The move is part of Gov. Andrew M. Cuomo’s phased approach to reopening the state hit hardest by coronavirus, a small but important milestone in what is projected to be a deliberate and potentially months-long effort to restart the economy and restore a sense of normalcy.
As the virus spreads across the country, it has left a trail of anxious patients with serious medical conditions, thousands of furloughed clinicians, and hospitals facing deep financial trouble due to the abrupt cancellation of core surgeries and services deemed non-emergencies. Few places have felt those effects as acutely as New York, and it is hoped that the calculated resumption of elective surgeries, set to begin Tuesday, will light a path forward for other hard-hit areas where the rapid onset of covid-19 forced health-care providers to take similarly drastic action.
The approach outlined by Cuomo (D) will be limited to areas where the prevalence of covid-19 is reduced — “exactly what we would expect,” said Bill Prentice, chief executive of the national Ambulatory Surgery Center Association. The governor’s plan, he added, “mirrors what the federal government and other states have been saying recently: We can’t continue to delay and postpone these surgeries further.”
Cuomo told reporters this week the state will permit elective outpatient treatments in areas where “hospitals are laying off people because they are so quiet.” Those hospitals must meet strict criteria. Procedures can return if, within the previous 10 days, there were fewer than 10 hospitalizations in the county due to covid-19. Available bed capacity must remain above 25 percent.
Many New York medical centers will not meet that threshold. As of Thursday, the state had tallied more than 260,000 confirmed cases, and the proportion of infected New Yorkers has exceeded 1 in 100.
But cases are spread unevenly across the state, clustering in the densely populated southeast — in Long Island, New York City and surrounding counties — which accounts for more than 90 percent of the state’s hospitalized cases. New York’s largest hospital system, Northwell Health, remains a “covid enterprise, to a large extent,” said chief executive Michael Dowling, with about 2,400 covid-19 patients currently being treated in its facilities. That is a decline of about one-third from the crisis’s apex.
Elective surgeries will not yet return to Northwell, whose network of 23 hospitals dot the greater New York City region and Long Island.
“At this pace, it is not expected the governor will allow downstate hospitals to resume elective surgeries until sometime next month at the earliest,” Northwell spokesman Terry Lynam said.
The picture is markedly different upstate, however. Cayuga Health, one of the largest hospital systems in New York’s Finger Lakes region, this week convened an “internal planning team to begin the process of preparing to resume elective surgery,” said spokesman John Turner. Locations that meet the reopening criteria include Cayuga Medical Center in Ithaca and Schuyler Hospital in Montour Falls, he said.
This type of limited reopening “does make sense,” said Jeanine Santelli, the executive director of the American Nurses Association-New York. In some places, she said, “moms are being encouraged to deliver at home.”
Restarting elective treatments would offer work to furloughed nurses and other hospital staff and provide funds to cash-strapped hospitals. “Even though there is such an almighty need downstate, nurses are getting laid off upstate,” Santelli said. “It is such a different world.” The procedures that have “been turned off for safety reasons” would normally fund “hardcore, heavy-duty high-level inpatient care,” she said — like what’s required for coronavirus patients.
Northwell and other large hospital systems in New York have lost on the order of $350 million per month since the coronavirus wave came through. “People will be tightening their belts,” Dowling said. “When you are in a situation losing the money we’re losing, you look at every opportunity to tighten and tighten.”
Extensive surgical procedures will return slowly. A clinician at a tertiary hospital in Manhattan, who spoke on the condition of anonymity to discuss internal plans, said that while the general surgical unit was starting to make preparations for patients without covid-19, the transplant unit would likely be one of the last to come back online.
Federal officials described phased steps of resuming non-emergency surgeries in guidelines released this week. In New York, only outpatient procedures — in which patients are well enough to enter and exit the medical center in a single day — are allowed to return, Cuomo said, to ensure that hospitals keep beds open should coronavirus cases surge in their areas.
“If you have a hernia, and you’re in intense pain, eventually you will want that fixed,” said Prentice, with the Ambulatory Surgery Center Association. “If you have blood in your stool, you are going to want that colonoscopy.”
Exactly what procedures the state will allow, though, is not yet explicit. “Guidance on resuming elective outpatient treatments is forthcoming," said New York State Department of Health spokesman Jonah Bruno.
Patients should consider how the risk of acquiring a coronavirus infection “squares with whatever the treatment is,” said New Jersey patient advocate AnnMarie McIlwain, chief executive of Patient Advocators. “Life is a series of trade-offs, and covid just ups the bar here.”
For patients who need chemotherapy in the Tri-State area, “maybe you don’t need to see doctors at Sloan Kettering,” the cancer treatment center in Manhattan, McIlwain said. “I’d send you to New Jersey or Connecticut.”
Santelli’s cautionary advice to patients seeking elective treatments would be to ask whether the medical facility has sufficient personal protective equipment. “And I wouldn’t ask the administration,” she said. “I’d ask the person doing my intake interview.”
“We are being told that there is enough PPE, but I’m still hearing about nurses who have not been given the PPE they should safely have,” Santelli said.
Hospital recovery comes with a host of questions, Dowling said. “What kind of surgery do you do first? Is it cardiac? Is it orthopedics? Is it general surgery? . . . Will you have the staff that are not deployed elsewhere? Do you test the patients as they come in? . . . How do you communicate to the public that it’s okay to come back?"
Santelli, Dowling and other health experts emphasized that hospitals can be safely sanitized. “It is very easy to be able to convert from a covid place to non-covid place,” Dowling said. As cases surged, Northwell placed patient beds in lobbies, cafeterias and conference rooms; those locations have since been disinfected, and “we’ve had numerous meetings” there, Dowling said.
Physician Arthur Fougner, president of the Medical Society of the State of New York, likened the “terminal cleaning” of hospitals to the process in “Pulp Fiction” by which a fixer, played by Harvey Keitel, meticulously erases a crime scene. “It’s a super-scrub and a bleach and a disinfection," he said.
Syosset Hospital on Long Island will be so cleaned to allow some critical surgeries to resume, Fougner said, while coronavirus patients continue to be treated at its sister hospital, Long Island Jewish Medical Center, which will remain one of the last to reopen.
“My guess is it will take us about a year to a year-and-a-half to go back to where we were a year ago. This is a slow process,” Dowling said. There will be changes. He predicted a “dramatic expansion of telemedicine in all its forms” as well as “much more of an investment in ambulatory outpatient care.”
“There will be a new normal,” Dowling said. “It will not be the old normal.”