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South Nassau hospital coping with aftermath of COVID-19's peak

Dr. Rajiv Datta, chair of surgery at Mount Sinai South Nassau hospital, performs neck surgery on a patient who delayed the procedure because of the COVID-19 pandemic. Credit: Newsday / Jeffrey Basinger

Although the number of COVID-19 patients at Mount Sinai South Nassau hospital has fallen to levels not seen since the beginning of the state’s March 22 stay-at-home order, the anguish caused by the pandemic endures, as people recovering from the disease continue to struggle at home, and patients who arrived during the pandemic’s peak remain weeks later, clinging to life on ventilators.

Crews are busy disinfecting rooms to make them safe for people without COVID-19. But many continue to avoid the hospital, for fear of contracting the coronavirus, and health care workers worry about another spike in cases.

South Nassau, like other hospitals across Long Island, is returning to some semblance of normalcy after an influx of hundreds of COVID-19 patients during the apex in early and mid-April threatened to overwhelm front-line workers at the Oceanside hospital.

The intensive care unit, which had nearly quadrupled in size to handle the surge of gravely ill people, had 72 COVID-19 patients on several days in early April, but only five on Thursday.

Yet, intensive-care nurse educator Katie DeMelis said, “It’s bittersweet. Our numbers are down, but they didn’t all leave the way we wanted them to.”

By Thursday, 399 people had died of COVID-19 at the hospital, and nearly 4,000 had perished across Long Island. 

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More now at the hospital likely will die of the disease, DeMelis said as she stood in a hallway outside the room of an unconscious man under heavy sedation who was only alive because of a ventilator that produced the breaths his body could not. The man's prognosis is poor, she said.

“We had five expirations on [May 17] alone from this unit,” DeMelis said. “It was not unexpected. Unfortunately, a lot of these patients are at end of life, so they’re actively dying or they’re going to be long-term care at this point,” living without mental awareness and only with the 24/7 help of machines.

Newsday visited South Nassau on May 18 and 19 to see how the drop in COVID-19 patients had changed the hospital, and to examine the toll the disease has taken on patients and employees. During a mid-April visit, the hospital had nearly 500 patients, far above the typical 340. Patients with COVID-19 and those suspecting of having the disease occupied more than three in four beds and flummoxed doctors and nurses with inexplicable symptoms and sometimes a rapid spiral toward death.

On Thursday, one in five of South Nassau’s 276 patients had COVID-19.

Doctors worry that the abnormally low number of non-COVID-19 patients means some Long Islanders are suffering needlessly at home or dying, because they still are afraid of getting infected with the coronavirus at the hospital.

“We’re going to end up having this whole group of people that are hurt, who never had COVID, but they’re going to be hurt by COVID,” said Dr. Adhi Sharma, chief medical officer of South Nassau.

With fewer patients, employees are visibly less stressed. Yet they confront the emotional aftermath of seeing so much death in so short a time.

In April, as many as 17 people a day were dying of COVID-19, overloading South Nassau’s small morgue and spurring the hospital to buy three 40-foot trailers to store corpses. There were 69 bodies in the trailers on April 20. On Wednesday, there were eight, and only one of the three trailers hummed with the sound of a refrigeration system that keeps bodies cold until backlogged funeral homes and cemeteries can pick them up.

Oceanside woman: 'I feel like I have leprosy'

Debbie Rifenbury is one of the ICU success stories. She left South Nassau on April 20 after 17 days, including six in the ICU.

She was ecstatic when she was discharged and returned to the Oceanside home she shares with her boyfriend, Michael Miller, 46, and his mother. A month later, she said she’s “very depressed.”

Her breathing is improving, but the progress is achingly slow, Rifenbury said. A recent achievement was walking up and down the driveway three times, and then down two houses to the corner and back. The exertion left her winded.

“My lungs are still messed up,” she said.

Rifenbury said some family and friends don’t call her as often. She thinks they’re afraid of her.

“I feel like I have leprosy,” said Rifenbury, who, after her doctor told her May 19 she was no longer contagious, finally was able to hug Miller.

Dr. Frank Coletta, the chief of critical care medicine at South Nassau, said even though Rifenbury is gradually getting better, “When you wake up every day and don’t see a lot of improvement, you get frustrated.”

