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How a Hospital Staff is Coping on the Front Lines of COVID-19

Masks and ventilators in short supply, but patients keep coming

Dr. Teresa Amato, chair of emergency medicine, Cheryl Thomas and Sasha Marsh, emergency department clerks and Kalsang Dickey, emergency department nurse, in the Emergency Department of Long Island Jewish Forest Hills Hospital, one of Northwell Health's 23

Courtesy, Northwell Health

En español | Three huge, white tents pitched in the parking lot of Stony Brook University Hospital make the COVID-19 pandemic sadly real to Carol Gomes, who runs the 624-bed hospital at the tip of Long Island.

“This is a M.A.S.H. unit situation,” says Gomes, referring to mobile Army surgical hospitals made famous in the movie and TV show. Gomes is president and CEO of Stony Brook, which as of April 2 was treating 200 COVID-positive patients and another 200 who are suspected of having it. “The number of patients requiring intubation and ventilators is escalating."

In the midst of this crisis, U.S. hospitals are demonstrating creativity and innovation as they confront their biggest challenge ever in the novel coronavirus, which is sapping limited resources, doctors and nurses and taxing their capacity to treat continuing patient surges.

Varying estimates say the peak of the pandemic will hit New York in seven to 21 days as more patients continue to succumb, Gomes said in a March 31 teleconference. And it's going to get more difficult. The state's governor, Andrew Cuomo, announced that hospitals need to double their current number of beds to meet surging patient demand. Gomes told CNBC that Stony Brook would need to expand its supply of intensive care unit beds to 235 from 65. “There's no doubt we're being stretched,” she said.

Gomes said it's vital to support hospital staff. "Every day they come in to take care of patients in an untenable situation, then go home to family members, sick children or elderly parents,” she said, overwhelmed by their selflessness. “The support these teams give to each other makes me appreciate how extraordinary they are, not just for their patients, but for each other. I will never be able to shake this feeling of pride I have in them."

The heart of the storm

The Empire State is currently the pandemic's epicenter, reporting more cases and deaths than any other state. On April 2, Cuomo confirmed 8,669 additional cases, for a statewide total of 92,381 and more than 2,500 deaths.

"We're in an unthinkable place with no control over our supply variability, so we have to take control and be creative,” said Gomes, citing hospital efforts to stretch the diminishing supply of N95 respiratory masks by disinfecting them with hydrogen peroxide.

Gomes said hospital staff members have shown their resourcefulness and resilience in the face of equipment and supply shortages. University chemists created a sanitizer the hospital is using. Staff developed bed shields and replacement parts for ventilators, using extension tubing to retrofit ventilators so they can be used by more than one patient at a time.

Nearby residents are donating goods and equipment, and stitching groups are making facial masks. “Right now it's about flexibility and adaptability,” Gomes said.

Northwell Health, headquartered on Long Island, is New York's largest health care system. Rheumatologist Mark Jarrett, senior vice president and chief quality officer for the 23-hospital group, said that as of April 1, Northwell was treating 2,500 COVID-19 patients, 23 percent of whom now require ventilators to breathe. He said the system is reporting an average of 30 deaths daily.

“Some patients walk into our emergency department and their oxygen levels drop precipitously and they are on ventilators within two to three hours,” said Jarrett, 70. “Our intensive care units are outstripped. We've effectively made whole units serving only COVID-positive patients. We don't have enough ICU nurses and intensivists, so now we have one ICU nurse assisted by two to three other nurses.”

"Northwell survived 9/11 and H1N1 and hurricanes and snowstorms,” Jarrett said. “We're good at this. We were prepared. But we never realized it could get this bad.”

He said hospital staff learned they can extend or reuse the N95 masks under CDC guidelines and said some hospitals have repurposed unused anesthesia machines as ventilators.

"They work, but must be turned off part of the day because, unlike ventilators, they were not designed to run continuously and need anesthesiologists to manage their care."

Northwell suspended its inpatient elective surgeries — the lifeblood of hospital revenue — and shut down many of its 800 offsite outpatient centers, redirecting the doctors, nurses and staff to main hospital areas where they're needed most. Jarrett said communication with staff, state and local public health agencies and the outside community is vital.

Jarrett said hospitals must also plan for the sad fact that many of their staff members will become ill and some may die.

"We've already lost one of our staff,” he said. “It's important to have your employee assistance program and behavioral health teams providing support. Our doctors and nurses are not only losing patients, but family members, friends and colleagues.”

Though Jarrett is realistic about the impact of the disease and the lives it will claim, he said there is good news: “Early on we had to furlough staff because they contracted the disease, but many are now coming back to work. It's also important for our staff to see people recover. It gives them purpose and hope."

Arizona bracing for the plague

Claudette Rodriguez in Scottsdale, Arizona, said it feels like the calm before the storm. Rodriguez, an emergency medicine specialist with the five-hospital HonorHealth System, said the pandemic isn't expected to peak there until late April.

"We know it's coming and have been planning for it,” said Rodriguez, 44, an ER physician for 13 years. But her hospital is not overloaded yet.

"The unknown is what's so scary and creepy to us,” she said. “The women in our ER group started a private chat text to support each other and help us deal with this.”

Eugene Litvak, president of the Institute for Healthcare Optimization outside Boston, said hospitals have demonstrated great creativity and resourcefulness and would like to see a website established where medical professionals could share what works and what doesn't.

Litvak, 70, also advised hospitals to separate their patients based on infection status, age and severity of their conditions, which would help hospitals deliver the appropriate care in the right setting and improve their efficiency, capacity and patient outcomes.

This is wartime, said Litvak: “We need statewide central commands, appointing someone with the authority to oversee and reallocate resources to benefit all.”

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