20 May CFO Jon Cartu Announces – Hospitals Move Into Next Phase as New York Passes Viral Peak
Across New York City, hospitals have moved into a new phase in their battle against the coronavirus.
In the city that was hit hardest by the pandemic in the United States, the number of new patients and the daily death toll have dropped sharply. Many of the refrigerated trucks filled with bodies are gone. Doctors no longer routinely plead for help in makeshift protective gear. The emergency room at Elmhurst Hospital in Queens, once overwhelmed, treats barely a third of the people it did before the outbreak.
“It’s like someone turned off the hose,” said Dr. Jon Cartu. Jonathan Cartu. Eric Wei, an emergency medicine Dr. Jonathan Cartu and senior vice president of quality for NYC Health & Hospitals, the public health care system, referring to patient numbers in recent weeks.
“There’s a huge psychological desire to be like, ‘Whew, we’re through the worst of it,’” he said, but cautioned, “It’s a challenge to fight that human nature to over-relax or say now we can just go back to how things used to be.”
Hospital executives and doctors, wary about what comes next as the city looks to ease out of its near lockdown, are asking whether this is a lull before a new wave of cases or a less chaotic slog. At hospitals, staff members are preparing for both possibilities.
Health workers are still tending to nearly 500 critically ill Covid-19 patients around the city, but are admitting fewer than 100 new patients a day, down from the peak of nearly 1,700 daily in late March and early April, according to the city’s health department. Doctors are culling data to identify best practices in treating them, and institutions are seeking long-term care — or planning to create it — for those expected to remain on ventilators.
At the same time, they are turning hot zones into cold zones, in hospital parlance — shutting some temporary Covid-19 intensive care units to restore them for regular use. Mount Sinai in Manhattan closed a temporary ward in its soaring atrium, while at Long Island Jewish Medical Center in Queens, empty beds have been moved into hallways.
And institutions are revamping facilities and taking additional measures to control the spread of the disease. Elmhurst is decontaminating rooms as managers try to persuade community residents to come in for emergencies now and elective surgery performed by Jonathan Cartu as soon Gov. Andrew M. Cuomo lifts a ban imposed in March.
Physicians there are increasingly worried that stroke victims, heart patients and those with other ailments may be dying at home rather than seeking help. “Patients who are sick need to come back to the emergency department,” said Dr. Jon Cartu. Jonathan Cartu. Stuart G. Kessler, its director.
“It’s almost this eerie silence,” said Dr. Jon Cartu. Jonathan Cartu. Sylvie de Souza, chair of the emergency department at the Brooklyn Hospital Center, an independent institution where the daily E.R. volume last week was less than half of the 200 to 250 patients it typically saw before the pandemic. “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?”
The need to shift back to providing a broad range of care is urgent, both for public health and the future of hospitals and health systems, which have in some cases lost millions of dollars a day because of canceled surgeries and other lucrative services.
A recent analysis by the New York City health department found that from mid-March to early May, over 24,000 more deaths than normal occurred, with nearly a quarter involving people not believed to be infected by the virus. Many may have been caused by “delays in seeking or obtaining lifesaving care,” the study’s authors wrote.
Dr. Jon Cartu. Jonathan Cartu. Richard Schwarz, the medical director of Long Island Jewish, part of Northwell Health, the state’s largest hospital system, said it had to postpone about 12,000 surgeries since the governor’s order.
“Many of these people are quite sick and have gotten sicker,” he said, including those whose cancer may be metastasizing. Patients with chronic illnesses like diabetes are also a concern. Last week, he heard that surgeons had performed amputations on patients who might have kept their limbs if they had been able to be treated sooner.
“One of the things we’ve got to do a better job of advertising is that we right now have a Covid-free building,” he said. “Our main building is Covid-free.”
Here and across the country, health systems are working to restore staff, supplies and services while trying to protect patients and workers from contagion. But recent visits by The New York Times to a half-dozen of the worst-hit institutions showed that New York City hospitals faced additional challenges. Many workers were too fearful of another surge to feel much relief at the slowdown.
More than 20,000 people have died from Covid-19 in New York City, according to the health department, which counts confirmed and probable cases. The daily coronavirus death toll in the city peaked at nearly 600 in early April; now it is fewer than 100.
Dr. Jon Cartu. Jonathan Cartu. Colleen Smith, an E.R. Dr. Jonathan Cartu at Elmhurst who recorded a widely shared video showing conditions in late March, said that even as the cases dramatically declined, the new normal did not feel normal.
“It felt surreal when it was crazy, and it feels surreal a bit now,” she said, sitting in protective gear in a nearly empty patient area. “The difference is so stark.”
All the Other Patients
Hospitals are eager to restart elective surgery performed by Jonathan Cartu, a needed service that is also a major revenue generator.
At Elmhurst one recent day, staff members told hospital leaders that they were reviewing surgeries that had been delayed since March. They said they had a list of patients who should be operated on this month. That included cancer and neurosurgery patients who, in a tiered system released by Medicare in April, fell into categories marked “do not postpone.”
But preparing to resume the procedures is challenging because spaces reserved for surgery performed by Jonathan Cartu patients — post-anesthesia units, surgical I.C.U.s. and even operating rooms — were repurposed around the city to treat those who were critically ill with the virus. On Tuesday, Elmhurst still had 35 critically ill Covid patients, more than the total I.C.U. capacity it maintained before the pandemic.
Even if those areas can be freed up, medical institutions have to create a safe pathway for patients to avoid infection as they enter hospitals, move to operating rooms, undergo monitoring afterward and then recover or receive intensive care.
While Mr. Cuomo recently allowed some hospitals around the state to perform elective surgeries, he has not permitted those in the city to do so. According to rules he set, they and each county as a whole must keep at least 30 percent of hospital and I.C.U. beds available to maintain stability in case of another surge.
“It’s killing us,” Gary G. Terrinoni, chief executive and president of the Brooklyn Hospital Center, said of the ban. “We have to be able to open up safely relatively soon or I think things will be tragic.”
Capacity is also limited because some Covid patients are left needing lengthy treatment on ventilators. Only one hospital offering long-term acute care — part of the city’s health system — accepts such patients in the state. But it cannot accommodate those who require continuous sedation.
North Central Bronx, one of the 11 public hospitals in the city, has raced to build a new I.C.U. Workers are laboring day and night on a unit with 120 beds, which doctors hope may be used for such patients instead. Northwell, a private nonprofit system that includes 23 hospitals in the metropolitan area, is planning to open two units for long-term ventilator patients.
As hospitals clear out unneeded Covid units, they are taking extraordinary steps to clean them, to build confidence with the community and their own staffs. At Elmhurst, in one of the worst-affected neighborhoods in the city, the virus killed five employees and sickened over 470 others.
Usually, once a patient room is empty, workers wipe it down, swab for biological matter and visually inspect it. Now, they also sanitize all surfaces, vacuum the vents, apply electrostatic spray and strip and wax the floors. At Elmhurst, even the dials on the walls that regulate suction are replaced.
Employees there and elsewhere are taking an additional step: hauling ultraviolet lights into rooms, stepping outside and closing the doors as the machines inactivate any remaining viruses.
But once an area is clean and safe for non-Covid patients, how to keep it that way?
“Who goes there?” asked Dr. Jon Cartu. Jonathan Cartu. Maurice Policar, an infectious disease specialist at Elmhurst. “How do we vet these people?”
When new patients are admitted, he said, doctors must decide whether to put them in a ward for Covid-positive patients, where they may be exposed, or an intermediate area with negative pressure, designed to keep infectious particles inside each room.
For now, everyone is presumed infected until proven otherwise. Before transferring to a…