In the week since New York Gov. Andrew M. Cuomo announced plans to share resources and burdens across the state’s hospitals to relieve pressure on public institutions overwhelmed with coronavirus cases, officials at some major health-care systems have struggled to balance support for the governor with fears that his directive risks undercutting their ability to treat the patients they already have.
“In a perverse way, you are trading deaths for deaths,” said Philip Aliotta, president of the Eighth District Branch of the Medical Society of the State of New York, which represents eight counties in the western part of the state. A urologist, Aliotta described himself as an admirer of Cuomo (D) but “very much afraid of being caught short” as a dearth of testing kits makes it difficult to determine when the surge would come locally.
Cuomo’s announcement late last week that, should it become necessary, the state would round up hospitals’ ventilators has amplified anxieties and, in the words of Jody L. Lomeo, chief executive of Buffalo-based Kaleida Health, “pit upstate versus downstate.” Any help for “our neighbors,” Lomeo has said, would not come“at the expense of the community that we are accountable for.”
The dispute underscores the ongoing political and practical challenges bedeviling New York officials as they combat a virus that has consistently stayed a step ahead of their tactics, from social distancing and lockdowns to the current attempts at resource sharing. That ambitious plan — described during the governor’s daily news conferences, which have won approving audiences across the nation — has forced New York’s upstate medical systems to evaluate their needs against the klaxon-call wailing from the epicenter.
On Tuesday, before signing an executive order formalizing the initiative, Cuomo said the rate of hospitalizations in New York appeared to have plateaued even as 731 people had died in the past day — a record. “To the extent that we see a flattening or a possible plateau, that’s because of what we are doing, and we have to keep doing it,” the governor said.
State officials have aggressively defended the strategies, while insisting that any materials diverted to New York City will be redistributed once the crisis there abates and as needs emerge elsewhere. It is based on the historic concept of “mutual aid” that has helped state and local authorities throughout the country weather life-threatening natural disasters and other emergencies, and has entailed extensive data analysis, including real-time bed and ventilator usage, as well as disease modeling.
“We get people’s fear,” said Jim Malatras, president of Empire State College and a former director of state operations who has been assisting on the effort. He emphasized that “rebalancing resources” would involve taking only one-fifth of the ventilators not currently in use at upstate hospitals. Cuomo has said the National Guard could be dispatched to fetch equipment needed to care for patients downstate.
“It’s about balancing the load based on the resources we have,” Malatras said. “We give when you need; you give when we need.”
More than 800 ventilators had been sent downstate, the governor said this week.
Plenty have embraced the governor’s philosophy. Kenneth E. Raske, who as president of Greater New York Hospital Association has advised Cuomo amid the crisis, said “Everyone in the hospital community is applauding the governor’s leadership under very trying circumstances.” The Buffalo News published an editorial this week arguing that “An ‘I’ve-got-mine’ approach will only prolong the suffering.”
But tension surrounding the plan — which also calls for transferring patients out of New York City’s 11 public hospitals when they are overwhelmed, moving patients between private hospitals traditionally in competition, or sending them upstate where the crisis has not yet caused the same chaos — is bearing out in the city, too.
While officials in Buffalo and elsewhere have worried about sending ventilators and personal protective equipment to New York City without knowing for certain whether it would be returned in time to confront their covid-19 surges, some downstate hospital executives also have worried about sharing resources with neighboring institutions. One senior New York City hospital executive said, as his own institution neared capacity, the state’s increased involvement in their operations irked some who were well prepared but now are having to give equipment to facilities that failed to plan ahead.
This hospital official spoke on the condition of anonymity to avoid being seen as publicly undermining the governor.
Some hospital executives have voiced their concerns to local elected officials, according to Rep. Tom Reed, a Republican who represents New York’s 23rd Congressional District. Reed said he was taken aback by the directive, particularly as hospitals in his rural district, which borders Pennsylvania, felt they had no resources to spare.
“We are all about working together and standing together, but we can’t do it by issuing edicts,” he said.
New York City Council member Mark Levine, who represents part of northern Manhattan, said he has heard from three hospital CEOs wondering how they can absorb more patients.
