Robert Chaloner, the chief administrative officer of Stony Brook Southampton Hospital, admits that even for a veteran hospital administrator like him, these are uncharted waters: “This is new. I’ve been at this 40 years, and this is the first time I’ve dealt with this thing. Even 9/11 was very different from this.”
He took time on Monday to answer some questions about the hospital’s response to the COVID-19 outbreak.
Q: Have you seen a significant increase in the last few days in the number of potential cases, as the numbers statewide seem to suggest?
Yeah, we’ve seen an increase. The number is very fluid, but we noticed, starting in the middle of last week, the number of visits to our ER and the number of patients being hospitalized have started to grow. It’s rapidly changing, so I don’t want to give specific numbers. … But it is definitely on the upsurge. That’s the reality for us now.
Q: Do you think that’s a result of more tests being administered, or more cases, or both?
I think it’s the natural spread of the disease. I think we’re seeing it like everywhere. It’s obviously spreading in the community, so as people have become exposed over time, they’re starting to show symptoms. I think that’s what we’re going to see over the next three to four weeks.
Q: We’re on the upswing this week, then?
Yeah, definitely. Consistent with what the rest of the state is seeing. … It’s rising sort of logarithmically.
Q: The governor ordered a 50-percent increase in hospital capacity throughout the state. How are you meeting that goal? Are you looking at other locations you can utilize temporarily? How about getting beds and equipment — how soon is that reasonably possible?
We are going to do that — we are absolutely committed [to meeting the governor’s demand for increased capacity]. That’s probably the thing we’re hardest at work at right now, heads down on creating that additional capacity.
The primary way that we’re focused on doing it is within the confines of the hospital proper — taking over other spaces that were utilized for other services that have been basically postponed until we get through the epidemic. The wound care center — that space will be taken over. Ambulatory surgery — we’re not doing elective surgeries now, so we’re taking over those treatment areas. We’re expanding into alcoves and additional spaces in the hospital to meet those numbers.
Q: Are you looking for other locations as well?
Right now, it’s not necessary. We’re confident that we can meet the governor’s targets with the space that we have. And, frankly, we’d rather try to utilize what we’ve got, because then we don’t have to spread our resources over multiple geographic sites.
Q: And beds and equipment?
We will need to get additional equipment. Some of these rooms didn’t have beds in them. So we’re looking, through all sources … we’re collaborating with the county, we’re collaborating with Stony Brook, and the state is trying to make resources available.
We are as well-stocked as any of the hospitals at this point. We’ve got what we need for today’s needs. But it’s all about anticipating what may come. That’s what we’re trying to build toward, making our best guess of when and what we’re going to need. There are a lot of things we’re trying to get our hands on rapidly.
Q: The hospital’s typical capacity is 125 beds, right?
We typically staff for about 94. But we are trying to get up to the [number the governor wants] — I think it’s 160, 180. … As of today, we don’t have the need. But we’re anticipating that’s going to change rapidly over the coming weeks. We’re confident we’ll have the beds open when we need them.
Q: There’s a lot of concern about hospitals having enough protective supplies for staff: masks, gloves, etc. How is the hospital stocked for those supplies? How hard is it to restock right now?
We’ve got what we need in most areas. We’re monitoring that very, very carefully. Today, we’re in decent shape.
The guidelines on use are changing rapidly, so we’re trying to keep up with those. Like everybody, I am concerned that we need to see more supplies come available in the coming weeks. Because we could run out quickly — when I say quickly, within a matter of weeks. And we don’t know for how long this is going on.
But for today’s needs, we’re fine.
Q: And how about supplies for patients — ventilators in particular?
Again, we’re fine with ventilators. But we’re trying to get our hands on more ventilators.
Q: How about tests? Do you have an adequate supply? How are they being administered — what’s the criteria for giving a patient a test?
So, testing has been a big issue, across the board. The criteria they’re using is: Have you traveled somewhere that’s a high-risk country? Are you exposed to someone who’s been a confirmed case? And are you showing signs and symptoms that would warrant [a test]?
Everybody wants to get tested. And the problem, just the reality, is that there’s not enough supplies to do testing for everybody who wants testing.
Part of it is because it’s not like you come in and they rub a swab on you — it’s a whole procedure. In order for a health care worker to test you, they’ve got to gown up, they’ve got to stick the swab up your nose, they’ve got to then handle that thing appropriately. It consumes a tremendous amount of resources, in terms of personal protective equipment, time and the testing material.
