CROI [a large, annual HIV and other retrovirus conference] in Boston, but the whole COVID story started blowing up. The CROI folks were saying that the conference was going to happen; in fact, some people had already gone up to Boston for a pre-conference. But then CROI said they were converting to a virtual conference. That made it real for me that COVID-19 was going to fundamentally change at least the near future of everything. So shortly after CROI, Gilead said that we would not be traveling or meeting people face to face, and my work is mostly travel.
Then NYC started getting seriously affected. I remember the helplessness I felt right after 9/11 when I was just starting my medical career at Callen-Lorde. I went down to [the now-defunct Greenwich Village hospital] St. Vincent’s in my scrubs with my stethoscope and said, “I’m here to help, what can I do?” And they said, “There aren’t enough survivors for us to need your help.” And I remember thinking that I’d been training all my life, but there was nothing I could do. Shortly after that, NYC formed their Medical Reserve Corps, and I joined and got an MRC polo shirt, but nothing ever happened.
Until COVID-19. I remember thinking that here I was, working from home, but meantime people in my city were dying and surely I could be more helpful. The reason I went into HIV, besides that I am gay, is that my work is very informed by social justice. With AIDS, I know that countless gay men died who didn’t have to die because of social determinants of health. So I knew that COVID-19 would disproportionately affect people who were poor and of color.
So Gilead generously let me take a month off from working from home, which ultimately turned into five weeks. I told the NYCMRC I lived in Brooklyn, so they asked if I wanted to be deployed to Woodhull, a 300-bed hospital on the boundary between Williamsburg, Bushwick, and Bed-Stuy. It was a public hospital, which was where I wanted to volunteer. So they did an emergency credentialing process, and I did a couple of days of online training, and by early April I went down to the hospital for an orientation and to get an assignment.
TM: So, what was your first day like?
GM: It was crazy. They were seeing 200 people a day in the ER, for a hospital with 300 beds. A lot of wards that normally served other functions had been converted into ICU wards. Secondhand, because I was not in the ER or inpatient units, I heard that the ER was impossible to walk through, it was so crowded. The whole hospital was extremely busy, and you could see the exhaustion and anxiety in the eyes of the staff. At the time, they weren’t even accepting non-COVID patients, so that whole ER was COVID.
Then there was the “code blue” call, when someone is going into respiratory distress, on the loudspeaker about once an hour, whereas usually you’ll hear that once the entire day. That gave a surreal texture to the day there, this constant interruption that was an uneasy acknowledgment of how serious the situation was. It was like you were in the Lifetime movie version of a hospital, with people dying left and right.
There also wasn’t enough personal protective equipment [PPE, like masks, face shields, and gowns], beds, or ventilators. My first day, I was supposed to observe how other doctors were doing stuff, but they couldn’t find me an N95 mask or face shield, so I wouldn’t get close to staff or patients as they were doing nasal swab sampling. I watched from a distance. I’m happy to say that I started seeing patients the next day, as soon as they located PPE for me. We would put surgical masks on over our N95s, because we were using the N95s multiple times.
I’d never done inpatient [hospitalized] care before, so they found the perfect place for me, which was in Employee Health Services, and my job was to screen employees for corona. Already, the hospital had nurses checking staff temperatures at the door so nobody with a fever could go in. Once staff were in, a supervisor would refer staff to us if they had symptoms or if someone they’d worked with closely was diagnosed with corona.
One thing that felt honorable was that many others I was working with were paid volunteers, NPs [nurse practitioners] and PAs [physician assistants] from Las Vegas, Texas, Alabama. Talk about heroes. They left their families, jobs, comfort, and safety to come to New York and work. And our job was to make sure that people who were contagious went home and those who weren’t stayed at their posts and worked. Because a significant number of hospital employees were appropriately terrified, and many just stopped coming to work and would call in sick.
Eventually, staff could come in for screening on their own, without a supervisor referral. If anybody complained of symptoms that sounded like COVID, we played it safe and sent them home. But the hospital was also very good at processing nasal swabs [detecting COVID-19 virus], so if someone was sent home and the test showed they didn’t have COVID, we could bring them back the next day. Eventually, we added antibody testing as well as swab testing for the virus itself.
TM: What if those people had a cold or flu instead?
