Robert Chaloner, chief administrative officer at Stony Brook Southampton Hospital, spoke Monday about the hospital’s current supplies and available beds (both adequate for now), help arriving (in the form of “agency nurses” from throughout the country), and his own COVID-19 scare in February (for which he was never tested):
Q: At the state level, the number of cases, and deaths, declined for the first time this weekend — potentially a plateau, or possibly just a “blip,” as the governor has said. How do the state numbers compare to what you’re seeing? Are the numbers leveling off? Or are they still rising?
It has leveled off from the end of last week. I was actually just on a call with all the hospital [officials], and the governor, and he was talking about that. He’s seen that a little bit as well.
But as he said — and I would agree — it’s just not enough of a trend yet to feel confident about it.
Q: Do you think we’re starting to see a payoff for the social distancing, as aggressively as we undertook it, at the state and local level?
Exactly. Exactly right. That was the whole goal, right? To bend the curve. We’re hopeful that’s maybe what we’re seeing.
Q: How many days in a row do you need to see before it really is a trend?
I’m not really an epidemiologist, so I don’t think I’d be comfortable … I mean, if we could see through a solid week where it stayed flat, to me, anyway, that would be a good sign.
Q: So, the current situation: potentially favorable, but don’t get too excited?
Very cautious optimism. … Remember that the virus is still lurking out there in the community, and it is still spreading. If we’re at a plateau, it just means we’re getting in the same number of [new] cases that we’re discharging. It doesn’t mean that it’s gone away.
… What we don’t want to do is give anyone the false impression that, “Oh, it’s great — let’s go outdoors, let’s go start socializing.” Because we then may see that turn around very quickly.
… You look at those “bending of the curve” graphs that they gave everybody: There was one scenario where it spikes up and then turns downward. The “bending of the curve” means it plateaus — the cases probably will be with us for quite some time. Which is why we need to be cautious.
I would interpret the good news as, hey, it’s working — let’s double down and really continue to be careful.
Q: You have seen patients who have then gone home from the hospital afterward, correct? That’s happening?
Yes, we have had some patients get discharged both from the emergency room and from the hospital itself. We’ve had some very good stories, actually, of people being discharged. We’re happy about that.
… Our experience is no different from any other hospital. That’s what we’re seeing. You know, early on, that first case that came here, that guy walked out and is doing remarkably well. So we were very excited and we thought, “Oh, maybe we’ll be good.” But, unfortunately, we’re not. We’re seeing deaths at a similar rate to other hospitals — and we’re seeing survivals similar to the other hospitals, also.
Q: Is there any intervention taking place? Some hospitals began using experimental treatments. Is there anything like that going on at Stony Brook Southampton Hospital?
Yes, we are doing that. We’re using a couple of the different drugs. … We are using a couple of the different approaches. That’s where being a part of the Stony Brook system works out really well, because they can guide us.
Q: Your ICU units — have you ever been at a point where they’ve been completely full?
Our original ICU has been full — but, no, we’ve been able to keep opening beds faster than we’re filling them. So we still have open beds in ICU, and we’ve been able to stay ahead of that. As our numbers grew, we’ve been able to keep finding additional space for them. Our original ICU has been full for some time. But we’ve been able to continue to redeploy other beds and make them into ICU beds.
Q: You had talked about doubling, tripling, the number of ICU beds?
Yeah, that’s where we’re at — we tripled them. We still have some beds open. And we’re looking at other sites. We’ve gotten pretty good at redeploying and opening up ICU beds.
Q: Has your capacity been tested?
No, not yet. We’ve followed the plan we initially said, and we’ve got open beds. We’ve got beds available. We haven’t had to double up on [ventilators] or any of that, and we have capacity, both in terms of general medical/surgical beds, and ICU beds. And ventilators.
So, no, we have not run out. We’re pretty happy with the way we’ve been able to stay two steps ahead at this point. We’re ready for a bigger surge than what we’ve seen. If it does level out, we’re going to be in very, very good shape for the foreseeable future.
Q: So you haven’t had to relocate patients to other facilities based on a lack of beds?
No, no, not at all, not at all. We’ve actually taken some patients from Eastern Long Island Hospital [in Greenport]. We’ve been collaborating with them, because we have more ICU capacity. So we were able to take patients who needed ICU to our hospital. We’re in very good shape.
And today, we started to welcome a new class, a whole bunch of “traveler nurses” who joined us, from all over the country, actually. There’s 20 of them. So, even staffwise, today, we’re in very, very good shape, actually. We’re not pressed, with staff, and units, and supplies.
The only thing I worry about now is gowns — we need more gowns, the plastic gowns that people are wearing. For some reason, I’m hearing it all over the place, that the latest shortage is gowns. We’ve got enough for the next week, but for whatever reason, that’s the thing that everyone’s struggling to find right now.
Q: You’re stocked up for now on …
Masks — surgical masks and N95s — we’ve got a good supply at this point, and we’re forecasting and trying to stay at least a week ahead of the demand. We’re in good shape with that. Gowns is the only thing we’re a little concerned about.
Q: Are there new guidelines with the use of Personal Protective Equipment, or PPE? Having to use it more than once? Has that changed over time?
Yeah, that’s changed quite a bit over the initial period. Initially, the N95s, they were saying every time you go from one patient to another, take it off, throw off your N95s. And then the guideline has been, you know, if you want [to get a new one] at the beginning of the shift, then hold on to it all day, and when you’re not wearing it, put it in a brown paper bag. We’ve been following that guideline, unless it becomes soiled or wet.