Rifenbury illustrates how devastating COVID-19 can be to the lungs.

Most people with non-COVID-19 pneumonia regain full function of their lungs, Coletta said. COVID-19 is too new a disease to know the long-term prognosis of patients like Rifenbury, but, Coletta said, “The expectation is these patients will have a much tougher recovery down the road.”

Anthony Greco, 53, a retired NYPD officer who spent 61 days at South Nassau and The Mount Sinai Hospital in Manhattan, has, like Rifenbury, an unclear path ahead, Coletta said.

Doctors had to remove one-sixth of his right lung because it was infected and inflamed. "We’ll expect some decrease in lung function just from that,” Coletta said.

Greco, a member of the Wantagh school district board, felt sick March 11 and teetered back and forth between mild and more severe symptoms until “I couldn’t breathe. Then I knew I was in big trouble.”

Still, he was able to walk to the car that his wife, Elizabeth Greco, 54, drove to South Nassau. She dropped him off at 11 a.m. on March 21, expecting to take him home within two days. Instead, two hours later she got a phone call that his condition dramatically worsened and he was being put on a ventilator. Doctors told Elizabeth Greco he may not make it through the night.

The disease is maddeningly unpredictable, said Coletta, who has seen patients he thought would recover suddenly deteriorate and die.

Greco beat the odds.

“My voice is still not back,” he said from his hospital bed May18, hoarse because his vocal cords are still recovering from the strain of having an endotracheal tube between them. “But my breathing’s getting better.”

Two days later, he was discharged to the rapturous applause of dozens of members of his extended family and hospital employees.

Elizabeth Greco, barred from visiting her husband in the hospital, said a day later that she was “over the moon” as she hugged him.

“He’s a real, real miracle,” she said.

Number of ventilators tripled

To handle the influx of patients like Greco with severe respiratory problems, South Nassau had to more than triple the number of ventilators it had, from 40 to 128.

Iris Halem, the respiratory manager, pointed to more than two dozen ventilators that sat wrapped in plastic, temporarily not needed post-surge.

“I’m going to keep everything until we get a vaccine,” she said.

Early studies concluded that most COVID-19 patients placed on ventilators died, but more recent studies, and reports from hospitals, indicate that most survive. 

Halem oversees respiratory therapists, who are critical to keeping COVID-19 patients alive, and had to scramble to find more as the number of cases at the hospital increased rapidly. Some came from out of state. Most have returned home. She said she’s ready to redeploy them if there’s a resurgence in cases. 

The hospital has other plans in place in case there is a second wave of cases, which some epidemiologists are predicting for the fall, Coletta said. It has a 90-day supply of machinery, personal protective equipment for employees and other resources, he said. Four tents erected to handle the first surge remain standing outside the hospital.

Hospital staff regularly talk of their fears of a new wave of infections, Coletta said.

“The concern is complacency,” he said. “If everyone thinks this is all over and they can resume the prior activities they did, including not social distancing, that’s a recipe for disaster.”

The hospital “got to the precipice” during the April peak, and if there had been a few dozen more cases, it “would have broken us,” Sharma said.

Dr. Joshua Kugler, chair of emergency medicine at the hospital, said that during the height of the crisis the emergency room was unable to separate COVID-19 and non-COVID-19 patients because people with COVID-19 overwhelmed the area, with beds in the hallways and seemingly every corner. Patients were tested, but it often took a week to get results.

Now, tests of ER patients are sent to an on-site lab, rather than to Manhattan or out of state, and results come back in one to two hours, he said. The emergency room separates those with the virus from those who test negative, with people awaiting test results in another area, wearing masks and staying at least 6 feet apart, he said.

On May 18, only seven of 40 ER patients were confirmed or suspected COVID-19 cases, Kugler said. They were isolated.

“We’re trying to reintroduce the principle that the hospital is a safe place to be seen,” he said.

Yet many people who need help avoid the emergency room, fearful they will contract the virus, he said.

Emergency room physician Dr. Musa Khan gestured toward an 86-year-old woman who had been complaining about pain for four days for what turned out to be a dislocated shoulder. Family members feared she would be exposed to the coronavirus in the emergency room, so they iced her shoulder and gave her Tylenol, finally calling an ambulance May 18 after her bruising and swelling got worse, Khan said.

