Thousands of coronavirus patients threaten to overwhelm CNY hospitals; what needs to be done now

A helicopter is seen from a distance on the roof of Upstate University Hospital

Someone stands behind a helicopter that just landed on the roof of Upstate University Hospital Thursday morning, October 19, 2017.Michael Greenlar | mgreenlar@syracuse.com

Syracuse, N.Y. — No one knows exactly when it will hit or how big it will be, but a wave of novel coronavirus cases will almost certainly crash into Onondaga County hospitals over the next six months to a year.

“This is going to be bad,” said Brian Leydet, an epidemiology and infectious diseases professor at SUNY College of Environmental Science and Forestry. “We need to get beds and people available to take care of the critical patients we know are to come.”

The timing is uncertain, but the impact is inevitable, health officials say. Local hospitals are mobilizing for what could be thousands of patients sickened by the virus streaming in over a short period, threatening to overwhelm the number of beds and the staff to watch over them.

It’s not just beds and nurses: Ventilators, the expensive machines that can keep patients alive while their lungs recover from the assault of the virus, could be in such high demand that patients who have trouble breathing won’t get them.

Increasing this crucial hospital capacity has been an essential element of the public response to the pandemic. Gov. Andrew Cuomo has been sounding the alarm for more than a week, saying the state might need an additional 50,000 hospital beds to deal with the crisis.

But it’s unclear what the Syracuse authorities are doing to respond to the crisis. Two of Syracuse’s three hospitals, Upstate and Crouse, declined to answer questions for this story. County Executive Ryan McMahon’s daily briefings, unlike Cuomo’s, have offered no details on the problem, and the county did not make its emergency management director available for an interview.

So, it’s difficult to know what decisions are being made or delayed on the problem.

What we do know is that the number of confirmed cases of COVID-19, the illness caused by the virus, are skyrocketing in New York state. Confirmed cases have more than tripled since Sunday to more than 2,300, with most of those in New York City and Westchester County. The numbers are much smaller in Onondaga County, but the trajectory is similar: The county went from two to six confirmed cases in two days.

“We are still at the water’s edge, but things won’t stay the way they are,” said Ron Lagoe, executive director of the Hospital Executive Council, a Syracuse hospital planning group.

A 20% hospitalization rate

Even with the drastic measures already in place — closing schools and colleges, forcing people to work from home, isolating the sick — coronavirus cases are expected to far outstrip what hospitals can cope with.

No one knows how many people will get the coronavirus, but about 20% of them are likely to end up in the hospital, according to Cuomo. Extrapolating from his statewide projections, Onondaga County could need a 1,000 or more additional hospital beds to accommodate the biggest surge of virus cases.

Syracuse hospitals — Crouse, St. Joseph’s and Upstate’s two campuses — have about 1,800 licensed beds, according to a recent county Health Department report. That doesn’t mean all of those beds are in use, though. If there’s not enough staff to serve the patient, a bed sits empty.

More important, 400 to 600 of those new beds would need to be high-level “critical care” beds, equipped with ventilators and equipment to give medication intravenously. St. Joseph’s Health can provide 60 of those critical care beds now, and could work to provide more, the hospital’s emergency manager said. Upstate declined to discuss its response to the crisis, and Crouse did not return phone calls.

Those are beds just for patients with COVID-19; it doesn’t include people who need to be hospitalized for the flu, cancer and other diseases.

Here’s another analysis of the potential shortfall of beds: According to a Harvard University study reported on the news website ProPublica, nearly 70,000 people could be infected with coronavirus over the course of a year in what’s called the Syracuse referral area, which contains 1.1 million people in 11 counties. That assumes 8% of all adults will need hospitalization for an average of 12 days.

That scenario would especially overwhelm intensive care units. The study said the Syracuse referral area has about 77 ICU beds open at any given time, but would need 500 at the peak of the epidemic. Estimates by Lagoe and St. Joseph’s, relying on projections from a separate study, were similar to that.

Most beds already full

Syracuse-area hospitals generally don’t have a lot of empty beds, said Thomas Dennison, a former professor of public health at Syracuse University who has served on boards of several local health care groups.