So we’ve been prioritizing the testing to people who are meeting the criteria that the [Centers for Disease Control and Prevention] and the State Department of Health have outlined for us. And that’s why we’ve been following those criteria very, very strictly.
And I know people are frustrated — “Why can’t I just get a test?” But for a lot of reasons, the tests just can’t be made available to everybody at this time. We’re hoping that there’ll be some additional new tests, that rapid testing will roll out faster.
Q: How are your staffing levels? Are you adding staff? If so, how?
Mostly what we’re focused on right now is redeploying staff, staff that are working in other areas. We’ve eliminated, stopped, our elective surgeries. So we have a lot of staff associated with our surgery program who can be redeployed.
And that’s the exercise we’re going through right now — to understand, when we open up these beds, what staff we have who can be redeployed. Priority, obviously, with doctors and nurses. We’ve got residents, medical students who aren’t in regular training — they can be redeployed.
That’s working for us today. Again, we may need to make calls to people we know in the community who used to work here and retired, and others who might be resources we can pull in. And the state’s trying to get a handle on that, too.
Q: How much of the staff have you lost to sickness or mandatory quarantine?
Pretty small number right now. Today, it’s a small number. It has not put a crimp in our staffing today.
Q: And I suspect you’re taking every step to make sure there isn’t transmission to staff in the hospital?
Oh, yeah, absolutely. That’s our biggest concern. And what we’re trying to do — not because we’re being selfish, but we’re trying to protect the workers, so they can take care of everyone else — and so making sure that [protective] equipment is available for them.
That’s one of these issues of just randomly testing everybody in the world — it just exposes a lot of health care workers to people who may never even develop the disease, or a strong case of the disease. We want to save those workers and supplies for the people who get really sick.
The workers are getting all the equipment they need. We’re rapidly training people. And we’re trying to do everything we can to protect our people. That’s why we shut down visitors, and things like that as well — to try to [limit] exposure, not only for our patients but for our staff as well.
Q: How is staff morale? It must be exceedingly stressful for doctors, nurses, support staff, administrators — everyone.
Incredibly brave. That’s the word I want to use.
I come to work, and, you know, you hear pockets of people — they admit they’re afraid. These are human beings — they’re worried, they’re afraid. But the level of bravery is just breathtaking. And what I’m seeing with my co-workers and their willingness to take this on and do the right thing, is just … well, I’ve never lost my faith in humanity, but it’s bolstered my faith in humanity, I’ll tell you.
Q: How can people help? And how can people support the hospital right now?
The best thing people can do is stay home. We need this whole “flattening of the curve” idea — that’s our biggest worry, that the epidemic will grow in the community faster than we can keep up with it. And right now, we are keeping up with it. But if people stay home and keep themselves safe … We’d rather see the patients trickle in here than suddenly flood in here. That absolutely is the most important thing we want people to do.
We love the offers of supplies and money and anything that people want to do. But: Stay home. Take care of yourselves. And keep the stream of patients from growing into something that we can’t manage. That’s what we really need people to do.
Q: What advice would you give to someone with symptoms?
The advice that the clinicians are giving: If you’ve got symptoms, monitor yourself. If it’s mild symptoms, and you think you can manage it at home, stay home, self-isolate, quarantine yourself from your family members.
Monitor yourself. If you get to the point where your symptoms — people will know that they’re just at a point where they can’t handle it anymore, they’re having respiratory issues, they’re having trouble breathing, and their symptoms are getting worse, then come to the emergency room.
[Calling ahead is not necessary: Patients experiencing severe COVID-19 symptoms should go directly to the Emergency Department entrance at the hospital, where a nurse is stationed 24/7 in the triage area, according to hospital officials.]
Q: If there’s one thing you want people in the community to know, what would it be?
The one thing I would want people to know is that we are here, we’re ready and we are prepared to serve. But the most important thing I want them to know is: follow the guidelines on staying home. Those are being put in place for a very important reason, and I really want them to follow that.
And stay calm. It’s frustrating — people are afraid, we understand that. But stay calm, and stay home.
And wash your hands.
If you have questions about COVID-19 symptoms, and whether you should go to the emergency room, you can call the hospital’s fact line at 631-726-FACT (3228). Stony Brook Medicine also offers a staffed hotline to answer other questions about COVID-19: 631-638-1320.