NEW YORK – Like battle-hardened veterans, New York City hospitals and nursing homes are preparing for a potential resurgence of coronavirus patients, drawing on lessons learned in the spring when the outbreak brought to its knees. to the largest city in the country.
The new plan stems from the apocalyptic days of March and April, when evidence and resources were scarce, emergency rooms were overflowing and funeral homes piled the bodies into refrigerated trailers.
That knowledge, no matter how much it has been gained, makes the city’s hospitals much less likely to collapse under a second wave of COVID-19, healthcare leaders said.
Even without a vaccine, doctors are promoting increasingly effective coronavirus treatments, three-month supplies of personal protective equipment and contingency staffing plans.
Similar preparations are underway in New York’s worst-hit nursing homes, which accounted for a staggering percentage of coronavirus deaths in the state.
“We didn’t even get tested in February when there was so much transmission,” Dr. Mitchell Katz, head of the city’s public hospital system, said in an interview. “I don’t see how we could have the same situation that we had in March and April, but we are preparing for that possibility anyway.”
Not only has critical care improved, Katz said, but coronavirus patients generally “are not becoming as intense as an exposure as before due to wearing face masks.” New cases also affect younger people, who are less likely than older patients to need hospitalization.
“Our hospitals are still calmer than they would have been a year ago because people are avoiding care due to concerns about COVID,” added Katz. “We can have several hundred additional patients and still not be complete.”
New York has recorded nearly 37,000 new COVID-19 infections in October and is on track to have more than twice as many sick people this month as it was in September.
But so far, that increase has led to only a modest increase in hospitalizations. On average, about 45 people a day were admitted to New York City hospitals every day in October, city statistics show, up from an average of 29 a day in September.
That compares with an average of 1,600 a day during the worst two weeks of the pandemic in March and April, a time when the state also recorded its highest number of daily deaths and ambulance sirens turned into a sinister band. sound of the pandemic out of control of the city.
Last week, by contrast, the city’s 11 public hospitals had six patients intubated in total, down from the maximum of 960.
The relative tranquility contrasts with hospitals in Europe and the western mountains, which have been increasingly overwhelmed by further surges.
“The measures that were put in place seem to be working,” said Dr. Fritz Francois, medical director of NYU Langone Health, alluding to the widespread use of masks, social distancing and the authorities’ focus on hotspots in areas. from the city.
“Even if we see something like a resurgence,” Francois said, “the prospect is that it will not be similar to what we experienced in the spring.”
Still, city hospitals are rewriting policies and stocking up on supplies while closely monitoring fluctuations in computer and case models across the state to decide whether and when to activate contingency plans.
The city’s public hospital system is installing new cameras and microphones in patient rooms to reduce exposure for nurses. NYU Langone has reduced the time it takes to open a dedicated COVID unit to a matter of hours. NewYork-Presbyterian has stockpiled ventilators, even as doctors now acknowledge that anesthesia machines can be made to function like ventilators in a pinch.
“I’m very confident that with any resurgence, we could deal with it,” said Dr. Steven Corwin, CEO of NewYork-Presbyterian, which has increased its number of intensive care beds from 450 to 600.
Anxiety levels remain high in New York nursing homes, where the coronavirus raged rampant for months. New York nursing homes reported 713 confirmed and suspected COVID-19 cases during the four weeks ending Oct. 11, according to federal Medicare data, up from 379 in the previous four weeks.
To prevent further outbreaks, state health officials restricted visits to nursing homes that can show they are “COVID-free” for 14 days, meaning there is no positive testing among residents or staff, a requirement that Nursing home owners said it has been extremely difficult to comply with, given the coming and going of facility staff.
Earlier this week, New York banned visits to most adult care centers within the coronavirus “red zones,” where infection rates have risen.
“Most nursing homes are not adequately staffed to meet the basic clinical needs of their residents under normal circumstances,” said Richard Mollot, executive director of the Long Term Care Community Coalition, a nonprofit advocacy group.
“We believe this problem has been exacerbated by the pandemic and we have not heard anything from nursing homes as a whole working to address this problem in the face of current needs, regardless of a second wave,” he said.
Still, like hospitals, nursing homes say they are better prepared for a possible second wave than the first, pointing to more widespread PPE testing and supplies.
“Nursing homes have learned through ordeal how to keep their patients, residents and staff safe,” said Chris Laxton, executive director of The Society for Post-Acute and Long-Term Care Medicine.
Gurwin Jewish, a 460-bed home on Long Island, has updated contingency staffing plans for a new outbreak and is teaching in-service classes to educate staff on infection prevention measures. The house is testing 1,000 people per week and has a three-month supply of PPE and insulation boards that it used in the spring to create a dedicated COVID unit.
Still, like other New York nursing homes, it operates at about 85% capacity.
“We think some are hesitant to send their loved one to a skilled nursing facility,” said Maureen Fagan, Gurwin’s Jewish spokeswoman. “People are afraid”.
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