“Our hospitals are often full,” Dennison said. “We have ambulances on rotation because intensive care is often full, and you have to be diverted to another hospital.”

Hospitals are already taking steps to free up beds for COVID-19 patients. Upstate and Crouse hospitals are canceling elective surgeries. That can free up 25% of hospital beds, Dennison said.

Another way to empty a hospital bed is to send patients to a lower level of care, such as a nursing home or home health care. Nascentia Health, the area’s largest home healthcare agency, is preparing to serve more patients, said Chief Clinical Officer Andrea Lazarek-LaQuay.

The company just bought 100 tablets so patients who don’t need constant care can have blood pressure and blood sugar levels monitored remotely, freeing up home health aides to check in on sicker people, Lazarek-LaQuay said.

If needed, St. Joseph’s can add second beds in most private emergency rooms, said Joseph Bick, the hospital’s head of emergency management and disaster preparedness. Of the 54 emergency rooms, 42 have a second head wall, which provides oxygen and other essential services.

“Anywhere we have one of those, we can put a stretcher or bed and have a modern hospital bed,” he said. While St. Joseph’s is not canceling elective surgeries yet, Bick said the hospital can increase its bed capacity by 25% with existing staff.

Cuomo estimates that the pandemic could start overwhelming hospitals in late April. While it’s not clear when that might happen in Central New York, Bick said hospitals will have weeks to prepare.

Hospitals can add beds, but can’t put patients in them unless there’s enough staff to care for them. There are a number of ways to increase staffing, including having existing nurses and other staff work longer hours. For patients moved from hospitals into lower levels of care, nurses could be diverted from non-essential programs, such as maternal and child health, Dennison said.

“You can also bring back retired nurses and physicians,” he said. Dennison said his wife, who is retired but still licensed to practice, has told St. Joseph’s she’s ready to come back if needed.

The other two hospitals have said little about their plans. Dr. Robert Corona, CEO of Upstate University Hospital, said Upstate is considering many options to expand capacity, but it’s premature to publicly disclose them. Crouse Hospital officials did not respond to requests for information about its plans.

Lack of ventilators

The biggest problem facing hospitals might not be beds, but a shortage of ventilators for the sickest patients whose lungs are overwhelmed by the virus. The Society of Critical Care Medicine projects that 960,000 coronavirus patients in the U.S. may need to be put on a ventilator, but the country has only 200,000.

New York would have enough respirators during a moderate pandemic, according to a 2015 state Department of Health report, the most recent figures available. In a severe pandemic, however, like the one that occurred in 1918, New York hospitals could have a shortfall of 16,000 ventilators, even with the 1,750 ventilators the state had stockpiled.

“In the event of an overwhelming burden on the health care system," the report said, "New York will not have sufficient ventilators to meet critical care needs despite its emergency stockpile.”

Bick said St. Joseph’s has enough ventilators for those 60 additional critical care beds, and is trying to get more, including some from the stockpiles.

“We have looked at purchasing more, and I know there have been in the past stockpiled ventilators for just this scenario,” he said.

President Trump has invoked a Korean War-era law to increase production of masks, ventilators and respirators. It’s not clear how many new ventilators could be made, or if they’ll be ready in time for the height of the epidemic.

Onondaga County emergency planners are also working on providing more beds and temporary hospital space should current hospitals get overwhelmed. County Executive Ryan McMahon said he did not anticipate any new construction, but the county could convert some facilities, which he did not name.

“We have plans under way for that right now,” McMahon said. “I think we know what we want to do. We just have to make sure they meet all the regs.”

During the H1N1 swine outbreak in 2009, public health officials considered diverting patients to the state fairgrounds. Fair Director Troy Waffner said he’s unaware of any state plans to use the fairgrounds as a site to respond to the pandemic.

After the World Trade Center terrorist attack on Sept. 11, 2001, plans were made to convert a fighter jet hangar at Hancock Field into a triage center in the event some of the casualties from the attack were sent here for medical care. That was never necessary.

Staff writers James Mulder and Tim Knauss contributed to this report

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