New York’s hospitals

‘Everybody’s in the same boat’: Coronavirus drives New York’s hospitals to breaking point

By SALLY GOLDENBERG, AMANDA EISENBERG and DANIELLE MUOIO

The coronavirus careening through New York City has brought one of the world’s premier medical capitals to its knees.

The city’s cash-strapped public hospitals were predictably overwhelmed by the breadth of the virus: Despite relocating certain patients and rearranging wards to open up space for the influx, the system was consumed by the crisis. So too was New York City’s network of private hospitals, most of which operate on much more comfortable margins and have boards that count New York’s civic elite as members.

In a city of extremes, the coronavirus has been an equalizer: Wealthy and poor alike are grappling with its grip on their medical resources.

“Everybody’s in the same boat — private hospitals, public hospitals, every hospital,” said Kenneth Raske, president of Greater New York Hospital Association. “They’re all responding to this crisis.”

The pandemic has exposed how ill-prepared hospitals are for a crisis of this magnitude, despite repeated pleas by medical professionals to bolster response plans. Some of that falls on the federal government, which under Democratic and Republican leadership alike has stripped funding for programs created in the wake of 9/11 to prepare health systems for a catastrophe.

“No one ever got enough money to actually get prepared for a major disaster like this,” said Irwin Redlener, a medical doctor and the director of the National Center for Disaster Preparedness, as well as an adviser to Mayor Bill de Blasio on public health matters.

City and state officials have scrambled to build makeshift hospitals at large sites that aren’t in use: The Javits Center in Manhattan opened Monday as an emergency facility with capacity for 2,500 beds, just as the U.S. Naval Ship Comfort docked in New York’s harbor to care for up to 1,000 patients displaced from traditional hospitals that are contending with the coronavirus. On Tuesday de Blasio announced the tennis stadium that hosts the U.S. Open in Queens would become a 350-bed hospital for coronavirus patients.

“All the hospitals combined had about 20,000 staffed hospital beds. We now need to — in just the next weeks — triple that number,” de Blasio said Tuesday, as he announced the transformation of the Billie Jean King National Tennis Center. “We're just going to keep going every single day adding and adding and adding to get to the point where we have what we need.”

Hours later, his administration reported an estimated 8,549 of the city’s 41,771 coronavirus patients had been hospitalized and 1,096 had died.

Meanwhile Gov. Andrew Cuomo and de Blasio have been at turns pleading and fighting with the Trump administration for more hospital supplies, and the mayor has said he expects the city to run out of masks and ventilators by April 5.

“This virus has been ahead of us from day one. We’ve been playing catch up from day one,” Cuomo said during his own daily press briefing on Tuesday.

As city officials watched the illness devastate Italy, the system that oversees 11 public hospitals began ramping up surge plans that govern how to manage a deluge of patients. Each site has its own plan, tailored to its building layout, and by January the city began fleshing out those blueprints to grapple with the coming storm, Mitchell Katz, president of the NYC Health + Hospitals, said in an interview Monday.

The hospital staff began by canceling surgeries that weren’t deemed medical emergencies, discharging homeless people who had been staying on site for months to hotels around the city and beefing up staffing rounds, Katz said.

He now routinely asks hospital heads how they are making the most of their sites to account for the uptick in coronavirus patients: “What space are you going to use? Where are you going next? What is the next ward that you’re going to turn into an ICU?”

Some have combined wards: At Lincoln Medical Center in the Bronx the obstetrics and pediatric patients were placed in the same wing, and those in the psychiatric emergency room were transferred to another section of the hospital to make room for those afflicted by the virus. Moving psychiatric patients is particularly delicate, since rooms cannot contain any items that would facilitate suicide, Katz said.

“Every one of my hospitals knew ahead of time what the order was. It’s true that the speed of this has made it very challenging to staff, but in each case we knew what [spaces] would open first,” Katz said. Lincoln, Bellevue Hospital Center in Manhattan and Elmhurst Hospital in Queens, which became the face of overcrowding last week, have all tripled their intensive care unit space, he said.

The ERs have morphed into battle zones, with intake staff having to forgo standard questions about tobacco history and family history as patients fall so ill so quickly they need intubation.

Redlener said pandemic planning is often put on the back burner of local and federal preparations with more immediate problems taking precedence, and New York is no exception.

Hospitals are now facing a shortage of ventilators. Some patients who need to go on life support don’t wake up, and the hospitals and city morgues are already filling — three weeks before the state’s expected virus apex. The state is working toward centralizing purchase orders for ventilators and coordinating with other states to avoid paying inflated prices due to bidding wars after pleas to the Trump administration fell on deaf ears.

“I can tell you from the frontline workers, we don’t have enough ventilators. We need them desperately,” Henry Garrido, executive director of DC 37, a large labor union,
said on the radio Tuesday afternoon. “Part of our job right now has to do with moving ventilators for different patients, unplugging one and plugging another one to keep people alive. That’s not how we should be handling this pandemic.”

The health systems burned through personal protective equipment, or PPE, at a dizzying rate and have since had to prolong the use of the gear, which medical professionals say has caused many health care workers to fall ill to the virus.

