Just over a quarter million New Yorkers have tested positive for COVID-19 as of Apr. 20 and it’s not over yet. 14,828 have died. Make no mistake. This is a tragedy. Aside from the loss of life, this crisis will forever leave a legacy – the trauma carried by all those who were unable to say goodbye, the horror of discovering bodies in the homes of those who died alone. How can we make sense of it?

 

Some positives may be salvageable. Not only did the pandemic give rise to a statewide centralized care plan, involving both public and private health care systems, it may also have changed the way we use hospital services, leading some in the health care profession to query if a permanent change to the medical landscape might be on the horizon.

 

NYC Health + Hospitals/North Central Bronx (NCB) is the smallest of 11 public hospitals in the City’s public health care system. Last year, the hospital handled more than 156,000 outpatient visits, more than 50,000 emergency room visits, and more than 7,500 admissions at its 232-bed facility. Yet, over the years there has been some concern and apprehension about the hospital’s future and whether further investment was merited.

 

Cristina Contreras is Executive Director at NCB. She explained to Norwood News how the hospital has been coping with the worst public health crisis the world has seen in decades, and how the situation may, ultimately, shape not just the hospital’s destiny, but perhaps the future of the current health care space as we know it.

 

“The plan? It changed,” Contreras said wryly, referring to NCB’s initial planning for the pandemic. “I mean, we have [sic] plans, preliminary discussions, I think, back in February,” she said, referring to when Health + Hospitals started considering things like supplies. “If I’m not mistaken, it was sometime in March, beginning of March where everything started to become real. We’ve been in crisis mode since then,” she said.

 

Contreras said that at a certain stage Mayor Bill de Blasio, in consultation with FEMA, identified NCB as one of several target locations for the construction of additional ICU beds, 120 in the case of NCB, in preparation for the crisis. “That is a dramatic change from everyday business here,” said John Doyle, a spokesman for the hospital.

 

Pre-pandemic operations at NCB catered to 15 intensive care unit (ICU) beds and 64 med-surg (medical-surgical) beds. Hospital med-surg units are reserved for adult patients who are acutely ill with a wide variety of medical issues or who are recovering from surgery and are provided with 24-hour care.

 

By Mar. 22, as the number of COVID-19 positive cases rose to 15,168 across 31 counties, Albany announced the opening of a 1,000-bed temporary hospital at the Javits Center and the State’s health department (DOH) issued an emergency order calling on all hospitals statewide to come up with a plan to expand their existing capacity by a minimum of 50 percent. In reality, the expectation was for all hospitals to double their capacity to meet the anticipated surge.

With NCB still in construction mode, Contreras said her team had to get creative, but they rose to the challenge. “Now I’m able to take 43 if not more ICU patients, and 126 med-surge for instance,” she said. First, they had to find immediate alternate space. They converted clinic spaces into med-surge units where patients could be given oxygen or observed, while other areas were identified for the additional ICUs that had sufficient space around them for monitoring purposes.

 

The plan also required a re-organization of the hospital itself and the transfer of existing patients to other units, as staff continued to handle the needs of their regular non-COVID in-patients. “We tried not to co-mingle people that were positive with negative for obvious reasons,” Contreras said, adding that the staff who were working with COVID patients were always dedicated to those units because they had to wear appropriate PPE to work there.

 

By Mar. 30, the number of positive COVID-19 cases had risen to 66,497 statewide (roughly four times the number reported the previous week). The number of deaths across the State had reached 1,218, and Gov. Andrew Cuomo announced an emergency statewide public-private hospital plan to deal with the accelerating surge. As part of the approach, any hospitals that were beginning to reach, or exceed capacity would transfer patients to other hospitals that were not yet as full.

 

They also agreed to share supplies, staff and other resources, as needed. DOH created a command center to share information between the hospitals about the supplies each hospital had in stock, and the supplies each hospital was ordering. The central inventory system helped to ensure purchasing and distribution of supplies was done strategically and efficiently. Contreras welcomed the move. “I love the way that the system works because to be honest with you, we really collaborate,” she said. “We give each other information in real time. We have daily calls.”

The NCB team were fortunate that they adapted to the crisis when they did. All their resources were and still are being used to full capacity. Contreras said knowing where each hospital was at, in terms of resources, really assisted with communication. “We’re receiving lots of transfers to help decompress the emergency room at the [other] hospitals because we’re all part of the surge,” she said.

 

“They have that conversation with the patients, and they offer them choices to be transferred to other facilities,” Contreras said. “That’s why I like working under the system because we’re helping each other. It’s not one hospital now because you go to Queens hospital or Jacobi hospital – if they’re dealing with a lot, I’m able to help.”

