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As apex is expected, Long Island hospitals prepare for surge of coronavirus patients

A line forms outside NYU Winthrop University emergency

A line forms outside NYU Winthrop University emergency room April 1 in Mineola. Credit: Howard Schnapp

Hospitals on Long Island said they're making final preparations to ensure there are enough beds, nurses and doctors to treat patients, and personal protective equipment for staff, as the peak of the COVID-19 pandemic nears.

Health systems as a whole are adding hundreds of medical professionals — including doctors and registered nurses — to the front lines of the COVID-19 battle as they also find creative ways to convert machines into ventilators and to treat coronavirus patients.

The tempered optimism that New York may be seeing "a flattening of the curve" is shared by top executives, although they added any relaxation of social distancing could be devastating to that progress.

"The early indication is we may be peaking a little earlier than models had predicted," said Dr. Patrick O'Shaughnessy, executive vice president and chief clinical officer at Catholic Health Services, which runs six hospitals on Long Island. "But I think it's still too early to tell if this really is the peak."

Staffing

CHS has offered pay differentials to staff willing to pick up extra shifts needed to confront the crisis, O'Shaughnessy said. The Rockville Centre-based health system also has repurposed staff from areas of the health system that are seeing few patients. 

"We are also trying to add staff to join our workforce, but every health system is trying to do that," he said.

There is a regionwide need for more nurses and respiratory therapists, said Dr. Joseph Greco, chief of hospital operations at NYU Winthrop. The Mineola hospital on Monday added 60 nurses from outside agencies to help, Greco said.

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"This is a welcome relief for our nurses," Greco said, adding that the hospital also will add NYU medical graduates next week. 

He said staff from NYU Langone practices also are joining hospital staff because "those practices are all down in volume."

Northwell Health is adding ambulatory staff to its hospitals, said Dr. Mark Jarrett, the health system's chief quality officer. Only about 200 of 800 Northwell ambulatory offices are functioning, he added.

"The physicians, nurse practitioners, physician assistants and nurses from those offices are coming to fill in holes," Jarrett said. 

Northwell also is starting to add nurses from health systems in regions of the country that are not yet impacted by COVID-19, he said. 

Staffing has become "difficult" at Stony Brook Hospital, said Carol Gomes, chief executive officer. 

With the total number of beds increasing from 624 to 902, the expansion has placed stress on staffing levels. "We’re starting to run low on staff," Gomes said.

She said they will work with Gov. Andrew M. Cuomo and FEMA to access some of the volunteer health care workers who have come from other areas.

Long Island Community Hospital in East Patchogue posted a message on its website seeking volunteers and has received about a dozen inquiries, said Richard T. Margulis, the hospital's chief executive.

PPEs

Hospitals across Long Island are in need of personal protective equipment such as masks and gowns, medical providers said.

They are extending their current supply by cleaning and reusing some items under “crisis capacity strategies” issued last month by the federal Centers for Disease Control and Prevention.

At Stony Brook, Gomes said, “We’re working through the proper government channels to try to obtain” more masks and gowns. But as the hospital awaits reinforcements, “We’re also doing what we can internally to try to create our own.”

Among the innovations, she said, are 3D face shields being created in mass by the university’s fleet of 3D printers.

President Donald Trump announced Sunday that 200,000 N95 masks were being sent to Suffolk to help area hospitals.

At LICH, Margulis said the hospital has about seven days worth of protective equipment left. He was pleased to hear the federal government was going to help.

“It will just give us a little more reassurance that our inventory will be larger if this comes through,” he said.

Capacity

Health systems have been directed to expand bed capacity by 50% to handle the pandemic. They've repurposed lobbies, converted gyms and pulled out 300 seats from an auditorium to create room, if needed.

Catholic Health Services has identified locations where more COVID-19 patients could go, if necessary, O'Shaughnessy said. CHS has a multidisciplinary and ambulatory office at 2200 Northern Blvd. in Manhasset that has yet to be converted. It also could shift patients to a section of its Our Lady of Consolation Nursing and Rehabilitative Care Center in West Islip. 

