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The impact was made worse because the city went into the pandemic less prepared than it could have been. The city hospital system has long been considered underfunded. Private hospitals in the outer boroughs, particularly Queens, had closed over the years. New York hospitals had long ignored alarms raised by the nurses’ union and respiratory therapists about insufficient staffing levels, according to nurses and respiratory therapists at several city hospitals.
A contributing factor was New York leaders’ delayed reaction. Early signs of the virus’s arrival—including a rise in patients with flulike symptoms visiting hospitals—went largely uninvestigated by hospital, state and city officials. The city health department was limiting testing primarily to travelers from China, following the federal government’s lead. Throughout February in calls with hospitals, the city health department played down the possibility that the virus could spread through the air or by asymptomatic people.
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While leaders in states like California and Ohio acted quickly to contain the spread, Messrs. Cuomo and de Blasio delayed taking measures to close the state and city even as the number of cases swelled, despite warnings from doctors, nurses and schoolteachers. California issued a statewide lockdown with 1,005 cases as of March 19, while New York remained open with 5,704 cases, according to updated Johns Hopkins data.
Even after New York announced its first coronavirus case on March 1, the city health department was advising New Yorkers they were more likely to get the flu. “I speak for the mayor also on this one—we think we have the best health-care system on the planet,” Mr. Cuomo said at a March 2 news conference.
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Among the missteps that would make matters worse after mid-March, health-care workers said, was that government officials and hospital administrators failed to create adequate plans to provide the needed staff as they expanded beds into operating theaters, old auditoriums and lobbies.
“Creating beds isn’t the most difficult thing,” said Northwell CEO Michael Dowling. “The issues that get complicated with the creation of beds is the staffing. This isn’t like you can put any staff on any bed at any place.”
The crisis would eventually peak at nearly 19,000 hospitalizations, but even that number overloaded the system.
As Covid-19 patients flooded into NewYork-Presbyterian/Columbia, the private hospital created new pop-up ICUs. The inadequacy of staffing levels quickly became clear in one operating-room-turned-ICU, according to medical staff there and emails residents sent attending physicians. Garbage in the makeshift 80-bed unit overflowed with contaminated needles, masks and gowns. Urine and blood stains were at times found on the ground and equipment, according to the workers and emails.
“The scope of patient needs compared with the training and resources available presented an absolute crisis,” said Julia Symborski, a nurse who worked in the new ICU. “You can magically make an ICU appear, but you can’t make staff appear immediately.”
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In the new operating-room ICU at NewYork-Presbyterian/Columbia, one respiratory therapist at times cared for over 80 patients a shift, according to workers and emails; seeing about 10 a shift is typical in normal times, respiratory therapists said. Overworked staffers there weren’t able to suction mucus out of patients’ lungs often enough, resulting in patient complications, according to the workers and emails. Intubated patients’ lips were bleeding and many developed sores on their backs, called pressure ulcers, from not being turned enough.
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Joji Thadathil, a Health + Hospitals Elmhurst respiratory therapist, estimated that more staffing and better equipment could have saved 30% to 40% of Covid-19 patients who died there. Rio Flores, a respiratory therapist, said he documented 50 patients who died in part due to improper ventilator settings by untrained staff and state-provided ventilators with limited functionality at the NewYork-Presbyterian system’s Lower Manhattan hospital.
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The article goes on to detail lack of supplies - not ventilators (although the ventilators that were delivered weren’t reliable), more the other supplies, including oxygen.
Also discussed at length were how “squabble” between the city and state government prevented patient transfers so some hospital beds were open while other hospitals were overrun. Then when patients were transferred, their medical records weren’t transferred, impacting their treatment and care.
Another issue was housing infected patients with suspected infections and others, which seeded and spread infection. It didn’t help that New York City, state government and hospital officials, often relying on CDC guidance, kept shifting guidelines about when sick and exposed front-line workers should return to work—and didn’t plan for thorough staff testing. Initially, the government and hospital officials recommended health-care workers with high-risk exposures quarantine for 14 days.
Then the city on March 17 changed its guidance, recommending hospitals tell such workers they could keep working so long as they didn’t show symptoms. Montefiore Medical Center passed that guidance along to workers in a March 18 memo. Some health-care workers there said they took that as an instruction to stay on the job.
The city’s guidance on testing further confused matters: “DO NOT TEST asymptomatic and/or exposed” workers, read a March 20 city memo to hospitals, citing supply shortages.
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The final point of the article discusses the lack of PPE.
Scott Amrhein, a trade-association executive who helped procure PPE for nursing-home workers, became so distraught about the shortage of protective gear, among other issues nursing homes faced, that he died by suicide March 30, his son said. His father, he said, felt government officials had ignored him and the situation was getting worse for nursing homes, which were also now taking in Covid patients from overloaded hospitals.
Mr. Amrhein was fielding hundreds of calls daily in late March from nursing homes and hadn’t slept in weeks, said his son, Justin Amrhein. In emails to his friends and colleagues, the father said he didn’t know how to slow the building disaster.
