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May 21, 2020

After New York's Covid-19 'surge,' what's next?

Daily Briefing

    As the growth rate of new Covid-19 cases and patient deaths declines in New York, hospitals in the state are focusing on how they can simultaneously treat Covid-19 long term and open their facilities to other patients.

    10 takeaways: What health systems must consider as they mull reopening

    Hospitals continue to treat smaller influx of Covid-19 patients

    New York City, which became the epicenter of America's Covid-19 epidemic, is seeing a drop in its growth rate of new Covid-19 cases and related deaths—and hospitals are noticing the difference.

    The New York City Health Department this month reported admitting fewer than 100 patients per day compared with a peak of almost 1,700 patients per day in late March and early April, and hospitals are reporting the daily death toll has dropped.

    "It's like someone turned off the hose," Eric Wei, an emergency medicine physician and SVP of quality for NYC Health & Hospitals, said.

    Now, New York City hospitals are working to determine the best way to treat the almost 500 critically ill Covid-19 patients that still need care. Some doctors are collecting data to identify best practices to treat Covid-19 patients, while others are seeking long-term acute care options for Covid-19 patients who are expected to remain on ventilators for an extended period of time.

    NYC hospitals prepare to resume services—and accept visitors

    While hospitals' focus on Covid-19 care is not going away entirely, the new declines in the growth rate of Covid-19 cases have allowed more hospitals to begin preparing for the post-Covid world, including once again allowing visitors.

    New York Gov. Andrew Cuomo (D) on Tuesday announced a two-week pilot program that will allow 16 New York hospitals to let patients resume having visitors.

    The program will be used "as a guide for more expansive visitation policies down the road," according to Brian Conway, a spokesperson for the Greater New York Hospital Association.

    "It is terrible to have someone in the hospital and then that person is isolated, not being able to see their family and friends," Cuomo said.

    In addition, while Cuomo's ban on scheduled surgeries remains in place in New York City, hospitals are working to meet state standards and resume those procedures once the ban is lifted. Cuomo has said hospitals must keep at least 30% of hospital and ICU beds available in case of another Covid-19 surge.

    In order to meet those standards, New York City hospitals are expanding capacity in creative ways.

    North Central Bronx is building a new, 120-bed ICU so it can treat both Covid-19 and non-Covid patients, and Northwell Health is planning to open two new units to treat long-term ventilator patients and free up capacity in its ICU.

    But as the hospitals prepare to allow elective surgeries, most are concerned about reducing transmission of the new coronavirus. Employees at Elmhurst Hospital and other New York hospitals are taking additional cleaning precautions such as swabbing empty rooms for biological mater, vacuuming the vents, and stripping the floors. Some are even using ultraviolet lights to disinfect rooms.

    Hospitals also are developing screening systems to use chest X-rays and thermometers to check non-Covid patients for the new coronavirus before they're admitted, according to Maurice Policar, an infectious disease specialist at Elmhurst.

    "We feel that that's a level of protection, even if we miss it and some people are there," Policar said.

    Hospitals face challenges going forward

    However, hospitals still have several hurdles to overcome, including ongoing personal protective equipment shortages, the Times reports.

    Christine Flaherty, senior VP of facilities management for Lincoln Medical Center, said a lot of necessary medical supplies—including dialysis catheters, blood transfusion tubes, and medications—are either delayed or sold out. In addition, the Times reports that the city's public hospital system is still experiencing a high "burn rate" for protective gear like gloves, masks, and gowns.

    Some doctors are also concerned that patients with chronic conditions will not want to come back to the hospitals due to fear of the new coronavirus, even with additional sanitation and safety measures in place.

    At Brooklyn Hospital Center, for instance, consultations have been down by about 70%.

    "You wonder, truthfully, where are all these people?" said Judy McLaughlin, SVP and chief nurse executive for Brooklyn Hospital Center.

    Hospital executives also fear what comes next, such as another wave of Covid-19 cases as the country looks to slowly reopen nonessential businesses and reduce social distancing measures.

    "It's almost this eerie silence," Sylvie de Souza, chair of the ED at Brooklyn Hospital Center. "None of us are at peace. We're sort of bracing for it to come back. All of us are wondering, can we go through this again?" (Fink, New York Times, 5/20; Passy, Wall Street Journal, 5/19).

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