Northwell Health said it could add hundreds of beds at North Shore University Hospital in Manhasset if the apex calls for it, Jarrett said. He pointed to an empty auditorium, a rehab center and a tent hospital at North Shore.

"That's all at one hospital," he said. "Other hospitals can add as well."

The number of COVID-19 patients at Northwell hit 3,300 on Monday, up from 3,100 on Friday. About a week ago, Northwell was reporting an increase of nearly 300 per day.

NYU Winthrop could still convert patient rooms into COVID-19 treatment areas if needed, Greco said.

Nassau University Medical Center has about 140 COVID-19 positive cases admitted and another 60 suspected patients who are admitted and are awaiting results, according to interim president Anthony Boutin.

Robert Detor, chairman of the public benefit corporation that runs NUMC, said the number of COVID-19 patients there has been holding steady since Saturday. Detor hopes this is an indication of the number of cases statewide plateauing, as Cuomo has suggested in recent days. 

"We've been seeing the same number of people coming in as those going home, so that's been a positive sign," Detor said. "We're hopeful." 

Detor said the hospital has enough beds dedicated for COVID-19 patients to care for another 40 patients and said ventilators is not a significant concern at the moment. 

Staffing, however, is becoming an issue. 

"This entire experience is putting a real stress on the staff," he said.

Detor said NUMC requested additional staff help through the state-run portal that opened Sunday to direct the thousands of volunteer health care workers to various hospitals. Detor said they haven't received word on what kind of additional staffing help they will receive. 

Ventilators

Health care system executives said they continue to retrofit other types of breathing devices in case they run short on ventilators for patients who need to be intubated. 

Northwell Health said it has converted bi-level positive airway pressure (BiPAP) machines by designing and 3D printing a small plastic T-adapter, which is then attached to the devices on one end. The adapter connects to an endotracheal tube, which is used to intubate a patient.

Northwell said it has about 350 of the machines in the system, and converting them has the potential to save thousands of lives.

Catholic Health Services and NYU Winthrop also are converting BiPAP machines, as well as anesthesia machines, to help COVID-19 patients breathe. 

"We are cautiously optimistic," Greco said.

At LICH, as many as 49 of the 57 ventilators are in use, Margulis said. Those include eight ventilators that came from the state. He said the hospital on Sunday requested 15 additional ventilators, and he is waiting to hear how many the state will provide.

Treatments

Medical providers said they're learning in real time about best practices in COVID-19 treatments. 

O'Shaughnessy said at CHS, they're "deploying medication sooner rather than later." He added that the medicine used depends on many factors.

Long Island hospitals have been involved in COVID-19 clinical trials. 

There is no approved vaccine or anti-viral drug to specifically treat patients who have tested positive.

Many of the drugs being tested have been cleared by the FDA, such as hydroxychloroquine (Plaquenil) for malaria and arthritis and the antibiotic azithromycin (Zithromax). The combination of the two has helped some patients recover from their illness, but the scientific community has been careful to point out it’s not a “silver bullet” for the virus.

The experimental drug remdesivir, developed to treat people infected with the Ebola virus, also may benefit COVID-19 patients. It is the subject of trials at hospitals operated by Northwell, Stony Brook, NYU Langone Health, Catholic Health Services, as well as Mount Sinai South Nassau.

Researchers are trying to determine if antibodies from the blood of patients who recovered from COVID-19 could stop the infection in another patient or prevent the infection.

Known as convalescent plasma, Northwell, Stony Brook and Catholic Health Services are poised to use it in clinical trials.

Meanwhile, Gomes said she finds hope in the good news she receives at their morning operations meeting: the number of people who went home in the last day.

"We see a lot of sadness," she said, "but we also see people who have recovered after being intubated and they're going home. Some patients are going home."

With Lisa L. Colangelo

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