Yves here. This article makes explicit something that’s not hard to infer from coverage of Covid strain on hospitals: in the first wave, the limiting factor was physical capacity, in particular beds. Now the constraint more often is manning…which is harder to measure well and can be stretched in the short term.
By Greg B. Smtih (email@example.com). Originally published at THE CITY on December 29, 2021
With hospitalizations for COVID patients rising rapidly, the number of available beds at several city-run hospitals has dropped to levels that could trigger a suspension of elective surgeries.
The state Department of Health has the power to impose this restriction on hospitals with low numbers of available beds in regions experiencing a high rate of COVID hospitalizations. Areas averaging more than 4 new COVID patients per 100,000 population each day over a seven-day average trigger the department’s potential intervention.
On Sunday New York City passed that threshold, with the average number of new patients with COVID entering city hospitals hitting 4.76 per 100,000 over the previous seven days, according to the city Department of Health and Mental Hygiene.
On Monday, that rate rose even higher to 5.48 new COVID patients per 100,000, city data show. Both are well above the 4 new patients per 100,000 cutoff.
The state Health Department told THE CITY on Wednesday that so far the influx of COVID patients has not yet triggered the imposition of an elective surgery suspension.
Agency spokesperson Erin Silk wrote in an emailed response, “New York City does not currently meet either of the gate criteria to be included in the elective surgery guidance.” She did not specify those criteria.
On Tuesday, Mayor Bill de Blasio mentioned the 4.76 rate from Sunday but did not mention the newer data. He conceded that the rate was “very high,” but insisted that hospitals within New York City have the situation under control.“Thank God, because of all the actions that have been taken, all the vaccination, our hospitals are handling the situation well,” he said.
Health care workers see the situation as more dire.
On Wednesday, nursing union officials expressed concerns that with the rising number of COVID hospitalizations, staffing has again reached inadequate levels reminiscent of spring 2020, when health care workers struggled with overwhelming COVID patient caseloads.
“What good is a physical hospital bed if there is not a nurse to take care of the patient occupying that bed?” said Pat Kane, an RN and director of the New York State Nurses Association.
“At a time when COVID-19 cases are skyrocketing and our health care system is once again coming under enormous strain due to the highly transmissible Omicron variant, health systems and policymakers should meet the challenge by staffing safely and protecting the frontlines.”
Kane said the union is “very concerned that federal and state agencies and hospital administrators are instead cutting corners on staffing levels, infection control, and other health and safety measures exactly when we need to protect health care workers and our patients the most.”
The patient squeeze appears to be hitting public hospitals the hardest.
The seven-day average bed capacity data for Tuesday show overall, New York City hospitals reported 26% of beds available. In contrast, five of the 11 hospitals run by the city’s Health and Hospitals Corporation register bed availability rates of 15% or lower, state figures show.
Over the last few days, several public hospitals have reported bed availability at or below 10% — the level Gov. Kathy Hochul Wednesday labeled “the danger zone.”
The most recent single-day figures suggest the situation is growing more urgent.
On Tuesday, Coney Island Hospital in Brooklyn dropped to the 7% mark, while Kings County in Brooklyn reported a 9% open bed capacity. That same day Elmhurst in Queens — one of the hardest-hit hospitals when the pandemic first arrived in spring 2020 — hit the “danger zone” mark of 10%.
The state hospital capacity data does not make a distinction between COVID and non-COVID patients — but federal stats suggest COVID’s growing role. U.S. Centers for Disease Control reporting for the week ending Dec. 26 show 11% of all hospital beds in Brooklyn and Queens occupied by COVID patients, 8% in The Bronx and Staten Island and 7% in Manhattan.
As of Tuesday, 3,178 people were hospitalized with COVID in New York City, according to the state health department — up from about 1,000 in mid-December.
HHC spokesperson Stephanie Guzmán said the agency is ready to rearrange staffing and add beds if required.
“We’re expediting safe discharges and utilizing our level-loading to ensure capacity is manageable by the second,” she wrote in an email. “Additionally, we’re prepared to scale up necessary capacity on an ongoing basis, which we haven’t had to do just yet.”
Guzmán said that the 10% capacity standard “is of current beds as they’re equipped. As a reminder, we tripled ICU capacity in the early days of the pandemic and have mechanisms to flip that switch even faster two years into the pandemic.”
Michael Lanza, a spokesman for the city Department of Health and Mental Hygiene, said the agency “supports the State’s efforts to preserve hospital capacity for serious illness, particularly those with severe COVID-19.”
The department is working with the Greater New York Hospital Association to coordinate efforts across all city hospitals “to provide support as we collectively work to end this wave,” Lanza added.
Short on Gear
Hospitals are also grappling with a state requirement to keep at least a 60-day supply of personal protective equipment (PPE) on hand.
Hospitals must report their supply level to the department on the first Tuesday of each month. In November and so far this month, more than 20 hospitals reported being out of compliance with that rule, according to records obtained by THE CITY via Freedom of Information Law.
Two are in the city: The public Woodhull Hospital in East Williamsburg, and University Hospital of Brooklyn, part of the SUNY Downstate state-run hospital system.
Woodhull is also short on beds: On Monday, Woodhull reported a 7-day average of available beds of 10%.
Guzmán said because all 11 HHC hospitals operate under the same management, Woodhull can obtain whatever PPE it needs from a central storehouse serving all city-run medical centers.
“We function as a health system of 11 hospitals and utilize central stockpiles to ensure our healthcare workers have the proper PPE while on the job,” she said. “We remain within the state’s requirement.”
Dawn Skeete Factor, a spokesperson for SUNY Downstate, said, “One factor that may be contributing to the spike in hospitalization rates is the ease with which the Omicron variant spreads. A high percentage of patients admitted to hospitals in New York City for non-COVID related issues test positive for COVID. This result requires the same intensive response all COVID specific patients receive.”
The number of new COVID patients arriving daily in New York City hospitals is nowhere near what it was when the pandemic first peaked in the spring of 2020, when the 7-day average of new admissions hit 1,667 on April 4. After the city locked down, that number dropped precipitously, then rose again in the winter of 2020 with the arrival of the Delta variant to peak at 385 on Feb. 10.
This past Thanksgiving, city hospitals were averaging about 53 new COVID patients daily, but then came the arrival of the highly contagious Omicron variant. The hospital admission numbers have since dramatically risen, reaching a 7-day average of 332 as of Tuesday.
One pattern remains constant: People who are unvaccinated are about 10 times more likely to be hospitalized with COVID infections than people who are fully vaccinated.