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Trauma Surgeon Gerard Baltazar '98 on Frontlines in COVID-19 Epicenter
Gerard Baltazar, D.O., ’98 is a trauma and intensive care surgeon at NYU Langone Health. Baltazar obtained his undergraduate degree in biology and fine art from Georgetown University and his doctorate from Touro University California. His postgraduate training focused on underserved urban communities in New York City and Newark, New Jersey. Before joining NYU, Baltazar was the Director of Surgical Critical Care at a safety-net hospital in the Bronx.
On the COVID frontline since his neighborhood in New Rochelle became an American pandemic epicenter, Baltazar has treated and performed research for critically-ill COVID patients. By sharing his experience from the frontline in a series of webinars, Baltazar aims to encourage understanding and positivity in the wake of tragedy.
What does your job currently entail, and how has your role shifted due to COVID-19?
I’m a trauma surgeon and surgical intensive care doctor, so my normal schedule is to cover general surgery that comes through the emergency room, trauma cases that come in through the trauma bay and the intensive care unit for critically ill surgical patients.The trauma center never closed, so we were still seeing bad trauma cases from falls, assaults, car accidents, although at a lower volume. In addition to our usual trauma duties, we also covered multiple COVID-19 ICUs, which were constantly full, and we covered the one multispecialty ICU that remained non-COVID.
What was it like making that change so quickly?
It was really hard. All of a sudden, COVID-19 was everywhere, and every patient who came in, even many of the trauma patients, had COVID-19. Especially initially, no one had any idea what this disease was or how we were supposed to approach treating it. And we didn’t know what our risk was, either. So on top of feeling unarmed to fight this thing, we also were highly stressed about our own safety and security and our families’ safety and security.
Tell me about your research related to COVID-19.
One project is on alternative ventilator strategies. Initially, based on the information coming out of China and some trickling out of Europe, the idea was to treat patients as if they had Acute Respiratory Distress Syndrome, which is a phenomenon we often see in patients with infection. That did not seem to make sense to my team. Intensive care surgeons see a variety of surgical patients and trauma patients who maybe had a shotgun wound to the chest, and we treat them with a ventilator in a different way than someone who with typical pneumonia would get treated. And when this disease started to present as an atypical pneumonia, our impression was that some of the tools that we had developed treating our specific population might be more appropriate for this type of disease.
We started using Airway Pressure Release Ventilation a way to allow more of the lung to be accessed while allowing the patient to breathe on their own. It allowed us to decrease the amount of sedation and painkillers we need to use to keep the patients comfortable. We were able to get better oxygenation of the patients, and their lung injuries seem to get better. We used less blood pressure medication and no longer needed to prone patients as frequently. Our project is still in the very early stages, but it’s fascinating that the approach that was initially adopted may not be the best approach. We have to be creative and draw on various talents to try to treat something the world had never seen before.
We’re also looking at how COVID-19 affects surgical and trauma outcomes. Our hospital is part of COVIDSurg, an international collaboration to analyze how COVID-19 affects surgical patients, and it clearly shows that patients who have COVID-19 have higher risk, mostly from a pulmonary perspective. That being the case, the idea of doing elective operations has to be treated much more carefully. Emergency surgeries are emergency surgeries—we have to do it if we have to do it. But we have to be much more cautious when we’re doing elective surgery. Is it absolutely necessary? Is it absolutely necessary now? Those are ideas we’re still looking at from every level.
One more thing I’m researching is using osteopathic manipulation, or manual treatments, to help patients recover from COVID-19. The last time there was a pandemic of this size was 1918-1919, the Spanish influenza pandemic. During that time, osteopathic manipulation treatment, or OMT, was associated with improved survival of patients who suffered from Spanish influenza. OMT approaches the disease state by augmenting a patient's inherent ability to heal and may help with this pandemic especially in absence of an effective antiviral or vaccine.
Why did you decide to create a webinar about your experience on the front lines?
I wanted to get my experience out there about what it’s actually like on the frontline, to tell the story in a personal way, something that can reach people so they can see that this is affecting so many patients and their families and also the healthcare workers who are putting themselves at risk. I also wanted to try to inspire my colleagues to get involved, especially since this thing is probably not going to go away for months or years. Also it’s very therapeutic for me to put ideas together and slowly make better and better talks.
What was it like being in New Rochelle, the new pandemic epicenter?
In January and February, we were just like normal people. We were all wondering, maybe it’ll hit here. If it’s going to hit someplace it’s going to hit New York; we’re an international city. We’re following the news like everybody else, we’re having some meetings within the hospital, and then all of a sudden it hits. But not only does it hit in New York City, it hits my neighbor a mile and a half down the road. Then all of a sudden there’s a containment area and the national guard is driving around our neighborhood, and it was shocking and really put us on our heels. My wife and I became very concerned, and we were locking down our family before the lockdown officially happened. We took our daughter out of school. There was a lot of anxiety and frustration.
Is there anything else you’d like to add?
My family is still down in Maryland and Delaware, and after speaking to them, I wonder how much the public is accepting or not accepting that this disease is truly as bad as some news reports are making it out to be. I think news reports are actually being a little too limited with their reporting. The disease itself is much more complex and deadly than the news is pushing out. Moreover, the loss and difficulties that healthcare workers are going through at the moment and went through during the surge—like losing people we cared about, being under so much stress and experiencing PTSD-like symptoms—this is a real challenge for us. I hope the public understands that this really is a bad disease, that it really is affecting those of us on the front lines in a major way and that we should all work together to limit its spread.
