NYC Hospital Workers, Knowing How Bad It Can Get, Brace for COVID 2nd Wave

5 years ago

No single municipality in the country suffered more in the first wave of the pandemic than New York City, which saw more than 24,000 deaths, mainly in the spring. Medical staff in New York know precisely how difficult and dangerous overwhelmed hospitals can be and are braced warily as infections begin to rise again.听

Around the New York metropolitan area, public health leaders and health care workers say they鈥檙e watching the trend lines, as intensive care units fill up in other parts of the United States and around the world. They say it gives them flashbacks to last spring, when ambulance sirens were omnipresent and the region was the country鈥檚 coronavirus epicenter.

There is wide agreement that hospitals and care providers are in much better shape now than then, because there is much more knowledge about the disease and how to handle it; much larger stockpiles of personal protective equipment; and much, much more widespread testing.

But at the same time, many front-line workers are nervous about hospital preparedness, and many observers are less bullish about the effectiveness of the coronavirus testing and tracing infrastructure.

鈥淚 think there鈥檚 a lot of anxiety about doing this a second time,鈥� said Dr. Laura Iavicoli, head of emergency preparedness for NYC Health + Hospitals, the country鈥檚 largest municipal hospital system. Iavicoli is also an active emergency room physician at Elmhurst Hospital, in Queens, which came to be called 鈥渢he epicenter of the epicenter鈥� back in April. Still, she has enormous confidence in the staff of the municipal hospital system.

鈥淭hey will rally, because I know them,鈥� she said. 鈥淚鈥檝e worked with them for 20 years, and they鈥檙e the most amazing people I can possibly speak of, but there鈥檚 anxiety and there鈥檚 COVID fatigue.鈥�

Iavicoli said some of the city鈥檚 hospitals are at capacity, but she hastened to add that she鈥檚 not talking about 鈥淐OVID capacity鈥� 鈥� meaning not all the beds and recently reconfigured spillover spaces for COVID patients are full. Rather, she said, two of the network鈥檚 11 hospitals have had to transfer ICU patients to others to make room for incoming patients.

鈥淲e are doing a little bit of redistributing around the system to give them COVID capacity, but it鈥檚 very manageable within the system,鈥� Iavicoli said. 鈥淭he increase is definitely typical in flu season, but knowing that we have just entered upon the second wave [of COVID-19] and predicting what is to come, we鈥檙e a little even more cognizant than normal to make sure we leave capacity in all of our facilities.鈥�

Many nurses, however, say hospital administrators have not learned enough from the experience in March and April.

鈥淲e鈥檙e scared because we鈥檙e afraid we鈥檙e going to have to go through this again,鈥� said Michelle Gonzalez, a critical care nurse at Montefiore Medical Center, in the Bronx, and a union representative for NYSNA, the New York State Nurses Association.

She said that in her unit nurses typically handle one or two intensive care unit patients at a time 鈥� but now have to handle three, with the number of COVID patients creeping up once again. Tending to four patients or more was common at the peak of the pandemic surge. Gonzalez said that鈥檚 overwhelming. If one patient crashes, several nurses need to converge at once, leaving other patients unmonitored.听听听

鈥淲hen we start to get triples with the frequency we鈥檙e seeing right now, we know it鈥檚 because we鈥檙e short-staffed, and they鈥檙e not getting ICU nurses into the building,鈥� she said at a demonstration that featured a phalanx of nurses marching from Montefiore to a nearby cemetery, bearing floral wreaths for fallen comrades, while a band and bagpiper played 鈥淲hen the Saints Go Marching In鈥� and 鈥淎mazing Grace.鈥�

A spokesperson for the union said Montefiore, by its own reckoning, has 476 vacant nursing positions 鈥� a number that has climbed by nearly 100 since 2019.

Nurses at Montefiore Medical Center, represented by the New York State Nurses Association, protest what they say is a staff shortage at several of the network鈥檚 hospitals in the Bronx and nearby suburbs on Nov. 19, 2020.(贵谤别诲听惭辞驳耻濒/奥狈驰颁)

鈥淢anagement is not living up to their promise to fill vacancies and hire nurses,鈥� said Kristi Barnes, from NYSNA. 鈥淎s of last week, they have 188 full-time nursing jobs they have not even posted, so there is no way they can be filled.鈥澨�

The Montefiore administration disagrees.

鈥淲e have a contractual agreement with the union, and we meet the contractual obligations of that agreement,鈥� said Peter Semczuk, senior vice president of operations. 鈥淲e tailor our staffing in such a flexible way to meet the needs of the patient.鈥�

Like many hospital systems, Montefiore relied heavily on temporary staffing agencies for 鈥渢raveling nurses鈥� from around the country. Hospitals are preparing to do so again 鈥� but there is demand all over the country.听

鈥淭hey got us travelers in April, but that was four or six weeks in, and until that we were on our own,鈥� said Kathy Santoiemma, who鈥檚 been a nurse at Montefiore New Rochelle for 43 years. 鈥淚 don鈥檛 even know where they鈥檙e going to get travelers now 鈥� everyone around the whole country needs travelers.鈥�

NYSNA led a on Tuesday, after contract negotiations in the works for two years stalled on Monday.

