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In hospitals and hospitals across New York City, and medical centers in the New York metropolitan area, public health executives and healthcare workers say they are monitoring trends, as units intensive care units in other parts of the United States and the world are filling up.
They say it gives them flashbacks last spring, when ambulance sirens were ubiquitous and the region was the country’s coronavirus epicenter.
Dr Laura Iavicoli, head of emergency preparedness for health and hospitals, the largest municipal hospital system in the country, explained that there were four types of days: ‘blue sky, or normal’, ‘busier than normal “,” a little stretched “and” Extremely stretched. “
“I think we’re at the top of ‘busy normal’, bordering on ‘a little more than overworked’,” said Dr Iavicoli. “What we are seeing in the system is that some of our facilities are definitely at full capacity.”
She was quick to add that she wasn’t talking about “COVID capability” – which means all the recently reconfigured beds and overflow spaces for COVID-19 patients are not full – but she says two of the 11 hospitals in the network have had to transfer intensive care patients to others. to make room.
“We’re doing a bit of redistribution around the system to give them COVID capability, but it’s very manageable within the system,” Dr Iavicoli said. “The increase is certainly typical of the flu season, but knowing that we have just entered the second wave [of COVID-19] and in predicting what will happen, we are a little more aware than usual to make sure we leave capacity in all of our facilities.
It is widely believed that hospitals and health care providers are in much better shape now than in the spring, as knowledge about the disease and how to treat it is much greater; much larger stocks of personal protective equipment; and much more widespread testing.
But at the same time, many frontline workers are worried about hospital readiness, and many observers are less optimistic about the effectiveness of the coronavirus screening and testing infrastructure.
“I think there’s a lot of anxiety in doing this a second time,” said Dr Iavicoli, who is also an active emergency room physician at Elmhurst Hospital in Queens, who has been called “the epicenter of the epicenter”.
“They will come together, because I know them,” she said. “I have worked with them for 20 years, and they are the most amazing people I can talk about, but there is COVID anxiety and fatigue.
Many nurses suggest, however, that hospital administrators have not learned enough from the experience of March and April.
“We’re scared because we’re scared of having to do the experience again,” said Michelle Gonzales, intensive care nurse at Montefiore Medical Center-Moses Campus in the Bronx and a union representative from New York. Association of State Nurses.
She said that in her unit, nurses typically treat one or two intensive care patients at a time – but now have to manage three, with the number of COVID-19 patients increasing again. Four or more patients were common during the peak of the pandemic outbreak. Gonzalez said it was overwhelming. If a patient “crashes,” several nurses must converge at once, leaving the other patients unattended.
“When we start having triples with the frequency that we’re seeing right now, we know it’s because we’re under-staffed and they’re not bringing ICU nurses into the building,” he said. she said at a protest that featured a phalanx of nurses marching from Montefiore to nearby Woodlawn cemetery, wearing flower wreaths for fallen comrades, while a group of bagpipes played “When the Saints Go Marching In ”and“ Amazing Grace ”.
A union spokesperson said Montefiore, by his own calculations, had 476 vacant nursing positions – a number that has climbed nearly 100 since 2019 last in the Bronx.
Nurses employed at the Montefiore Health System in the Bronx march towards Woodlawn Cemetery, protesting their demands for more nurses.
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“Management is not keeping its promise to fill vacancies and hire nurses,” said Kristi Barnes of NYSNA. “As of last week, they have 188 full-time nursing jobs that they haven’t even posted, so there’s no way to fill them.
The Montefiore administration disagrees.
“We have a contractual agreement with the union and we are fulfilling the contractual obligations of that agreement,” said Dr. Peter Semczuk, senior vice president of operations. “We adapt our staff so flexibly to meet the needs of the patient.”
Like many hospital systems, Montefiore relied heavily on temporary recruiting agencies for “traveling nurses” across the country at the height of the pandemic earlier this year. Hospitals are preparing to do it again – Dr Iavicoli said each of the facilities in his network has already submitted requests, so health and hospitals can now place a preliminary order.