 

This actually provides some interesting context to the daily statistics reported by DOH which sees the Bronx ranking third in terms of both positive COVID-19 cases and deaths, behind Brooklyn and Queens. Given that all these transfers took place and continue to take place across the State, it’s possible that some of the positive cases and deaths attributed to the Bronx represent patient transfers from other parts of City or State. Equally, some of the positive cases and deaths reported for those other areas could represent transfers from Bronx hospitals.

 

Transfers between public and private hospitals also took place, with NCB taking transfers from Jamaica, St. Barnabas and others. “They’ve been able to coordinate for us to support all the hospitals outside of H+H so I think it’s working great,” Contreras said. In fact, NCB were already an old hand at collaborating within the public Health + Hospitals system.

 

In July 2019, Norwood News reported that NCB would formally merge with its sister hospital NYC Health + Hospitals/Jacobi Medical Center. Staff had already been rotating between the two facilities for twenty years. The aim of the merger, and of operating under one license, was to enhance the existing model by streamlining the staff credentialing process for new doctors and reduce wait times for patients.

 

On Apr. 2, CBS local news reported that dozens of health care workers had protested at Jacobi on Mar. 28 saying management had offered limited Personal Protective Equipment (PPE) supplies to them, and had asked nurses to re-use their masks for an entire week.

 

While Contreras’s remit as executive director only extends to NCB, she acknowledged that it has been challenging for the staff at all facilities to deal with concerns over potential infection. “We are all doing the best we can to keep them informed on safety practices and the proper use of PPE,” she said.

“Sometimes, people are afraid when they hear a lot of different information, and it can be overwhelming and sometimes generates concerns,” she added, explaining that there had been rolling updates to protocol and guidance from DOH and the Centers for Disease Control and Prevention (CDC), as the crisis unfolded on exactly who was required to wear PPE, what type, and in which unit.

 

“We do a very good job with coordinating with nursing, material management and the providers to ensure that everybody has adequate PPE,” Contreras said. “Not everybody’s complaining.” She added that sometimes it was a matter of education. “We tried to do in-service constantly,” she said. “We have a team that goes around trying to teach people how to wear the PPE correctly, because, again, if you’re misusing PPE, it’s not going to protect you.” Contreras said she too had to learn how to use it.

 

“We’re managing,” she added, while acknowledging that there had been challenges not only citywide and statewide, but worldwide in coordinating PPE supplies. “I mean, can we use more PPE? Of course! Everybody can use more PPE. I’m not going to say that we, in the future, we’re not going to need it, but we don’t want it right now. We have adequate so I, you know, thank God for that.”

 

Then there was the matter of considering older health care workers who, themselves, fell into the high-risk category for contracting the virus. In New Jersey, for example, it was reported by JAMA network that, on average, the state had the oldest physicians in the nation.

“We obviously don’t force people to expose themselves,” Contreras said, explaining that guidelines were in place to move anyone who felt uncomfortable to another unit where they weren’t exposed to COVID-related activities. “I think I have one person that was relocated to another facility,” she said. “I don’t think it’s impacting us that bad.”

 

Staffing wise, Contreras said the hospital received a number of volunteers [some paid and some unpaid] from the medical profession, ranging from anesthesiologists to family practice providers, both from in-state and from all across the country. “We have nurses, doctors, we have administrative staff supporting, you know, helping us even answering the phone, so the nurses can do what they do best,” she said.

 

On arrival, they ask the volunteers what their area of expertise is and try to match them to an appropriate unit though she said this is not always possible. The Navy helped too. “We just received 28 nurses that started today, [Apr. 10] and we have 11 providers from the Navy that are starting today as well so yes, we have adequate staffing to support not only the crisis, but to help alleviate some of the stress on our current staff as well.”

 

Perhaps another consideration, with all the talk of ventilators, was the high instance of asthma in the Bronx, especially among kids, as previously reported by Norwood News. “Whether they’re kids or adults, if you are asthmatic, you obviously fall into a different [at-risk] category,” Contreras said. “It doesn’t mean that you’re automatically going to require ventilation. There’s certain criteria.”

 

Contreras did confirm that NCB gets more at-risk cases than people who don’t have underlying health-related issues, but she said she had not had any pediatric cases yet. “For some reason, the South Bronx seems to be getting a lot more cases and I’m not sure why,” she said. “That’s part of the research that’s being conducted right now.” She said that in Norwood, NCB wasn’t seeing an influx of direct patients coming through their emergency room.

 

“We’re dealing with the [COVID-19] cases but the majority of the cases are transfers from other facilities,” she said. “People with concerns? Yeah, concerns and, you know, people are afraid and they think they have symptoms. They do come to be seen but not necessarily that they’re positive.”

