Like soldiers preparing for yet another war, New York City hospitals and nursing homes prepare for a possible resurgence of coronavirus patients, drawing on lessons learned in the spring, when the outbreak brought the outbreak to its knees. largest city in the country.
The new preparedness manual stems from the apocalyptic days of March and April, when evidence and resources were scarce, emergency rooms were overflowing, and funeral homes were stacking corpses in refrigerated trailers.
These hard-won ideas make city hospitals much less likely to collapse under a second wave of COVID-19, city health leaders said.
Even without a vaccine, doctors are promoting increasingly effective coronavirus treatments, three-month supplies of personal protective equipment and emergency personnel plans.
Similar preparations are underway in New York’s nursing homes, which were responsible for a staggering percentage of coronavirus deaths in the state.
“We didn’t even have the tests 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 in general “are not getting as intense exposure as they used to because of wearing masks.”
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The new cases are also affecting younger people, who are less likely than older patients to need hospitalization.
“Our hospitals are still quieter than they would have been a year ago because people are avoiding care due to concerns about COVID,” Katz added. “We can have several hundred additional patients and still not be full.”
New York had nearly 37,000 new COVID-19 infections in October and is on track to have more than twice as many people sick this month as those who got sick in September.
But so far, that increase has led to a modest increase in hospitalizations. City statistics show that, on average, about 45 people a day have been admitted to New York City hospitals each day in October, up from an average of 29 a day in September.
This compares with an average of 1,600 a day during the two worst weeks of the pandemic in March and April, at which point the state also recorded its highest daily death toll and ambulance sirens became an ominous soundtrack of the pandemic out of control of the city.
Last week, by contrast, the city’s 11 public hospitals had a total of six intubated patients, down from the peak of 960.
The relative tranquility contrasts with hospitals in Europe and the west of the mountain, which have been increasingly overwhelmed by the new waves.
“The measures that have been put in place seem to be working,” said Dr. Fritz Francois, chief medical officer at New York University Langone Health, alluding to the widespread use of masks, social distancing and the attention that authorities pay to the conflictive points of some sectors of the city.
“Even if we see something of a resurgence,” Francois said, “the outlook is that it’s not going to be similar to what we experienced in the spring.”
Still, city hospitals are rewriting their policies and stocking up on supplies while closely monitoring fluctuations in cases across the state and making computer models to decide if 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. The NewYork-Presbyterian has stocked ventilators, even as doctors now recognize that anesthesia machines can double as ventilators in a pinch.
“I’m very confident that with any resurgence, we could cope with it,” said Dr. Steven Corwin, executive director of the NewYork-Presbyterian, which has increased its number of intensive care beds from 450 to 600.
Anxiety levels remain high in New York’s 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, compared to 379 in the previous four weeks.
In order to prevent further outbreaks, state health authorities restricted visits to nursing homes that can show they are “COVID-free” for 14 days, meaning there is no positive test among residents or staff, a requirement that Nursing home owners said it has been very difficult to comply, 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 Community Long-Term Care Coalition, a nonprofit advocacy group. profit.
“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 believe that 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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