“They took us on a trip in April, but it lasted four or six weeks, and until we were alone,” said Kathy Santoemma, a nurse at Montefiore New Rochelle for 43 years. “I don’t even know where they’re going to take the travelers now – everyone across the country needs travelers.”
Personal protective equipment, or PPE, is also much more sufficient than last spring, but similarly the amount needed remains in dispute.
New York State health officials are asking hospitals to stockpile a 90-day supply of PPE and nursing homes, worth 60 days. Many met the September and October deadlines, but others did not.
Montefiore, Health and Hospitals and other large hospital networks claim to have at least as many, if not more.
Nurses say, however, that they should be able to obtain N95 masks each time they see a new patient, in order to limit the risk of contamination. Many administrators counter that this is not feasible, given the precariousness of the supply chain – and that CDC guidelines allow “prolonged use.”
“They change gloves between each patient, but they can wear the same Nn95 mask during a shift and put a surgical mask on just to preserve it and only turn it off if there is an integrity problem or if it is contaminated, ”said Dr. Iavicoli. “But surely the next shift, they will have a new one.
Health planners are hoping New Yorkers aren’t going to invade emergency rooms this time around. They point to the modest increase in COVID-19-related hospitalizations over the past two months compared to other regions, including New Jersey and Connecticut. One of the things they hope to keep the curve relatively flat is the test, which is more prevalent than almost anywhere in the country.
About 200,000 people per day in New York State are tested each day, of which about a third are in New York.
“This is the first step in stopping the spread,” said Dr Dave Chokshi, the city’s health commissioner.
He said mass testing works at two levels – highlighting areas that are hot spots, so health workers can target residents with “hyper-local” messages about the spread of COVID-19 and encourage them to change their behavior; and also by allowing contact tracers to communicate individually with newly infected individuals.
“Once someone tests positive, we help them isolate themselves very quickly,” Dr Chokshi said. “We do an interview with them to find out who their close contacts are, and then we call those contacts to make sure they are also in quarantine.”
However, the city’s contact tracing program has had a mixed record. Those affected say they are staying put – but less than half of them share the names of people they may have exposed.
Dr Denis Nash, an epidemiologist who previously worked for the city’s health department and the CDC, said the city had failed to understand how the coronavirus actually spreads because contact tracers do not pose enough questions of people about their behaviors and possible exposures. .
“During the summer and early fall, when things were slowly picking up, there were missed opportunities to use contact tracing to talk to 80 or 90% of all newly diagnosed people, to understand what their risk factors were and what types of things were doing. they were exposed to it, which could have caused them to contract the virus, ”he said.
“You can never know with 100% certainty [where they contracted the virus], but if you ask these questions, you might begin to understand what some likely patterns were, for example, of using public transportation or working in office buildings without rigorous security protocols or eating inside. Nash added.
This knowledge, while imperfect, could lead to more informed public policy decisions, Nash said, about whether to close indoor restaurants, beauty salons or fitness centers.
Others blame the city’s testing and tracing program for not reaching enough to poor communities of color – who suffered disproportionately in the first wave of COVID-19. Dr Chokshi said setting up testing sites in these neighborhoods is a priority – but recent analysis suggests it’s not working as well as the city expected.
“There is clearly a disparity in the provision of widespread testing across New York City,” said Wil Lieberman-Cribbin, graduate student and environmental health researcher at Columbia University.
He looked at how many people get tested, by neighborhood, and correlated those numbers with race, income level, and positivity. In wealthier areas, people are tested a lot more and are much less sick. In the poorest people, people undergo much less testing and are much sicker. More testing in these areas would catch cases earlier, before people develop symptoms.
“Testing is really, really necessary, not only to protect the most vulnerable, but to collectively try to bring COVID under control and reopen New York,” Lieberman-Cribbin said.
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