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Doctor memo describes 'health care disaster' caused by coronavirus 

Dr. Kenneth Kaushansky, senior vice president of health

Dr. Kenneth Kaushansky, senior vice president of health sciences at Stony Brook University Hospital, on Feb. 13. Credit: Randee Daddona

Stony Brook University Hospital internal correspondence paints a portrait of a flagship Long Island health care institution urgently responding to the coronavirus onslaught, from the stresses of nursing on a virus unit to searching for treatments in medical laboratories.

The correspondence includes a letter to the hospital community from Dr. Kenneth Kaushansky, senior vice president of health sciences, and three emails that a nursing supervisor wrote to update her staff on the hospital’s mobilization from March 23 to March 25. Kaushansky also sat for a Newsday interview.

Together, the correspondence and the interview show the medical center scrambling to expand intensive care capacity, using a disinfectant process to conserve protective masks, stockpiling oxygen tanks to meet ventilator demands and increasing staff with newly graduating medical students as well as with experienced physicians whose practices are normally far different.

“Needless to say, it is not hyperbole to state that none of us have seen, or will ever see during our careers so severe a health care disaster as being dropped on our doorstep,” wrote Kaushansky, adding, “So what we do here, what we do now will define us!”

As Kaushansky was providing hospital staff with an institutional overview, the nursing manager informed her staff about day-by-day developments and offered perspectives on tending to a growing number of severely ill patients carrying the highly infectious virus under battlefield-like conditions.

A source, and not the nursing manager, provided the emails to Newsday. They were authenticated. Newsday is not identifying the nursing manager.

In her March 24 email, she wrote:

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The unit "will be completely full with the same types of patients very soon. Most important, try and accept that you will not be able to give stellar care to your patients. You do the best you can and then you go home and make peace with that. You are all superstars but you will burn out in a week if you do not let things go. This is disaster medicine.”

On that day, the nursing manager reported 31 confirmed virus cases and 160 patients awaiting confirmation. An emergency field unit had opened and 13 patients were moving to a new long-stay ward “ASAP.” She cautioned that on one unit “the acuity level is extremely higher than what you are used to." 

The acuity level reflects the severity of a hospitalized patient's illness and the level of attention he or she will need from staff.

Finally, she advised, “Staff who have never had a panic attack are having them.”

A full-service and teaching hospital, Stony Brook is rated as one of the top 100 in the country by Healthgrades, which ranks hospitals by clinical outcomes. It is the largest single-site employer on Long Island, with 7,000 employees. The Renaissance School of Medicine at Stony Brook University is the top-ranked public medical school in New York.

The hospital is certified for 624 beds, with 85 ICU beds. It is in the process of increasing that ICU capacity by 50% in three weeks and doubling capacity in 10 weeks. The total number of beds will be 1,300. Of those, 235 will be ICU beds, according to Stony Brook spokeswoman Lauren Sheprow.

 As of April 1, 344 patients with the virus, or who had symptoms and were awaiting test results, were admitted to the hospital, occupying more than half the hospital’s beds, Kaushansky said Wednesday. Admissions were increasing by 20-40 patients a day, he said.

Of those 344 patients, 91 were in intensive care, and 80 of those were on ventilators. The normal maximum number of ICU beds is 65, he said. 

Additionally, 99 employees have tested positive for the virus. About half have recovered and can resume work, Kaushansky said.

“These people who’ve had the virus and recovered are super-workers — they can’t get infected again,” he said.

In his letter to “Members of the Health Sciences Campus of Stony Brook University,” Kaushansky wrote, “We have prepared for the coming ‘perfect storm.’ ”

Still, he wrote that personnel protective equipment "is in extremely short supply,” adding:

“We have sufficient PPE for staff and continue to develop alternate resources to stay ahead of growing PPE needs. For example, we are bringing to Stony Brook a system to safely sterilize (the now famous) N95 masks, allowing their re-use many times.”

To help meet the need for plastic face shields, staff worked with Stony Brook’s College of Engineering and Applied Sciences to fashion a new type of face shield, then worked with a local plastics fabricator to deliver them in large numbers, Kaushansky wrote.

Kaushansky said the hospital received 20 ventilators from the state and that the College of Engineering and Applied Sciences is actively designing a new kind of ventilator and testing a prototype, which he said could be ready to use in two to three weeks.

Stony Brook is also participating in clinical trials. In about a week, it will begin accepting plasma donated from people who’ve recovered from coronavirus, which could be used to help those who’ve contracted it, he said.

Another proposed clinical trial could help those who are sick with coronavirus but do not require hospitalization, he said. This includes a combination of two drugs, the anti-malarial hydroxychloroquine and the antibiotic azithromycin, which has shown success in a study in France. This combination has been heralded by President Donald Trump.

“I presented this idea to NYS Health Commissioner Dr. Howard Zucker, who is considering our proposal,” Kaushansky said in his letter.

Looking down the road, Kaushansky said ramping up the number of hospital beds was not the hardest task. The big concern is that this is a crisis that will last a long time, and that it will burn out medical staff, he said.

The senior class of physicians will graduate weeks early in April, he said. Of the 108 graduates, 73 have signed up to help treat coronavirus patients at Stony Brook, he said.

Staff members are working long hours. Kaushansky and the nursing manager are each putting in 14- to 16-hour days. For the nurses, that means caring for increasing numbers of patients with dire needs. Basics that are taken for granted as part of quality care may have to be sacrificed, the manager wrote.

“Charting comes last. Bathing can wait. Sparkling clean sheets is a thing of the past,” she counseled.

On March 25, she again advised staff members that rising caseloads would heighten demands placed on individual nurses who have been dedicated to meeting high standards of care.

“I am torn between being an alarmist but we all need to prepare for the time when you will have three or four of these patients with staff working under you,” she wrote. “I cannot emphasize enough that you need to make peace with the fact that you will do the best that you can and that’s all you can do.”

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