On March 1, when New York City recorded its first confirmed case of the virus, the city’s health department had on hand 101,000 N95 face masks, 19 million surgical masks, more than 40,000 gloves, more than 38,000 gowns and 3,500 ventilators, mayoral spokesperson Laura Feyer said.

Recognizing the virus’s reach, the city scrambled to order more — the health department and the hospital network procure goods separately from one another — but found itself competing for a limited supply with harder-hit areas around the world. A spokesperson for Health + Hospitals did not provide the amount of equipment it had on hand on March 1.

Feyer said the city is buying another 5 million masks from 3M, as it continues to dole out equipment to both its own hospital network and the often well-funded private sites that have found themselves similarly short on supplies.

As of Tuesday afternoon, the health department had provided hospitals 2,077,980 N95 masks, nearly 8.3 million surgical masks and more than 1.9 million gloves, Feyer said.

But it’s not enough — de Blasio this week asked the Trump administration for for 15,000 ventilators, three million N-95 masks, 50 million surgical masks and 25 million sets of gowns, gloves and other protective equipment.

Isaac Weisfuse, who left his job at the city’s health department in 2012, said a review of the equipment stockpiles during his tenure revealed a shortage of ventilators and masks in the event of a pandemic.

“Given that New York City is a global destination, if any novel strain becomes easily transmissible from human to human, we will not be able to keep influenza from entering the city [or] prevent transmission once it arrives, but [we] will attempt to slow transmission,” he wrote in an article 2006.

Reached by phone on Tuesday, he said an agency buying spree around 2006 beefed up the supply, but was insufficient for this type of outbreak.

“We used the 1918 Spanish influenza outbreak as our model of a really bad pandemic. We held that up as the model of the big one,” he said. “I’ll be the first to say we didn’t purchase enough ventilators to deal with that, but we tried to use our funds to fill in the gaps.”

Northwell Health uses about 20,000 N95 masks a month under normal circumstances. Now, the system is going through about 25,000 masks a week — a rate dictated by rationing, said spokesperson Terry Lynam.

The Montefiore health system broke from city guidance last week to allow staff showing a fever to get tested for the coronavirus. More than a dozen medical professionals employed at systems across New York City told POLITICO that positive tests keep people from working and create staffing shortages — a scenario the state is bracing for.

“It’s like hear no evil, see no evil,” said one hospital staffer based in New York City, who requested anonymity for fear of retaliation. “[The hospitals are] banking on not everyone contracting a severe case. I think that’s why they’re implementing these protocols with PPE because they’re treating everyone as if they are positive.”

She added: “Everyone is sick. Everyone is sick. I’ve never, ever, ever seen anything like this. It’s really bad.”

While hospitals have their own stockpiles of supplies, most rely on immediate ordering to save on the costs of warehousing massive amounts of equipment — limiting the stash of gloves, gowns and masks facilities can dip into in a time of crisis.

“Very few hospitals constantly have a comfortable reserve — they have huge budgets, but they also have very thin margins,” Redlener said. “So you can imagine the conversations that go on internally. If someone says, ‘We need to invest $10 million to make the hospital ready for a major disaster for stockpiling,’ then they’re going to get pushback and there’s going to be conflict there.”

NYC Health + Hospitals/Lincoln and Mount Sinai — hospitals that treat the city’s poorest and richest residents, respectively — have set up GoFundMe pages to raise money for more PPE as bidding wars raise the price of essential equipment.

The lack of protective equipment has left some workers to improvise, fashioning makeshift face shields and using trash bags for additional coverage, regardless of where they work, said Patricia Kane, executive director of the New York State Nurses Association.

NYU Langone took away bins of hand sanitizer, surgical masks and N95 masks that are usually accessible to staff at the beginning of March, telling employees they were rationing supplies to prepare for an influx of coronavirus patients, said one nurse who also requested anonymity out of fear for retaliation. The hospital is encouraging nurses to use N95 masks and protective face shields for a week unless they’re visibly soiled; workers put their PPE in paper bags at the end of each shift.

“It’s definitely not an ideal situation,” said the nurse. “Ideally, we would be changing out our masks and disposing them each time we exit a patient room, but now I’m putting it on multiple times during the day and also using it for up to a week.”

Some hospitals are relying on donations from nontraditional sources to make up for the lack of essential equipment. Madiha Choksi, a librarian at Columbia University, began 3D printing face shields out of her apartment after someone at New York Presbyterian contacted her about the dire need for supplies. She now has a full assembly line at the 92nd Street Y, churning out more than 700 face shields a day and distributing them to hospitals across the city.

Elmhurst Hospital in Queens has made headlines as the medical facility facing the brunt of the crisis, with an emergency room doctor raising concern about limited supplies of ventilators and N95 face masks.

While the borough has seen a surge in cases, medical professionals say hospitals throughout the city are starting to see the same kind of patient demand — including several other facilities in the city's network, like Bellevue and Kings County hospitals.

“That initial spike in Queens is now being matched by the entire city,” Joseph Masci, a research director at the city's public hospital system, said during a recent virtual town hall.

“Elmhurst was hit hard because it was the only hospital in central Queens. But they didn’t do anything wrong. In fact they tripled their ICU in order to meet the demand,” Katz said. “I think what will happen going forward is that next week, maybe even sooner, a lot of hospitals will look like Elmhurst looked last week."