Cuomo: New York will wage next COVID-19 'war' on the hospital front

Gov. Andrew M. Cuomo declared Monday the state is entering a new phase of the fight against COVID-19, likening it to "war" and announcing a series of new emergency actions as New York braces for a holiday surge of confirmed cases.

Cuomo said his biggest fear is that hospitals become overwhelmed by caseloads of COVID-19 patients, mirroring what happened this past spring at Elmhurst Hospital in Queens and in hospitals in Italy. He ordered hospitals to prepare to increase their capacity by 50%.

He also instructed them to "balance" their caseloads by transferring patients within their systems so that some do not become overloaded. He said hospitals will have to transfer patients among different systems such as Northwell and NYU Langone, if need be, to prevent any particular hospital from becoming overwhelmed.

"It’s a new phase in the war against COVID," Cuomo said at a news briefing in Manhattan. "I think of this as a war. It’s a war of attrition … COVID is an enemy that we’re dealing with. It’s attacking people. It’s killing people."

He quoted Sun Tzu’s "The Art of War," and noted, "COVID is shifting the battlefield dramatically."

The focus on hospitals, Cuomo said, is necessary as the virus mounts a resurgence that he called "a surge on a surge" during the holidays.

"The chessboard has really changed and then we are coming into the holiday season and the holiday season is going to have a profound effect. It already has," Cuomo said. "Increased mobility, increased social activity, increased viral infection rate. It is directly proportionate."

Cuomo ordered hospitals to start locating retired doctors and nurses who could help if the crisis intensifies. Last spring, medical personnel from around the country came to New York to help, but now they are probably unavailable because the crisis has spread across the United States.

"We’re not going to live through the nightmare of overwhelmed hospitals again," Cuomo said. "This was a serious issue last time."

If a hospital gets overwhelmed, the state will investigate, and if it finds the hospital did not redistribute its patients properly, it will be considered "malpractice," Cuomo said.

The ultimate "end" of the war will come with mass distribution of a vaccine, Cuomo said, but he does not expect that to be accomplished until late spring or early summer.

"That is going to be the weapon that will end the war. The only question is when," he said.

Five-step plan in new offensive

In his five steps of the new offensive, Cuomo said keeping schools open is critical, especially in kindergarten through eighth grade. He noted that positivity rates for the virus are very low in schools.

The five steps Cuomo outlined include strengthening the hospital system, bolstering testing and making sure it is done equitably, including with hard-hit minority groups, while keeping schools open as long as it is safe.

The plan also includes combating the "living room spread" at small gatherings that has become the biggest source of new cases, accounting for 65%, and ensuring New York has the best vaccination program in the nation.

The governor warned that New York could enter a "NY Pause" or general shutdown again, if the virus becomes widespread. He told hospitals in upstate Erie County to halt elective surgeries starting Friday because high numbers of COVID-19 patients are straining hospitals. Through the spring crisis, the state even had field hospitals built to increase capacity, including two on Long Island that were never used.

The state will change the way it designates "microclusters" or "hot spots" with high levels of infection, Cuomo said. The new approach will be based not only on positivity but will include hospitalization rates, death and case rates, available hospital beds and staff levels.

The metrics will be set this week, after state officials review data following the Thanksgiving holiday, he said. The zones are divided by color — red, orange and yellow — depending on their infection levels.

Area health system executives said they already have met some of Cuomo's new demands, including expanded bed capacity in the spring, and will do so again.

"We've kept space in reserve in anticipation of this," said Dr. Marc Adler, chief medical officer at NYU Langone Hospital-Long Island in Mineola, which has a capacity of about 500 beds.

The hospital has just under 50 hospitalized COVID-19 patients, well under the nearly 500 it had during the pandemic's height in April, Adler said.

Dr. David Battinelli, chief medical officer at Northwell, added "we converted auditorium and conference space, and we will do it again. To expand 50%, we will be using every square foot of the hospitals."

Catholic Health Services, which operates six hospitals on Long Island, moved patients from one facility to another last spring "depending on space considerations and the hospital with the best situation for a specific patient's needs," said Dr. Jason Golbin, chief quality officer at the health system.

Golbin added that CHS would continue load-balancing if certain hospitals faced a surge.

Battinelli said Northwell could move patients throughout its system, which includes hospitals in Westchester County, Staten Island, Manhattan and Long Island.

Health system leaders acknowledged that unlike last spring, it would be more difficult to recruit medical help from other parts of the country.

Golbin said CHS has cross-trained medical staff to help in a critical care setting.

The level of positivity in tests in the state's "microclusters" or "hot spots" was 6.22% in results on Sunday. It was 4.02% in the rest of the state excluding the hot spots, and 4.57% including the hot spots, which are oversampled.

Statewide, 54 people died Sunday of coronavirus-related causes.

The number of new confirmed cases from results Sunday was 520 in Nassau, 658 in Suffolk, and 2,504 in New York City. Long Island as a whole surpassed 1,000 new daily cases last week for the first time since the spring, and did so again Sunday with a total of 1,178.

Long Island's positivity rate was 4.5% Sunday, up from 4.1% on Saturday and 3.4% on Friday. The level Sunday in New York City was 3.9%.

"The trend we’re seeing right now is clear and concerning" in Nassau, County Executive Laura Curran said.

The number of people in the state hospitalized with the virus increased on Sunday by 160, to 3,532.

More testing, more patients

Bonnie Simmons, chair of Urgent Care for ProHEALTH, which has 24 locations on Long Island and New York City, said they have seen volume more than double during the holiday surge, up to nearly 100 people seeking COVID-19 tests per day.

To manage capacity, ProHEALTH added six new drive-thru testing sites, including Riverhead and Jericho.

"We’ve seen wait times increase ahead of the holiday and now after the holiday," Simmons said. "Many are families concerned about exposure during travel and seeing their loved ones in closed spaces, and also seeing their family without masks while eating dinner, for example."

Joy Lee-Calio, a CityMD spokeswoman, said demand due to COVID-19, including for testing, "remains consistently high" and "is creating long lines" at most of its walk-in centers, "so we ask patients to plan accordingly."

Susan Bortone, director of operations at Northwell Health-GoHealth Urgent Care, which has 31 Long Island locations, said, "We have seen the need for COVID testing increase dramatically over the past weeks, and expect it to continue throughout the progression of the pandemic."

Stony Brook University Hospital said Monday it had 58 inpatients positive for the virus, up from 30 for the same period a week ago.

Northwell Health said it had 583 COVID-19 patients, up from 414 a week ago.

With Robert Brodsky