Later that Monday, a young man arrived in the emergency room with a gash in his thigh from accidentally stabbing himself with garden shears.

“The patient’s wife was very worried about him coming to the hospital” because of coronavirus fears, said Oceanside Fire Department paramedic Ross Feinman, who assured her he’d be safe.

Sharma said “this is the best time” for a non-COVID-19 patient to seek hospital care, before the number of COVID-19 cases potentially begins to rise again. He believes that a number of Long Islanders likely died of non-COVID-19 causes because they feared going to the hospital.

In addition, the state’s two-month-old ban on elective surgeries — which Gov. Andrew M. Cuomo lifted for Nassau County on May 19, three days after he did so for Suffolk — caused delays in needed treatment, Sharma said. Cuomo stopped elective surgeries to ensure there were enough beds for COVID-19 patients.

Ban caused delays in treatments

In March, Dr. Jason Freeman, South Nassau's director of interventional cardiology, removed a 99% blockage in the main artery to the bottom of the heart of Helen Montano, 66, of Lynbrook. He saw during that procedure that another artery had an 85% blockage, but didn’t believe the elective surgery ban allowed him to remove it as soon as he had wanted. Once Montano reported cardiac symptoms like shortness of breath, he scheduled the procedure.

Montano said May 18 as she rested after the successful procedure that the delay caused her to have “a lot of anxiety that it was going to get worse.”

Dr. Rajiv Datta, the chairman of surgery, said that, until the number of COVID-19 patients declined, he avoided all but the most urgent surgeries because finding a COVID-free path through the hospital to the operating room “was very difficult.”

In addition, he said, "We had no space, no staff, nothing. Four weeks ago, we were in such a dire state."

A surgery Datta performed May 19 to remove a growth from the neck of Roderick Middleton, 26, of Jamaica, Queens, was weeks later than it would have been, he said. The growth turned out to be a nonmalignant cyst, but Datta said there had been a small chance it had been cancer.

All surgery patients are tested for COVID-19, and Middleton tested negative, but, even so, everyone in the operating room donned an N95 mask.

Throughout the hospital, extra precautions have become routine, because some patients who test negative have later been found to be positive. In the heart catherization area, some recovery beds are not used, “just to err on the side of caution,” so there is social distancing between patients, nurse Debbie Giannitsis said.

The hospital has taken a big financial hit from the COVID-19 crisis, losing $10.4 million between March 13 and April 30, chief financial officer John Pohlman said.

The resumption of elective surgeries, which generally earn more money for the hospital than COVID-19 treatment, will help stem the losses, said Richard Murphy, president and CEO of South Nassau. Nearly 1,200 operations were deferred because of the elective-surgery ban, he said.

Still, with the number of patients much lower than normal, the hospital expects to lose $12 million to $15 million a month in May, June and July, Pohlman said.

The hospital has received $75.1 million in federal stimulus money, he said. It is unclear whether the money will be enough to cover losses, hospital officials said.

Pace becomes less hectic

With the drop in patients, the pace of work for many employees has become less hectic. The double shifts and working for weeks with no day off are largely over. Yet that has given some employees more time to reflect on the horrors of COVID-19 they have witnessed.

DeMelis said during the peak of cases, “I was moving so fast, I didn’t have time to think.” Now, “All the thoughts are coming at me,” and she often has trouble sleeping.

In addition, employees have been stressed out by the fear of infecting family members, said Janet Kahn-Scolaro, administrative director at South Nassau and a therapist. Of 629 South Nassau employees tested for the coronavirus, 224 tested positive, and three died of COVID-19, hospital officials said.

Some employees will develop post-traumatic stress disorder, Kahn-Scolaro predicted.

The hospital created a 24-hour hotline — staffed by licensed therapists — for employees and the public to help them deal with the emotional impact of the COVID-19 crisis.

Some employees did not want to bring home to loved ones what “we suffered through for weeks at a time that no one in health care has ever experienced,” said Rita Regan, vice president for quality and care management.

“I mean, what’s your husband going to say to you?: 'How was your day?' ” she asked. “What’s the answer to that? You can’t possibly tell your family what your day was like, and it almost felt like you were shutting down. But you didn’t want to relive it, and you didn’t even want to take the time to think about what you had just gone through.”

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