The Military Should Airlift New York City’s Coronavirus Patients

Shortly after the start of the Cold War, the Soviets blockaded the roads, railways and canals leading to West Berlin in 1948. Overnight, some two million people were cut off from food and fuel. The Western allies panicked, but under the leadership of President Harry Truman, the crisis was solved with the Berlin Airlift.

Supply an entire city indefinitely by air? Critics declared it dangerous and prohibitively expensive. But in those postwar years it seemed that with proper leadership little was beyond our potential.

Indeed, the Allies, led by the U.S. Air Force, shocked the world. In the span of 15 months, Allied pilots — mostly Americans — flew through the Iron Curtain more than 275,000 times to deliver everything from corn to coal. By the spring of 1949, we delivered more cargo than previously had arrived by rail. The Soviets had no choice but to withdraw the blockade. West Berlin not only escaped peril, but also thrived. Thousands of lives were saved, and the world was left inspired.

New York City today faces a challenge that is possibly greater than the one West Berlin overcame in 1948. The president, governor and mayor are working tirelessly to acquire ventilators and create makeshift hospitals and I.C.U.s. Scores of nurses are being trained. Orthopedists, dermatologists and radiologists are staffing emergency rooms and triage tents. Even medical students are prematurely being thrust into action. Nonetheless, projections show shortages are about to worsen. Meanwhile, the city’s morgues are filling up, requiring the Federal Emergency Management Agency to deliver 85 refrigerated trucks for the dead.

With New York City at its breaking point, Gov. Andrew Cuomo continues to plead for more resources to be brought to patients. But we are reaching the limits of this singular strategy. It is time we also bring patients to the resources.

To save New York, like Berlin, we need an airlift. Only in reverse. We need federal assistance to distribute patients from hospitals facing the pandemic’s surge to less-affected facilities.

Across the country, other states, cities and health systems are preparing for their own surges. At Johns Hopkins Hospital in Baltimore and Brigham and Women’s Hospital in Boston, where the two of us work, our leaders are hustling to build capacity. We have emptied entire floors, canceled thousands of elective operations, reconfigured staff schedules and readied hundreds of ventilators in just a few weeks. Hospitals everywhere are following similar strategies. But not all are feeling the surge like New York City. Many are fully staffed yet only partly full. With no patients, some are even cutting pay and laying off staff.

In our feverish preparations, we seemed to have overlooked one possibility — what should be done with extra capacity if the dreaded surge doesn’t come?

For example, look at San Francisco, the second-densest city in the United States, which had its first case around the same time as New York. Thanks to early and strict social distancing, its hospitals haven’t been overrun. University of California San Francisco, the Bay Area’s largest hospital system, with 789 beds, had just 16 patients with Covid-19 on Friday. At the Johns Hopkins Hospital in Baltimore, which has 1,162 beds, there were 92 inpatients with Covid-19. Numbers are steadily climbing here, but like San Francisco, Baltimore has now had over two weeks of social distancing. There may be no overwhelming surge here. For comparison, Brooklyn Methodist has approximately 400 patients with Covid-19 and 651 beds.

Across the country this scenario will continue to play out. Some cities will erupt into hot spots while others nearby wait at the ready. To save lives, we must all share the load. The federal government must lead the way by enlisting hospitals to report open beds and calling on the U.S. military, with it fleet of trucks and helicopters, to aid with the transfer of patients.

To be clear, sending equipment and personnel to hospitals in crisis is vitally important. It will remain so. But supplementing these efforts with the transfer of patients between hospitals will better match patient demand with health care supply. To save lives, it is better to have more hospitals running at peak capacity than a few bearing the brunt. Shouldn’t we mobilize the existing capacity at places like Johns Hopkins Hospital — which is already staffed and equipped for this kind of care — before relying on makeshift hospitals set up at places like the Javits Center?

Of course, transferring a sick patient requires thoughtful and deliberate planning. If the patient is critically ill, the challenge is greater yet, often requiring helicopter transport and flight paramedics. The efforts could start with coronavirus-negative patients — such as people with acute or chronic heart failure or drug overdoses — while the difficult task of transferring contagious patients is more carefully coordinated. Once those patients are transferred, I.C.U. beds should open up for coronavirus patients.

For transfers to meaningfully supplement local response, they would need to be substantial in scale — perhaps in the thousands of patients. They could occur by ground or air, as most large hospitals have a helipad.

It might seem harsh to move Covid-19 patients far from their families and friends. But many hospitals have already closed their doors to visitors, so communication between patients and their loved ones is happening now via phone or internet.

Some will say that hospitals should handle transfers between themselves. However, as hospitals hunker down, they are unlikely to volunteer their beds. After all, they have their own patients, employees, public image and bottom line to look after. Understandably, the welfare of patients at other hospitals is not their first concern. These incentives and realities necessitate government leadership, and when transfers cross state lines, federal action will be required.

Others will say doing this at scale is dangerous and prohibitively expensive. But these critics, like those in 1948, underestimate our potential. Our nation’s military has the necessary combination of expertise, resources and authority to oversee and carry out the transfers. And let’s not forget, federal leadership in moving patients during a crisis is not without precedent. When Hurricane Katrina hit New Orleans in 2005, thousands of patients were flown from flooded areas to nearby facilities. The mistake then was a delay in action. We should learn from that mistake.

If we are to succeed, Mr. Trump must lead like Truman, New York must become our new Berlin, and the airlift should be ordered immediately. If we do so, once again countless lives will be saved. And a world inspired.

Michael Rose is a resident physician in internal medicine and pediatrics at Johns Hopkins Hospital in Baltimore. Sumit Agarwal is an internist at Brigham and Women’s Hospital and Harvard Medical School in Boston.

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