A Scamble For Space, Protection, Equipment And Hands On Deck For Hospital Staff As COVID-19 Wave Builds

The entrance to the emergency department at Stony Brook Southampton Hospital. Michael Wright

Hospital staff and health professionals throughout the East End this week are scrambling to prepare facilities for the anticipated steep increases in the number of hospitalized people they must treat as the coronavirus epidemic swells in the region.

Whereas ramping up testing for the virus was the top priority last week, estimates saying tens of thousands of county residents could be infected with coronavirus in the coming weeks and months — with as many as 20 percent of those infected needing to be hospitalized, expanding the capacity of medical treatment facilities has surged to the fore.
More hospital beds, mountains more protective garb for hospital staff and more life-sustaining ventilator machines — as well as locations in which to expand medical services if existing facilities are overwhelmed, are at the top of the long list of priority acquisitions as a logistical struggle unprecedented in U.S. history spreads its tentacles onto the South Fork.

As the U.S. Army Corps of Engineers and New York State officials began working on the logistics of setting up mammoth temporary hospitals in places like the Jacob K. Javits Center in Manhattan and at two State University of New York campuses on Long Island, local hospital administrators looked for places closer to home to expand their medical care as patients flood in.

Governor Andrew M. Cuomo issued a mandate on Sunday that all hospitals make preparations to increase their hospital-bed capacity by 50 percent and set an ultimate goal of a 100-percent increase.

“Right now, in New York specifically, the rate of the curve suggests that in 45 days we could have … people needing 110,000 beds — that compares to our current capacity of 53,000 beds,” Mr. Cuomo said late last week, “37,000 ICU units, ventilators, which compares to a capacity currently of 3,000 ventilators. That’s our main issue. “

At Stony Brook Southampton Hospital, a new emergency room wing in adjacent Parrish Memorial Hall has already been set up to be ready for overflow of the existing emergency department when it comes, and hospital administrators said they have already started steps to triple the number of intensive care rooms they have available.

Staff members are re-organizing other areas of the hospital building to make room for nearly double the number of patients the hospital usually is prepared to accommodate, administrators said this week. From rooms dedicated to ambulatory surgery and other care services that have been suspended because of the virus outbreak, down to hallway alcoves, are being transformed into new patient rooms, the hospital’s chief administrator, Robert Chaloner, told the Express News Group on Monday.

The hospital is typically set up to accommodate 94 patient rooms, but Mr. Chaloner said the hospital is now working toward a capacity of 160 to 180 admitted patients.

So-called “telehealth” video medical consultation services are being expanded as well, to shift more consultations with doctors away from face-to-face interactions and make it easier for sick individuals to connect with a doctor before leaving their home and potentially infecting others.

Peconic Bay Medical Center in Riverhead has taken similar steps to Stony Brook, setting up a 16-bed overflow emergency room in an unfinished space that had been set aside when a new critical care wing was constructed for a future expansion of the emergency room. The hospital has also leased the former Mercy High School campus and is preparing it to be used as a satellite medical facility if needed.

Both hospitals have postponed elective surgeries and other non-critical care procedures until further notice, to free up space and staff and minimize infection risks to patients and medical personnel.

New York State officials have led the charge in securing massive amounts of new medical supplies for the state’s health care system, with Governor Andrew Cuomo making daily appeals for any agency or company with spare ventilators and other medical supplies to make them available to the state — which has vaulted to the top of the list of states with the most cases of COVID-19 in the country.

“We are literally scouring the globe for medical supplies,” the governor said during one of his daily public briefings over the weekend. “Ventilators, ventilators, ventilators. That is what we need. Anyone that has one that is not in use, we want it.”

He said that apparel companies have been pressed into service to manufacture masks for doctors. A state-contracted company that employs prisoners at State Department of Corrections facilities, Corcraft, has begun manufacturing hand sanitizer for the state.
Last week, President Donald Trump ordered one of the U.S. Navy’s hospital ships, with room for 1,000 patients, to set sail for New York Harbor, and on Sunday authorized mobilizing the National Guard in New York to assist with preparations of medical facilities.
As of Monday night, New York had confirmed more than 22,000 cases of COVID-19, with more than 12,000 in New York City alone and the number in Suffolk County expected to top 2,000 by Wednesday.

Hospital officials said that, thus far, they are keeping up with the demand for hospital beds and protective medical supplies, but that the margins are small enough to be quickly overwhelmed by a surge in hospitalizations.

