N.Y. Hospitals Pitch Tents, Nix Surgeries to Prepare for Influx

New York hospitals are pushing forward with emergency plans to make rooms and resources available for a surge in coronavirus cases that’s expected to place historic pressure on the region’s health-care system.

New York Presbyterian’s 13 hospital network and New York City’s public hospitals announced they would cease elective surgeries, a move likely to be followed by others in the area. Tents were erected in the parking lots of medical facilities across the city to triage lower-risk patients, and laboratories and hospitals were finally ramping up their ability to test people with symptoms.

The efforts — deployed in concert by some of the most prestigious hospitals and research institutions in the world — are being watched closely as a potential model as coronavirus spreads across the U.S. But their ability to cope with a surge of cases will be determined largely by how effectively they slow the spread of the virus. Those questions underscore how complicated and costly it is likely to be to contain a virus in New York City that has already wreaked havoc around the world.

There are 53,000 hospital beds in New York state, and only 3,200 intensive care unit beds, Governor Andrew Cuomo said. Less than half of both are in New York City, the country’s largest with a population of more than 8 million.

Making sure hospitals aren’t overwhelmed by patients will require herculean efforts by state and local health officials after federal-government-led testing failed to find and isolate early patients, likely enabling the disease to spread.

But officials find themselves in uncharted territory, and medical professionals and policymakers are still debating the best way forward. Should schools close? Should “disease detectives” put any more effort into tracing the virus’s path? How widespread should testing be?

“We certainly understand the difficulties of the decisions they’ve faced in the absence of widespread testing,” Paul Bieniasz, a virologist at Rockefeller University who has called on the city to close public schools. “The policies that are put in place now have to be based on a best guess. It’s an unprecedented situation.”

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For many in New York’s medical community, the uncertainty around the pandemic became apparent this week when Demetre Daskalakis, deputy commissioner for disease control at the city’s department of health, offered a view into the city’s thinking during a talk at Mount Sinai Hospital.

Daskalakis painted a grim picture: that coronavirus had possibly spread undetected through the city beyond the point of being able to crush its advance. This made disease detectives largely irrelevant, and even widespread testing risky, because it merely brought more infected people in contact with vulnerable individuals in the health-care system, he said.

The city was “starting to shift away from this ‘Let’s keep it locked down’ to more ‘Let’s figure out how we can keep our health-care system and other services afloat,’” Daskalakis said. Too much testing would mean “finding some of those people who are less sick, and bringing them to health care, where they’re going to sit next to Grandma who’s 80, on chemotherapy, and potentially give her coronavirus,” he said.

The remarks were met with skepticism by some in the audience, who saw testing as key to understanding the scope of the virus’ spread and disease detectives as crucial to “flattening the curve” — shorthand for slowing new cases enough so as not to overwhelm hospitals.

In remarks on March 10, the city’s health commissioner, Oxiris Barbot, said the city was doubling down on disease detectives to 100 in the coming weeks, in an effort to prevent clusters like the one that developed in Westchester County, just north of the city.

New York has been emphasizing good hygiene, self-quarantining and so-called social distancing, which includes avoiding crowds and maintaining physical distance from others.

In addition to rooms and beds, hospitals are trying to protect two other key resources: people and equipment. They’ve been limiting travel for medical professionals and considering how best to deploy 5,000 ventilators to the sickest patients.

The grim math of ventilators underscores the urgent need to slow the advance of the virus. Coronavirus could infect as much as 70% of the population, with as many as 20% of cases requiring hospitalization and 5% needing ventilators. An abundance of cases in New York at the same time could overwhelm the ventilator supply several times over if the country can’t figure out how to slow down and spread out the pace of cases so health systems can cope with the volume.

Read More: Virus Drives Patients to Virtual Doctors and Buoys Telemedicine

The city has so far resisted closing schools, saying that doing so would hurt poor students who rely on the system for meals. Officials also say it would place a burden on workers, including health-care professionals, to provide full-time child care. Unlike influenza, which can be equally harmful to young children and the elderly, coronavirus hasn’t proved especially harmful to children.

But children could still transmit the virus, said Theodora Hatziioannou, another Rockefeller University virologist, who, along with Bieniasz and more than 30 other experts, has called for school closures. “Social distancing is impossible to achieve if you don’t close the schools,” Hatziioannou said.

Political pressure to close schools is mounting, with the teachers union and members of the City Council warning that open schools risked more spread of the virus. But Mayor Bill de Blasio has received tacit support from the governor, who has left decisions about schools closings to local authorities, and an explicit endorsement from the 1199 Local of the Service Employees International Union, which represents hospital workers.

Testing capacity is improving. As of Friday, New York University and Columbia University each had the ability to test as many as 500 people daily, according to a medical professional familiar with the figures. Cornell Weill will soon have similar capacity, according to the person, who added that Labcorp, Quest Diagnostics Inc. and BioReference Laboratories would in the coming days reach a combined capacity of more than 35,000 daily tests. Much of that will be focused on the New York region, the person said.

NYU Langone Health is deploying video technology to screen and treat patients, said Paul Testa, an emergency medicine specialist. Patients download an app and talk for 10 to 20 minutes with doctors who virtually examine patients with many types of conditions. Suspected coronavirus patients are designated for further testing.

Although 35 patients a day used the virtual urgent care service a month ago, Testa expects the rate to increase to 600 a day by next week.

“Telemedicine is the new front line to address this pandemic,” Testa said. “It certainly eases the strain on the both the waiting rooms and the patients.”

— With assistance by David Voreacos

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