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Slowdown in virus cases brings relief to Long Island hospitals

Emergency department chief Dr. Joshua Kugler speaks with

Emergency department chief Dr. Joshua Kugler speaks with paramedics after they bring in a patient to Mount Sinai South Nassau hopsital in Oceanside on April 13. Credit: Jeffrey Basinger

This story was reported by Mark Harrington, Sandra Peddie and Matt Clark. It was written by Peddie.

The surge of coronavirus patients that inundated Long Island hospitals slowed over the past two weeks, providing a measure of relief to medical institutions operating on a war footing.

In both Nassau and Suffolk counties, the number of new COVID-19 cases confirmed each day – one measure of the pressure on hospitals – has fallen from peaks around the end of the first week in April.

On April 7, the counties recorded an islandwide total of 3,265 new confirmed cases. On April 22, the number was 1,282, a 61% decline after dropping even lower two days earlier.

Similarly, the Island’s medical centers have experienced falling numbers of hospitalized patients, intensive-care unit admissions and the use of ventilators to support breathing.

“We have clearly crested and may be on a downward slope,” said Dr. David Battinelli, Northwell Health’s chief medical officer and senior vice president. But, he cautioned, “The numbers are still very, very high.”

Gov. Andew M. Cuomo said on Friday that health authorities will monitor evidence that stay-at-home orders and social distancing have produced falling infection rates in determining when to begin reopening the economy. He said the authorities will watch for two straight weeks of stabilized or declining rates.

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At the same time, coronavirus caseloads in hospitals have yet to fall far enough for the hospitals to avoid crises in the event of a sudden surge in new cases, let alone to resume activities like elective surgeries.

“We don’t even know what normal will look like,” said Carol Gomes, chief executive officer and chief operating officer of Stony Brook University Hospital. “I think our definition of normal will change.”

Monitoring the data is key to understanding what’s next, according to front-line doctors.

Islandwide coronavirus hospitalizations have declined from a high on April 10 of 4,108 patients to 3,118 on Wednesday, a drop of 24%.

Nassau’s hospitalizations peaked on April 13 at 2,477 COVID-19 patients. By Wednesday, the number was down to 1,778. In Suffolk, the caseload dropped from a high on April 10 of 1,658 patients to 1,340 on Wednesday.

Intensive care unit caseloads are also declining from peaks, although not as dramatically.

Across Long Island, the number of ICU patients peaked at 1,154 on April 14 and stood at 990 on Wednesday. Nassau fell from 592 patients to 496, Suffolk from 562 to 494.

The number of patients supported by ventilators has dropped less dramatically: in Nassau from 503 on April 13 to 415 on April 22, and in Suffolk to 411 from 466.

The number of intubated patients had remained comparatively steady because patients are requiring extended assistance breathing, Gomes said.

“Some of them are on vents for several weeks at a time. That’s why we’re seeing so many patients on vents. It takes a while for them to come off the vents,” she said.

Medical officials saw reason for optimism in the numbers but cautioned that the trend line needs to continue and could change as plans to reopen businesses and the larger society take effect.

“It gives people a much-needed break, a respite,” said Sean Clouston, associate professor at Stony Brook University’s Program in Public Health, who has been studying the virus to model its progression in Suffolk County and for the Stony Brook hospital system.

Clouston cautioned against drawing conclusions until longer trends emerge. He noted that ventilator patient declines were not yet in the double digits.  

Dr. Adhi Sharma, chief medical officer and executive vice president of Mount Sinai South Nassau Hospital in Oceanside, said falling coronavirus statistics are encouraging, but noted that coronavirus patient census is still high.

“While there is a decline in the new numbers, the patients don’t recover that quickly. There is a stacking phenomenon,” he said.

The hospital currently is treating 250 COVID-19 patients, out of 382 beds. “We still have a heavy burden of COVID patients,” Sharma said.

The hospital will need “a minimum of two weeks” until some time in early May before it can start getting back to normal operations.

Clouston said the unknown in the numbers is “how much of a downward trend there is when you account for delays in testing” and “incomplete data.”

Indeed, the total number of COVID-19 tests in both Nassau and Suffolk has declined.

In Nassau County just 1,980 people were tested for COVID-19 on April 22, down sharply from a peak of 4,179 on April 7, according to the figures.

In Suffolk the figures are similar: just 2,428 tests were done on April 22, down from a high of 3,889 on April 8. It’s unclear whether the lower testing numbers are related to lower capacity or fewer people showing up at testing centers.

Battinelli said that people panicked early in the pandemic and rushed to get tested, but that panic has eased.

Testing may also have declined because the criteria to get tested are stringent and there is a shortage of key components, like swabs, said Northwell spokesman Terry Lynam.

Currently, tests are limited to people who are experiencing symptoms and are essential workers, immune-compromised or elderly with underlying medical conditions. “Nobody else is being tested because of the shortage of swabs,” he said.

If the problem is capacity, Cuomo on Wednesday has said the state’s approximately 300 testing centers have been ordered to double their current capacity from 20,000 COVID-19 tests per day to 40,000. The testing centers are mostly privately operated.

“That’s the maximum capacity of all the machines in the state,” Cuomo said, likening it to holding down the accelerator on a car and hoping nothing breaks.

Clouston of Stony Brook said the state’s plan for more testing will help modelers better understand the virus as the state begins to ponder plans to selectively lift the lockdown order.

Right now, he said, it’s “unclear to what extent it [the declines] carries forward into a steady drop or a slower pace of decline.” His own modeling suggests the future decline is somewhere between a sharp drop and a slow one. “My model says a couple of hundred cases per day into mid-May.”

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