Suffolk County Department of Health Services Commissioner Dr. Gregson Pigott said on Monday that countywide there are just over 600 hospital beds open and 87 intensive care rooms available. Of the approximately 1,700 people who had been confirmed positive as of Monday evening, 116 people have had to be hospitalized by COVID-19 infections and 38 are in intensive care units.

“The question is not what do we have available now, it’s a question of what’s going to be needed three, four, five weeks from now when this virus hits its peak,” Mr. Bellone said Thursday. “We’ve already seen a 200-bed increase since yesterday. Hospitals are doing everything they can to expand bed capacity. It’s really about the peak.”

The death toll from the disease in Suffolk County was 13 as of Monday evening, ranging in age from 50 to 97. At least four of those who have died were elderly residents at Peconic Landing senior living and care facility in Greenport.

The state and county have appealed to non-essential companies that have stores of latex gloves, face masks or protective gowns, to donate them to the coronavirus response effort, and Suffolk County Executive Steve Bellone said on Monday that the county has received tens of thousands of items from construction companies and personal care facilities.

Mr. Chaloner said that Stony Brook Southampton Hospital has thus far had sufficient protective equipment for its staff, but will need more if there’s a surge in patients.
Concerns are also mounting about how the numbers of trained medical professionals will hold up if numbers of cases skyrocket and some doctors and nurses are inevitably lost to illness themselves. Appeals have gone out from local, county and state health care agencies to retired or former doctors, medical staff and hospital workers to make themselves available to fill in as needed as the crisis unfolds.

Emergency responders are also making public appeals, both for more supplies of personal protective equipment to protect their crews as well as for the public to be more selective about when they call for an ambulance.

With the safety protocols for EMTs and paramedics being ramped up and each ambulance call posing risks to crucial medical personnel, and each ambulance trip to a hospital also taking longer because of protective measures, all of the region’s ambulance companies are asking residents to please consult with the physicians prior to calling for an ambulance.
Reducing calls will be necessary to ensure that true emergency cases like possible heart attacks, strokes and trauma cases can be responded to quickly and with sufficient staff, they have said. Ambulance companies are asking ill patients to meet them outside homes whenever possible to protect the responding medical staff

“We have to treat every call as though it’s a COVID-19 call now,” said Lisa Charde, chief of the East Hampton Village Ambulance Association. “We are already struggling to make sure we have enough crew. We have 43 members, all volunteers, and frankly they are an aging group. We are not allowing anyone over 70 to go on calls, and there are some people who have had to excuse themselves because of their own immunity issues, or those of a loved one, and they can’t risk exposure. It’s dwindled us down.”

Mr. Bellone said that protecting medical staff that will be critical to helping manage the height of the viral infection spread needs to be the first priority of all citizens.

“Keeping the people who are on the front lines, the healthcare workers and first responders and every one of those essential personnel, we owe them all a great debt of gratitude and we owe it to them to protect them,” Mr. Bellone said. “We have to make sure that they have the personal protective equipment they need.”

Mr. Bellone said on Sunday that the state has designated 500,000 n95 protective masks be sent to Long Island medical staff.

And there is evidence within the state that the social distancing and self-quarantining by the bulk of a given populace can reduce infection rates. In Westchester County, where the state saw its first mushrooming of cases, Governor Cuomo said over the weekend, the rate of new infections being discovered has waned.

“Our hotspot in Westchester is slowing, that’s good news,” Mr. Cuomo said.

There have been some efforts started already to combat the effects of the disease. A common malaria drug has been shown to have some impact, though limited, and Stony Brook University Hospital has been administering the drug to COVID-19 patients in its hospitals.

Governor Cuomo also said this week that state health officials have begun to allow clinical trials of antibody testing, in which the blood of a person who has been infected with the disease and developed antibodies to it in their blood, is injected into a patient suffering severe illness from the virus.

Officials hammered home throughout the week that adhering as strictly as humanly possible social distancing and hygiene guidelines will be the best bet for getting the population through the virus crisis with the fewest deaths.

In the meantime, the medical industry’s fight remains about capacity: where to put more patients and how care for them.

“It’s not just about clearing out space,” Mr. Bellone said over the weekend. “You have to put the beds in. You’ve got to fill these spaces. It’s not like there’s just thousands of beds in storage on the island. And you’ve got staff it, you’ve got to put the furniture in. You’ve got to put the equipment in.

“It is a Herculaean task,” he concluded. “It’ is something that has not been done before. You are seeing it in real time.”