 

Indeed, generally, she said the public had heeded the instructions of officials, had followed protocol and were not showing up at the hospital unless they were very ill. “Yeah, I have to say I’m very impressed,” she said. “And I know that the governor was alluding to some of that, but it seems kind of interesting when you see the less utilization [sic] of hospitals.”

 

So, are all of these efforts shaping the future of how hospitals will operate going forward? “A lot of us are having those discussions already,” Contreras said, adding that they are all eager to see some level of normalcy return. “What is normal going to look like for us going forward?” she asked. “Is it ever going to be the same for healthcare? I can’t speak to that. My only personal opinion would be that nothing is going to be ever the same, and maybe in a good way.”

 

What is clear to Contreras is that people are going to be more aware and more educated about prioritizing certain things in life, and she said health would be one of them. “That’s just my personal speculation, not anything clinical, or based on any statistics or anything right now,” she said.

 

In terms of emergency visits to NCB, Contreras said they have also noticed a definite drop in non-coronavirus emergencies. “I’m like, what happened to the others?” she asked. “I heard the governor – they’re looking at all that statistically. Obviously, there’s less people driving so there are less car accidents. People are really not getting sick.”

 

She stressed that the hospital was, nonetheless, continuing to cater to their patients’ needs. “Remember, we’re still seeing our patients,” she said. “The doctors are calling the patients. They’re having the conversations. They’re sending the prescriptions. They’re just being seen in a more innovative way.”

 

She referenced the use of My Chart, the hospital’s online tool for communicating with patients, where they can review their files or specify if they need to speak to their doctor, or review some of the comments from a previous visit. She said more interaction with the platform might be needed before people feel truly comfortable with it but that, generally, it helped manage the crisis in a safe way by encouraging people to stay home.

“Unless, if the doctor feels, ‘Listen, I need to see them, they’re high-risk,’ or ‘This is a situation that I need to address personally,’ then they come in,” she said, adding that if patients needed a nurse to go to their home, for whatever reason, that was also arranged.

 

“Is that like, you know, the new way of the future? I don’t know,” Contreras said. “But for now, we’re trying to do everything possible to keep patients safe and have fluid communication with the [medical] providers. They’re here. They’re here to see them. They’re here to talk to them.”

 

There have been, nonetheless, grave concerns among the community about the number of people who have been found dead at home, as well as initial reported inaccuracies about the true cause of death for those who died at home. Norwood News asked Contreras if she thought that maybe people had been hesitant to reach out to the hospitals at the right moment, perhaps believing that their condition was not as serious as it ultimately proved to be. Contreras said this was more a question for DOH. Norwood News has reached out to DOH to clarify some of the reported numbers for at-home fatalities in the Bronx.

 

Flexibility and long-hours were key factors in the hospital’s handling of the crisis and Contreras was anxious to praise all the health care professionals at NCB for their hard work. “You see people work in different functions, like I have the midwives doing nursing,” she said. “I have some people volunteering to draw blood, being trained in short time, OBGYN doctors helping the critical care, helping respiratory therapists – everybody’s helping.”

 

“It’s like something so difficult and critical in this health crisis, it’s just bringing people together and that is something that I’m happy and proud that I was able to see, and I’m grateful for that,” she said. “I can’t even describe it.” And it was not easy. Contreras said that everybody had, understandably, been anxious about contagion but had put their concerns and anxieties aside to take care of their patients. “I think this is just, you know, something historically that no one anticipated, no one had to deal with, I guess, in this century,” Contreras said.

 

As for the future of NCB, she said that with all the uncertainty of the past, she could never have envisaged that the hospital would be right now responding, on a statewide basis, to the crisis, while also managing their regular operations which includes delivering around 80 babies each month.

 

She anticipates that, in the future, the hospital may even be used to respond to the crisis outside of New York state if, for example, other states need additional ICU beds. “This is why this is a great opportunity, because in addition to dealing with a [sic] current situation, they also identified potential for future [need],” she said.

 

Of course, Contreras hopes for the sake of any future patients, that NCB’s services will not be needed but she does have a message for her fellow Americans if that need arises. “We’re here to help,” she said.

 

Council Member Andrew Cohen confirmed in a newsletter on Apr. 21 that a GoFundMe campaign has been set up for 2,000 front-line staff at NCB. Funds will be used to purchase meals/coffee/groceries/gift cards from local stores and restaurants for hospital staff who are putting in long shifts, sometimes 16-24 hours at a stretch without time to grab a meal, under challenging circumstances, all while keeping smiles on their faces and an amazing attitude. Donations can be made here.