"It's been frustrating watching people reinventing the wheel as they're going along," said Stuart Weiss, an emergency doctor and mass-casualty expert who founded the medical consulting group Intelligent Crowd Solutions, headquartered in Manhattan. "The first day it was like three patients," he said of Javits's slow start, "and then it was four patients, and I was like, ugh!"
The tale of these two temporary hospitals is one of disconnect between public expectations and political declarations, and what’s possible to achieve — logistically and medically — under the circumstances. Covid-19 patients can deteriorate rapidly and suddenly, even when they seem to be on the mend, and often require oxygen for days or weeks. With an increase in the severity of cases treated comes the need for more equipment and staffing. And at the moment, it remains to be seen whether either the Javits Center or the Comfort can adequately care for very many of the most seriously ill covid-19 patients, as state and federal officials have indicated is their new mission.
Between the two, there are 1,200 beds available, military officials said — far fewer than the 3,000 described in public statements by Gov. Andrew M. Cuomo (D) or the 5,000 touted in initial media announcements. As of Friday, about 250 beds were occupied, officials said.
Military officials said they are continually revising their admissions criteria as they’ve had to transform the facilities into ICU-capable covid-19 field hospitals, instead of medical wards to treat noncritical, non-covid patients as New York state initially requested. The slow start, one defense official said, is owed in part to the military being unfamiliar with the local hospitals and the hospitals’ unfamiliarity with the military medical system.
Dario Gonzalez, a top medical official for the city’s emergency management agency and the fire department, who is an on-site consultant at Javits, said the effort has faced multiple hurdles. Intensive care capability was limited to “just a couple” of ventilators, he said. X-ray machines and lab stations — equipment from the federal stockpile, which was also servicing growing crisis zones in Chicago and Detroit — have been slow to arrive.
“I know people are frustrated, and I know people are upset. Everybody wants it to be faster, but we want it to be safe,” he said. “But I need the resources, the staff, the equipment. This was not set up as a mobile ICU.”
Initially, both the Javits Center and the Comfort were envisioned as overflow facilities capable of relieving the city’s hospitals of the added burden of providing more-routine care, so they could focus exclusively on the surge of coronavirus cases. But victims of trauma and other ailments vanished from emergency departments as automobile traffic and crime rates — except for domestic violence — plunged.
“Lo and behold,” said physician Arthur Fougner, president of the Medical Society of the State of New York, “there aren’t that many non-covid patients.”
Everything was upended last week, after an uproar from hospital executives who questioned why these federal facilities were sitting nearly empty when the city’s doctors and nurses were overwhelmed. At first, Javits began accepting covid-19 patients transferred from hospitals, but only those convalescing, which “means they are in the recovery period and less likely to deteriorate and require major medical care,” a military official, speaking on the condition of anonymity because of sensitivities over the matter, said via email. “We had no safety outlet if the patient deteriorated (i.e. no ventilators, no ICU beds, etc.).”
The situation has since improved, the email indicated, and the Javits Center now has some ability to accept more patients “at different points in their clinical progression.” Military officials said “there are currently hundreds of ventilators on hand” there.
It is unclear, however, whether there is a sufficient supply of oxygen. The military official said “a few” beds are set up for oxygen. Gonzalez, with the city’s emergency management agency, said they’re working on a system for piping oxygen into the building but don’t have one yet for needs he characterized as “tremendous.”
“We are doing everything we can to put the right patients in the right places, fully knowing that the volume of patients and complexity of the disease process makes that difficult at times,” the military official said. While freeing up hospital beds for the sickest covid-19 patients is the goal, his email noted, “we have recommended to our local hospital partners that if they are planning to discharge the patient in 1-2 days, that a trip to Javits may be more of a burden than a help.”
The Comfort arrived at Pier 90, on Manhattan’s West Side, on March 30 as many New York hospitals were morphing into coronavirus centers. Only a few dozen patients, none with covid-19, were treated aboard the ship during its first week in the city.
The ship began accepting covid patients Tuesday. Its 1,000-bed capacity has been reduced to 500 to account for the higher care needs. There are 100 ICU beds with ventilators plus operating rooms for treating higher-risk patients, officials said. As of Friday morning, 62 patients were onboard the ship, half of them with covid-19, officials said. One crew member also has tested positive for the disease.
Lt. Marycate Walsh, a Navy spokeswoman, said, “USNS Comfort’s support to New York cannot be accurately captured through the quantity of patients onboard,” adding that, on Thursday, doctors there performed a 10-hour lifesaving surgery on a coronavirus patient. Earlier in the week, 37 military personnel transported 18 covid-19 patients to the Comfort and other hospitals when one hospital’s oxygen system went on the fritz.
It was only a month ago when Cuomo and New York Mayor Bill de Blasio (D) suggested that the crisis would blow over. But as the need for more hospital beds became clear, Cuomo, at his daily news briefings, described his forceful push on the Federal Emergency Management Agency, and then his calls to President Trump, to allow covid-19 patients at the Javits Center.
Yet until the admission criteria were updated this week, the threshold for sending patients to either the Javits Center or the Comfort were so restrictive that few people qualified, said one frustrated New York doctor, who spoke on the condition anonymity to be candid. “The hospitals are housing ICU-level patients in the lobbies and the cafeterias,” the doctor said, while the Javits beds added “nothing.”
The military has attempted to streamline the transfer process. Because they’re both taking covid patients now, the Javits Center and the Comfort are working as one unit. Military doctors have been dispatched to hospitals around New York City where they help identify potential patients who can be transferred to the temporary sites. A command center within Javits decides whether ambulances ferry them to the convention hall or the ship.
But even that is a complicated process. The Comfort was built to rescue trauma patients from battlefields and natural disasters. Getting a covid patient who’s attached to a ventilator through the ship’s passageways, which are narrower than a hospital’s, can be time-intensive, according to military officials.
And often, Gonzalez said, military teams doing patient selection will go to hospitals and get turned away by doctors who tell them their patients are too unstable to move.
Walsh, the Navy spokeswoman, said Javits and the Comfort plan to continually “reassess our patient admission criteria to see how we can take on more patients.”
Late in the week, the military patient assessment team sent out an email relaxing the restrictions for sicker covid patients to enter the Javits Center, yet again. What the medical teams were learning was that trying to screen for the most stable patients with this disease was pretty much like playing roulette. “It’s Las Vegas. You just hope you get it right,” said Gonzalez.
Even under the earlier guidelines, Gonzalez said, several covid patients at the Javits Center had crashed and were being treated in the convention hall’s makeshift ICU. The restrictions on patient numbers, he added, are intended to protect them. “I could fill this place over the weekend,” he said, “but if you ramp up to 1,000 and you don’t do it right, you’re going to have a lot of casualties. . . . There is no blueprint for this.”