Iavicoli said each of her network鈥檚 facilities has submitted requests, so that NYC Health + Hospitals could place a preliminary order now.

Health planners are hoping New Yorkers won鈥檛 flood into emergency rooms this time. They point to the over the past two months compared with other areas, including and. One thing they hope will keep the curve relatively flat is testing, which is more pervasive in New York than. About 200,000 people across New York state are getting tested each day, roughly one-third of them in New York City.

鈥淚t鈥檚 the first step to actually interrupting further spread,鈥� said Dr. Dave Chokshi, the city health commissioner.

He said mass testing works on two levels 鈥� by highlighting which areas are hot zones, so health workers can target residents with 鈥渉yper-local鈥� messages about COVID-19 spread, to get them to change their behavior, and also by allowing contact tracers to communicate individually with newly infected people.

鈥淥nce someone tests positive, we very quickly help them isolate,鈥� Chokshi said. 鈥淲e do an interview with them to know who their close contacts are, and then we call those contacts and make sure they鈥檙e quarantining as well.鈥�

However, the city鈥檚 contact-tracing program has had a mixed record. The people it reaches say they鈥檙e staying put 鈥� but share names of people they might have exposed. Denis Nash, an epidemiologist who previously worked for the city鈥檚 Department of Health and Mental Hygiene and the Centers for Disease Control and Prevention, said the city hasn鈥檛 successfully drilled down into how the coronavirus actually spreads, because contact tracers aren鈥檛 asking people enough questions about their behaviors and possible exposures.

鈥�During the summer and early fall, when things were slowly ramping up, there were missed opportunities to use contact tracing to talk to 80 or 90% of all newly diagnosed people, to understand what their risk factors were and what kinds of things 鈥� were they exposed to that could have potentially resulted in them getting the virus,鈥� he said. 鈥淵ou can never know with 100% certainty [where they contracted the virus], but if you ask these questions, you could begin to understand what some likely patterns were 鈥� for example, of public transportation use, or working in office buildings that didn鈥檛 have rigorous safety protocols, or indoor dining.鈥�

This knowledge, though imperfect, could lead to better informed public policy decisions, Nash said, about whether to close indoor restaurants, beauty salons or fitness centers. Without that data, leaders are just making guesses.

Others fault the city鈥檚 testing and tracing program for not reaching out enough to poor communities of color 鈥� which suffered disproportionately during the first COVID wave. Chokshi, the health commissioner, said getting testing sites to these neighborhoods has been a priority 鈥� but suggested it鈥檚 not working as well as the city intended.

鈥淭here鈥檚 clearly a disparity in providing widespread testing across New York City,鈥� said Wil Lieberman-Cribbin, a graduate student and environmental health researcher at Columbia University.

He looked at how many people are getting tested, by neighborhood, and correlated those figures with race, income level and COVID positivity. In wealthier areas, people are getting many more tests and have much less illness. In poorer ones, people are getting many fewer tests and are much sicker. More testing in those areas would pick up cases sooner, before people develop symptoms.

鈥淭esting is really, really needed, not only to protect the most vulnerable, but to collectively try and get a handle on COVID and reopen New York City,鈥� Lieberman-Cribbin said.

Personal protective equipment, or PPE, is also much more ample than it was last spring but, similarly, remains a source of contention.

New York state health authorities are requiring hospitals to stockpile a 90-day supply of PPE; for nursing homes, it鈥檚 60 days鈥� worth. Many facilities have complied with September and October deadlines, but.

Montefiore, NYC Health + Hospitals, and other large hospital networks say they have at least that much, if not more.听听听听

Nurses, though, say they should be able to get fresh N95 masks each time they see a new patient, to limit the risk of contamination. Many administrators counter that isn鈥檛 feasible, given the precariousness of the supply chain. They note that permit 鈥渆xtended use鈥� of some PPE.

鈥淸Nurses and other caregivers] change their gloves between every patient, but they might wear the same N95 mask for one shift and put a surgical mask over it just to preserve it and only switch it out if there鈥檚 some integrity issue or it gets contaminated,鈥� said Iavicoli, of the city hospital system. 鈥淏ut definitely at the next shift, they鈥檙e getting a new one.鈥�

Iavicoli acknowledged the challenges as the pandemic rolls on and said there are four kinds of days: 鈥渂lue skies, or normal,鈥� 鈥渂usier than normal,鈥� 鈥渁 little stretched鈥� and 鈥渆xtremely stretched.鈥澨�

鈥淚 think we鈥檙e at the top end of 鈥榖usy normal鈥� bordering on 鈥榓 little more than overstretched,鈥欌€� said Iavicoli.

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