As the number of COVID-19 patients in Long Island hospitals continues to rise, hospital officials say months of planning, purchases of new equipment and lessons learned during the spring deluge of coronavirus cases has them prepared if there is a new surge.
"We’ve been preparing continuously since the day we stopped having a surge," said Dr. Aaron Glatt, chairman of medicine and chief of infectious diseases at Mount Sinai South Nassau hospital in Oceanside.
Hospital officials said they are stocked with personal protective equipment, can quickly move staff around to treat a major influx of COVID-19 patients, and have conference rooms and other space ready to accommodate beds and medical equipment — if needed.
The spring surge, which at its peak in April had thousands of Long Islanders hospitalized with COVID-19, occurred suddenly and rapidly.
In one week in late March, the number of COVID-19 patients at South Nassau increased nearly tenfold, and the coronavirus caseload kept climbing through mid-April, as doctors, nurses and other hospital staff scrambled to keep up. Some patients lay in beds in hallways until rooms were available. Similar scenarios played out at other Long Island hospitals.
Stony Brook Medicine has been analyzing "what went right, what went wrong, what would we do again and what would we do differently," said Dr. Susan Donelan, medical director of health care epidemiology at Stony Brook.
Donelan and other area hospital officials say that, even though the number of coronavirus patients has increased in the past few weeks, it is still a fraction of the COVID-19 patients in the spring.
In March and April, hospitals that pre-COVID-19 often had only a few days' supply of N95 masks and other personal protective equipment suddenly faced an exponential increase in demand, and that sent hospitals scouring the globe — online, by phone and sometimes in person — looking for PPE that thousands of other hospitals worldwide also needed.
The state enacted regulations in July that require hospitals statewide to have at least 90 days of PPE on hand.
Hospitals also have been purchasing new equipment. Mount Sinai South Nassau now has 125 ventilators — up from 40 pre-COVID-19 — and 65 are in storage, ready in case of a surge, hospital spokesman Joe Calderone said.
In addition, South Nassau bought giant vaporizers that are able to convert five times more liquid oxygen into gas for use in the ventilators and other respiratory devices, he said. Two tents constructed outside the hospital to handle the spring overflow of patients remain in place.
Hospitals in the spring also faced staff shortages, especially people experienced in working with patients with severe respiratory problems. Many temporarily brought in personnel from around the country — an option that, with the coronavirus now severely impacting almost every state, may be less available.
Anticipating that, Long Island Community Hospital in Patchogue is securing agreements with staffing agencies that would give the hospital priority access to respiratory therapists, nurses, physician assistants and others, said Richard Margulis, the hospital’s president and CEO.
At Northwell Health, many employees from throughout the system were trained during the spring to work with COVID-19 patients so, for example, nurses who did not typically work with intensive-care patients were given additional training and paired with experienced critical-care nurses, said Dr. Mark Jarrett, the health system’s chief quality officer. Others were trained after the surge in anticipation of another one, he said.
"We built up a reserve corps of staff we can pull in," Jarrett said.
In the spring, NYU Langone Hospital-Long Island moved quickly to create additional patient-care space to comply with a state mandate to increase capacity by 50%, said Dr. Joseph Greco, chief of operations at the hospital.
A large conference room and library that had been converted into an intensive care unit have not been used since and will be ready for patients in case of a new surge, he said.
At Stony Brook, some patient rooms were converted into negative pressure rooms, from which contaminated air is emitted through a vent and filter in the window and does not escape into the hallway, Donelan said.
One frustration of hospitals during the spring crisis was a shortage of coronavirus tests, which sometimes led to days of waiting for results.
At the six Catholic Health Services of Long Island hospitals, test results often are now returned within an hour, said Dr. Patrick O'Shaughnessy, executive vice president and chief clinical officer.
If someone arrives at the hospital with COVID-19 symptoms and is considered at high risk for a severe case of the disease, that person is isolated and kept at the hospital until a test result comes back, he said. Now, the hospitals can find out quickly if the patient has, for example, the flu instead of COVID-19 and provide better treatment for either illness, admitting them if necessary or sending them home if appropriate, he said.
Months of experience caring for coronavirus patients means that treatment has improved, Jarrett said.
"Our care is better from learning," he said. "We have new therapeutics and different ways of approaching the patient, and all of that makes a difference and lowers the mortality rate."
Although hospital officials across the Island have spent months preparing for a surge as big or greater than the spring influx of coronavirus patients, they said they're hopeful that one will not occur.
Unlike March, "People are wearing masks," Greco said. "We have more frequent testing. We are spacing people in restaurants and at large gatherings. We’re taking a lot of steps to prevent" a new surge.