GM: Anyone with a fever was filtered out. It’s hard to know how many symptoms were psychosomatic, as a result of anxiety. And we realized that, among those without fever, it was really hard to know who had actual virus in their nasal passage. One woman came in; she’d read online that loss of taste and smell was a symptom, and after she read that, she reported that she had that, but with no other symptoms. I’m thinking, “Wow, the power of the mind.” We sent her back to work. Lo and behold, hours later, her swab test was positive and we sent her home for the week. Then we’d have people coughing, short of breath, looked sick, so we’d screen them and send them home, and the next day their test would be COVID negative.
TM: What were the demographics of the staff that you saw?
GM: Incredibly diverse, lots of people of color. But I noticed that who was sick was more a function of where in the hospital they worked. People from the ER were very likely to test positive, whereas almost nobody from medical records did. It seemed more about levels of exposure than race or other demographic variables.
TM: In all, your unit screened more than 1,000 patients in five weeks?
GM: I personally oversaw 256 people. My last day there, both my own swab and antibody tests were negative. Data has shown that New York state health workers have actually been infected at lower rates than the general public, which is absolutely a testament to the role of PPE. But I bet there is still variability in terms of susceptibility to infection, because everyone in the hospital was using PPE, so why did some get it and others didn’t?
TM: Were there any deaths among the workers you screened?
GM: Not that I know of. We really wanted to make sure that didn’t happen, so whenever someone’s swab was positive, we made sure they went home immediately, or continued to stay home, for seven days minimum or until symptoms resided, and we called every employee daily to make sure they were OK.
TM: We’ve heard about many COVID patients who seemed stable suddenly taking a turn for the worse with their breathing. Did you see that?
GM: Yeah, there was one young woman, a nurse in her 20s from our unit, whom I sent home because of her cough. She tested positive. The first couple of days, she was fine, her cough was getting better, and one day I called and I could immediately hear that she was getting short of breath while talking to me. She asked, “My son has asthma—should I take his prednisone?” I said no. She went to her personal doctor, who gave her a pulse oximeter [to monitor her respiratory state], and she got better. But I felt my heart drop an inch when I heard her on the phone that day.
TM: You were there the whole month of April and a bit of early May. Did you see a drop-off in the number of cases in that time that correlates with what NYC saw overall through April?
GM: Absolutely. At one point, the ER population dropped from 200 to 70. And the last couple weeks I was there, we did antibody testing for a lot of staff whose wards were converting from COVID back to normal wards.
TM: What are your personal takeaways on this virus? Are there HIV parallels?
GM: There are two clear parallels. One is that that it disproportionately affects people who are already marginalized. The other is that there have been countless unnecessary deaths due to political inaction. In this case, unlike with HIV, politicians can’t just pretend that it doesn’t affect them. It clearly affects everyone. But people who generally are cared about less are being cared about even lesser right now.
TM: What’s your take, after this experience, on how unprepared was the federal government, the state, the city, or the NYC public hospital system?
GM: I don’t have enough perspective to comment knowledgeably about that. I don’t want to get political about it, except to say that our federal government’s approach is marked way more by politics than science, which is an embarrassment.
TM: You don’t want to comment on the role of the city or the public hospital system?
GM: No, because I don’t know what happened there. I wasn’t privy to any meetings. But I’ll say that one of the privileges for me was to work alongside employees who were under so much stress that just showing up to work, at a public city hospital, was an act of heroism. We’re talking about a very brave and dedicated group of people. And it was a privilege for me to care for the caregivers. For five minutes with me, they had an opportunity to be the patients, talk about their fears, anxieties, grief about people they’d lost. They’d talk about who they were afraid to bring it home to—children, parents, spouses. One woman, an immigrant from Colombia, broke down crying one day. She and her husband both worked in this hospital and lived with their kid and her mother, who was the primary caretaker of the kid. And every day this woman had to choose between coming to work and then denying herself the pleasure of being physically close to her kid when she got home. She turned out not to be positive. And it was great to be able to tell her that the city had a hotel program if she or her husband had to socially distance from her mom or kid if they got sick.
TM: What was it like for you seeing patients again after seven years?
GM: I miss it. I love, love, love the job I have now. It’s doing PrEP [pre-exposure prophylaxis] expansion for Gilead. I have an opportunity to have a really positive impact on many more people than I would ever reach as a clinician. But it doesn’t quite replace those magical moments when you’re one on one with a patient looking to you for guidance, advice, and caring. When I left Woodhull, I told them that once things go back to normal a little, I’d be open to volunteering with them again here and there.