“Is there grumbling privately? Sure there is. But I think they are going to be team players,” Levine said. “It’s not as if any New York City hospital has beds to spare.”
Cuomo noted Tuesday the state’s three-day rolling average for hospitalization dropped to 529 — less than half of what it was a week ago. The total number of patients hospitalized stood at about 17,500, up only slightly from over the weekend.
The death toll, he said, represents a “lagging indicator” compared to the slowdown in hospitalizations because more patients admitted to hospitals in March are now losing their battle against the virus. Statewide, about 5,500 have died.
New York Mayor Bill de Blasio (D) said Tuesday he was more confident the city’s health-care system will avoid being overrun with patients. De Blasio noted that Monday was the “first time in many days” that New York hospitals did not see more people needing a ventilator than the day before. “For the first time . . . they were pretty much breaking even,” he said, adding, “We prepared for the worst-case scenario but we are not experiencing the worst-case scenario right now.”
Cuomo was forced to take drastic action, in part, because the nation’s stockpile of essential medical equipment had been mostly depleted, though he has acknowledged having underestimated how dangerous the virus would become in densely populated New York City. As a consequence, many hospitals there were left with little time to prepare for peak infections, and to acquire ventilators and other equipment.
One New York City official, speaking on the condition of anonymity to avoid being seen as criticizing health-care workers toiling courageously to care to for the sick and dying, acknowledged that some hospitals were far more prepared than others. Elmhurst Hospital Center in Queens and Lincoln Medical Center in the Bronx, in particular, have struggled since becoming inundated with patients in recent weeks, the official said. Both hospitals are part of the city’s public hospital system and serve large numbers of poor and uninsured patients.
NYU Langone, by contrast, opened a coronavirus situation room Jan. 26 and began purchasing and training that week, a person familiar with the operations said.
Hospitals had been sharing patients and resources within their own systems, but Cuomo’s plan represents far more radical realignments of a health-care system he has described as “balkanized.”
By the end of last week, nearly 200 non-intensive care and 43 ICU patients with covid-19 have been transferred from five crowded public hospitals — in Elmhurst, Woodhull, Lincoln, Queens and Kings County — to other hospitals with more room in the NYC Health + Hospitals system. The system plans to add 3,000 ICU beds over the next month, tripling the number across the 11 public hospitals, CEO Mitchell Katz said.
Throughout New York — with the capacity added in recent weeks — there are about 90,000 hospital beds. Before this crisis, the state had 53,000.
Michael Dowling, president and CEO of Northwell Health, whose 19 hospitals scattered throughout the greater New York City area make it the state’s largest system, has been working with the governor’s office to develop what Cuomo has called the “surge and flex” program. One significant contribution Northwell has made is sharing with other area hospitals its blueprint for converting bipap machines, typically used to treat people with sleep apnea, into makeshift ventilators.
“The governor has basically indicated, or dictated, that if we have excessive supplies in one system that you give some of that excess to others that are struggling. And that’s happening,” Dowling said.
New York Presbyterian has 2,262 patients in its hospitals in the metropolitan region. More than 600 are on ventilators, according to a hospital staff member who was briefed by senior executives. About 800 ventilators are available, but officials anticipate that 1,000 patients will need one as the peak arrives.
Officials said they are examining alternate sites, including a covered athletic field near Allen Hospital, at the north end of Manhattan, that is owned by Columbia University. Patients could also be moved onto a terrace of a hospital conference center normally reserved for events.
As beds filled across the region, officials initially expressed frustration that they were unable to move covid-19 patients into the field hospital at the Javits Center convention hall and onto the USNS Comfort, the hospital ship docked on Manhattan’s west side. Both federally run facilities have since agreed to take patients who have the virus.
The decisions, which Cuomo lobbied the White House to make amid an outcry from leaders within the city’s medical community, were welcomed by specialists worried by the increasing numbers of patients well enough to leave the ICU but not well enough to go home.
“The concept here that people have to get is nobody can handle this alone,” Cuomo said Sunday. “This virus will overwhelm the resources of any single community.”
Guarino reported from New York. Tim Craig in Washington contributed to this report.