… We’ve been very, very fortunate to date that we’ve been able to manage our supply, follow the guidelines, and we’re not seeing the situation where you hear these apocryphal stories of staff being told to wear the same mask for days, or wear garbage bags, things like that. We’re absolutely not there.
I go around, one of the first questions I ask my staff, other than “how are you doing?” is “Are you getting what you need?” And their response always is, “Yes, we are, thank you. You’re making sure you get us everything we need.”
Like I said, that’s the resource I worry the most about, is them. Because they’re the most valuable, quite frankly. Anything we can do to get them the protection that they need has been our absolute priority.
Q: Five ventilators were donated last week by Dr. Peter Michalos’s organization …
That’s right — and that was terrific. That bought us some definite additional capacity. Today, we are comfortable that we can get through this week, even if we were seeing the same growth rates we had last week, I could get through this week with the ventilator supply we have. Beyond that, we’ve put in request for additional [ventilators], so we’re optimistic that we’re going to get some additional units in.
We’ve been able to keep up with that demand. Anyone who has needed a ventilator has gotten one.
Q: What’s the situation with testing availability? And how does the importance of testing change as the crisis evolves — does it become more or less important to have adequate testing?
So, I think testing, ultimately … You know, we think of this as a public health crisis. Testing is extremely important to manage a public health issue. Because we want to know if it exists in the community.
Initially, there was a huge clamor for testing, which I think was more from a … a fear factor was kind of driving it: “Oh, my God, do I have it?” Then we also had an issue, when the virus started to emerge, at least locally, it was in the winter, when we saw people still had flu and colds and those things. I mean, I had a cold in the middle of February, and I thought, “Oh, my God, I wonder if I’ve got coronavirus. I ought to get a test.” I think a lot of people [had] that same thought: I have been hanging out with somebody who was exposed to somebody, so maybe I ought to get a test. And we didn’t really have the testing available to us.
The unfortunate truth is that the virus had already spread in our communities, and in our country, before the testing was widely available.
So the testing hasn’t really been helpful, I don’t believe, on a broad portion of the population. Just knowing you’re exposed or not? Some people say, “Oh, I want the test so I know I don’t have it.” To me that’s meaningless, because I don’t know if you’re going to walk out, bump into somebody and get it five minutes after you’ve had the test done.
So I don’t think that initial clamor — and that’s died down. I think most people have kind of realized that’s not really helpful.
I think where it’s going to become crucial, though, is that this is not a virus that’s going to go away quickly, until we can get a vaccine perfected. So let’s assume, through social distancing, we’re able to beat it back, and get the community back out on the streets and enjoying themselves: It will be crucial, at that point, that every time somebody starts to develop symptoms, that we can quickly test them and figure out if they’ve got it … then track down their contacts.
Because it’s going to be like a forest fire that rages across the land, and then you get sparks, little flare-ups, around the periphery of it. Once you get the big fire under control, you want to stop all those little brush fires from turning into something. So we have to quickly be able to beat those down. And that’s where testing becomes vital. Rapid testing, at every hospital and every doctor’s office.
Q: You said you haven’t actually been tested?
No, I haven’t. We’re reserving the tests … I’m not a front-line worker. There’s really been no reason for me to be tested. The workers we’re testing are the ones who are front line, who are worried about exposure.
Q: Have you had any cases where staff has been infected by exposure at the hospital?
Yeah. We’ve had a few. Less than a half-dozen. And they’re all doing well, thank God — every one of them so far that’s been exposed, none has been hospitalized. None of our own staff has been hospitalized, fortunately.
Q: Have you started pulling in workers from the community?
We haven’t had to do that yet. We were fortunate we got in the queue early for agency nurses. Because we have such a large number of ambulatory programs, we’ve been able to redeploy those staffs, and I think that’s really helped us. And our medical residency [program] has been invaluable, having all those young doctors. And we’ve had some of our other doctors, from the Meeting House Lane practices, it’s been heartwarming to watch them come and volunteer and step up. They’ve been able to cover the core hospital, we’re doing really well from that perspective. I’m glad we have all that extra capacity.
Q: Is it true that Stony Brook University Hospital sent oncology patients to the Phillips Cancer Center for treatment, so that they could free up the Oncology Department at Stony Brook for treating COVID-19 cases?
Yeah, they’re opening up beds like we are. … Our Phillips Family Cancer Center is still in the early stages of growth, so we have a number of chairs there. One of the ways they’re creating new space is by using their cancer center as a place to put beds, so we were able to accept those patients here. … It’s actually something good, the system — I’m glad we had the opportunity to help them with that, because they’ve been helping us with a lot of things, also.
Q: Are you seeing, as have other hospitals in the state, that non-COVID-19 cases are generally down, because everyone is self-quarantined and staying home?
Oh, yeah. That’s absolutely true. Every hospital … it’s all across the country, the hospital volumes have really shrunk. Upstate New York, they’re talking about potentially furloughing some of their workers. We obviously have the need for our workers, with the epidemic going on here. But between the ambulatory surgery cases being down, people just leery and staying home generally, it’s kind of striking, actually, how few cases are coming in to the hospital.
Q: All of which makes it more manageable, right?
Yeah, it does. I mean, I’m happy about that, because it does make it … we’ve been able to redeploy the spaces, able to redeploy the staff. The concern is what’s going to happen when it’s over with. There may be a second surge of everything else catching up. Because people can only delay their health care for so long.