Coronavirus Persists And Southampton Hospital Has Weathered Storm, But COVID-19 Care Is Here To Stay

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

While much attention is being paid to the apparent slowing of the spread of coronavirus in New York, and talk has shifted to a reopening of businesses still weeks away, the virus is continuing to spread on the South Fork and throughout Suffolk County, sending hundreds more people to hospitals this week with severe symptoms of the COVID-19 disease and claiming the lives of some 200 additional county residents.

The total number of fatalities in Suffolk County from the coronavirus is nearing 900 in just over a month, with more than 2,000 hospitalized. Hospitalizations have decreased somewhat from the peak of a little less than two weeks ago, but the death rate has continued to mount at a rate of dozens per day.

Suffolk County officials have focused largely on the declining overall number of hospitalized people and the faintly easing strain on medical facilities as patients admitted during the surge of new cases earlier this month recover and are discharged. But new cases, nearly 100 per day on some days this past week, have been admitted to hospitals — evidence that the virus is still being spread to uninfected people throughout the region, albeit at a slower pace than was seen during the peak of the surge during the first week of the month.

Locally, Stony Brook Southampton Hospital’s administrators say they have seen their total number of patients stabilize at a manageable level as early COVID-19 cases are steadily being discharged, but are also still seeing steady flow of new, serious cases arriving at the hospital’s doors each day.

“It hasn’t dropped off significantly,” Robert Chaloner, the chief administrative officer at the hospital, said this week. “It’s not like it has disappeared.”

“We’re keeping the same number of patients,” he said, with new admissions coming in at a rate of “a few per day that are replacing those that we discharge.”

The hospital has ample available space currently, is using only about half of its ventilators, and doctors at the facility have identified some treatment approaches that they say are showing signs of helping people overcome the worst of the COVID-19 effects, Mr. Chaloner said.

Protective equipment for doctors and nurses has been in sufficient supply and the hospital got a boost from a local volunteer effort this week that Mr. Chaloner said he hopes will keep the hospital stocked with one of the most difficult to source protective products: plastic gowns.

An effort mustered by Wright & Company Construction, Riverhead Building Supply and Reilly Architects secured materials and designs for making the gowns and has enlisted a team of nearly 100 volunteers to make the transparent, disposable gowns. The first batch of 1,500 was delivered on Monday and Mr. Chaloner said the group’s production rate should be able to out-pace the rate at which hospital staff are going through the gowns now.

“That will be invaluable,” he said.

The hospital saw it’s peak influx of new patients in a single day on or about April 9, after which there was a slight decline in the daily number and, since then, a plateau of similar daily numbers. But there has been no steep reduction in new cases.

“The good news is we have been able to discharge people and get people off ventilators,” he said, lamenting that there have also been additional deaths from the virus at the hospital — though how many has not been released. “Overall, we’re happy with the number of people we’re discharging home at this point.”

Mr. Chaloner said that some of those suffering the worst effects of the virus have been in the hospital for as long as three weeks.

Only about half of the ventilators the hospital has on hand are currently in use, despite the fact that the medical staff has found that putting patients on ventilators sooner seems to be improving odds of survival.

“When the epidemic started, they were putting people on ventilators only as a last ditch effort, but now are recognizing that maybe putting people on ventilators sooner rather than later leads to a better outcome,” the veteran hospital administrator said. “That is probably the biggest thing we’re noticing locally. None of this is proven yet … but there is, I know, among our doctors, a sense that [they should] not wait till the very end to try a ventilator.”

With almost all non-critical care halted and no elective surgeries being performed, about half of all patients at the hospital right now are COVID-19 positive. The hospital has increased its total capacity to 184 beds and could add a handful more if needed, but Mr. Chaloner said that right now the hospital has “a lot of empty beds” — a cushion of capacity he welcomes, given the breadth of the unknowns about how the epidemic will evolve.

Governor Andrew M. Cuomo said on Monday that it appears from the rates of new hospitalizations that the downstate region of New York has likely passed the peak infection rate and is on the downslope of the bell curve that it has long been anticipated that infection rates would follow as the impact of social distancing guidelines arrested the spread.

“The question now is, if we are off the plateau and on the descent, how steep is the descent,” the governor said. “Nobody knows. We’re trying to figure that out.”

With death rates lagging a week or more behind hospitalization trends, the number of dead has continued to ring up daily in tragic figures. The state has now seen more than 15,000 people die from coronavirus infections — with nearly 500 still dying each day.

“If you are looking for the optimist’s view, it’s not as bad as it was,” the governor said somberly. “But 478 New Yorkers died yesterday of this virus.”

The governor has labeled the effort to find a way to get “normal” life back on track “Reimagine New York” because of the new standards that will have to be applied to nearly every walk of life.

In the meantime, he warned, the public needs to remain vigilant about social distancing to avoid allowing the virus to gain new footholds.

“The weather is going to warm up, people are a little more relaxed because they see the numbers going down and we know human behavior,” the governor warned. “When that activity level increases, you can very well see that infection rate spread. Infection rate is primarily a function of contact.”

Hospitals know that it is going to likely be a long time before the fear of a new surge in cases is off their radar.

Mr. Chaloner said that Southampton Hospital has begun talking about how it will reconfigure its services to establish an isolated COVID-19 unit, indefinitely, while allowing other medical services to come back online. Some specialty units have been absorbed into the current COVID-19 treatment areas and will only be able to be returned to their intended usage as the coronavirus cases decline.

Ultimately compressing the COVID-19 treatment into a dedicated wing will allow for more efficient treatment of cases and reduced usage of the protective garb worn by nurses and doctors when treating infectious patients. The hospital is also eager for advances in the reliability of antibody testing — which doctors hope will identify immunity in some members of the public — a major potential boost to determining which staff can work in a COVID-19 unit safely.

How soon the hospital is able to start transitioning back to its broader care mission remains to be seen and will hinge on a number of factors far beyond its control — foremost being the continued slowing of the spread. With talk of reopening comes the threat of renewed spikes in cases, and there is already concern being aired nationally about a resurgence in the fall — if the epidemic even fades through the summer in the first place.

“Everyone talks about the 1918 influenza and that it died down and then came back with a vengeance, and I think we’re all a little worried about that in healthcare,” Mr. Chaloner said.

“We don’t want to see that happen. We want to see that when this dies down, that it stays down.”