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| One Hospital Was Besieged by the Virus. Nearby Was ‘Plenty of Space.’ | One Hospital Was Besieged by the Virus. Nearby Was ‘Plenty of Space.’ |
| (32 minutes later) | |
| In late March, as the most dire public health crisis in a century swept across New York, sick people and those caring for them faced a hospital system that was less than the sum of its mighty parts. | In late March, as the most dire public health crisis in a century swept across New York, sick people and those caring for them faced a hospital system that was less than the sum of its mighty parts. |
| At Elmhurst Hospital in Queens, hundreds of Covid-19 patients arrived in need of more help than besieged medical workers could give. Patients were found dead in rooms. One medical resident described conditions as “apocalyptic.” | At Elmhurst Hospital in Queens, hundreds of Covid-19 patients arrived in need of more help than besieged medical workers could give. Patients were found dead in rooms. One medical resident described conditions as “apocalyptic.” |
| Yet at the same time, 3,500 beds were free in other New York hospitals, some no more than 20 minutes from Elmhurst, according to state records. The city, which runs Elmhurst, had a fleet of 26 new ambulances available to transfer patients. | Yet at the same time, 3,500 beds were free in other New York hospitals, some no more than 20 minutes from Elmhurst, according to state records. The city, which runs Elmhurst, had a fleet of 26 new ambulances available to transfer patients. |
| Elmhurst, it seems, was trapped between the pressures of the moment and forces of history that put little value on the cooperation needed during a pandemic. | Elmhurst, it seems, was trapped between the pressures of the moment and forces of history that put little value on the cooperation needed during a pandemic. |
| For decades, hospital organizations in New York, just as in many parts of the country, have existed as independent fiefs, rivals that had virtually nothing to do with each other. The state is home to more than 200 hospitals private and public, run by about 80 nonprofit corporations and government agencies. | For decades, hospital organizations in New York, just as in many parts of the country, have existed as independent fiefs, rivals that had virtually nothing to do with each other. The state is home to more than 200 hospitals private and public, run by about 80 nonprofit corporations and government agencies. |
| “We don’t really have a public health care ‘system,’” Gov. Andrew M. Cuomo said. “We have a system of hospitals.” | “We don’t really have a public health care ‘system,’” Gov. Andrew M. Cuomo said. “We have a system of hospitals.” |
| In the week that began March 16, the number of Covid-19 hospital patients increased tenfold. | In the week that began March 16, the number of Covid-19 hospital patients increased tenfold. |
| The hospital networks stood on the brink of replicating the fatal confusion of Sept. 11, 2001, when the police and fire departments responding to the attacks at the World Trade Center did not work together or communicate, costing many lives. | The hospital networks stood on the brink of replicating the fatal confusion of Sept. 11, 2001, when the police and fire departments responding to the attacks at the World Trade Center did not work together or communicate, costing many lives. |
| Even as the hospitals scrambled to expand, Elmhurst revealed a gap that city and state officials had not foreseen: No single body existed to match patients with the beds that were already available across scores of separate systems and independent hospitals. | Even as the hospitals scrambled to expand, Elmhurst revealed a gap that city and state officials had not foreseen: No single body existed to match patients with the beds that were already available across scores of separate systems and independent hospitals. |
| Within days, the state created one in the form of an early warning system, a live daily map of conditions at each hospital, regardless of who operated it. When a hospital was filling up, scouts in the field would identify patients who could be moved. Then state officials coaxed or helped hospital staff to transfer them to less-crowded facilities. | Within days, the state created one in the form of an early warning system, a live daily map of conditions at each hospital, regardless of who operated it. When a hospital was filling up, scouts in the field would identify patients who could be moved. Then state officials coaxed or helped hospital staff to transfer them to less-crowded facilities. |
| The dashboard hacked together by Mr. Cuomo’s aides did not create a permanently integrated health system by any measure, but it allowed New York at the worst of the pandemic to make the most — or, at least, more — of what the state had. | The dashboard hacked together by Mr. Cuomo’s aides did not create a permanently integrated health system by any measure, but it allowed New York at the worst of the pandemic to make the most — or, at least, more — of what the state had. |
| “It wasn’t the problem that every hospital was full,” said Gareth Rhodes, a Cuomo aide. “It was a problem that a handful of hospitals were nearing capacity, while hospitals within a 15- mile-to-20 mile radius had plenty of space.” | “It wasn’t the problem that every hospital was full,” said Gareth Rhodes, a Cuomo aide. “It was a problem that a handful of hospitals were nearing capacity, while hospitals within a 15- mile-to-20 mile radius had plenty of space.” |
| Why weren’t patients moved sooner from Elmhurst, with room available elsewhere? | Why weren’t patients moved sooner from Elmhurst, with room available elsewhere? |
| “It’s a fair question that makes sense,” said Matthew Siegler, executive vice president of the Health & Hospitals Corporation, the public agency that runs the city hospitals. | “It’s a fair question that makes sense,” said Matthew Siegler, executive vice president of the Health & Hospitals Corporation, the public agency that runs the city hospitals. |
| In the first days, Mr. Siegler said, doctors worried that patients were too unstable to move, the disease too unpredictable. Instead, the agency sent reinforcements to the hospital. | In the first days, Mr. Siegler said, doctors worried that patients were too unstable to move, the disease too unpredictable. Instead, the agency sent reinforcements to the hospital. |
| “There’s a strong ethos of whatever comes through the door, we can and will take care of it,” Mr. Siegler said. | “There’s a strong ethos of whatever comes through the door, we can and will take care of it,” Mr. Siegler said. |
| State officials said they had believed that patient transfers would be handled by the public and private networks themselves, through what seemed to be robust existing transportation operations. Two private hospitals caught in the same flood tide as Elmhurst had eased their load by moving dozens of people to less crowded places beginning on March 21, records show. | State officials said they had believed that patient transfers would be handled by the public and private networks themselves, through what seemed to be robust existing transportation operations. Two private hospitals caught in the same flood tide as Elmhurst had eased their load by moving dozens of people to less crowded places beginning on March 21, records show. |
| “The issue at Elmhurst was not one of capacity,” said Dani Lever, the governor’s communication director, noting that there were thousands of free beds in the city, including within Health & Hospitals’ own network. “It was a patient management issue.” | “The issue at Elmhurst was not one of capacity,” said Dani Lever, the governor’s communication director, noting that there were thousands of free beds in the city, including within Health & Hospitals’ own network. “It was a patient management issue.” |
| City authorities changed course on March 25, as news reports and video revealed conditions at Elmhurst. | City authorities changed course on March 25, as news reports and video revealed conditions at Elmhurst. |
| “We dramatically increased the number of transfers out,” Mr. Siegler said. | “We dramatically increased the number of transfers out,” Mr. Siegler said. |
| A team of doctors and administrators from across the city smoothed the way. That process became even more important as the number of sick mounted, said Mitchell Katz, the chairman of Health & Hospitals. | A team of doctors and administrators from across the city smoothed the way. That process became even more important as the number of sick mounted, said Mitchell Katz, the chairman of Health & Hospitals. |
| “For us, doing the transfers has been a critical part of getting through the pandemic,” Dr. Katz said. | “For us, doing the transfers has been a critical part of getting through the pandemic,” Dr. Katz said. |
| By the end of March, the new state system was in place. It may have had its biggest impact during eight consecutive days starting April 7, when more than 18,000 Covid-19 patients were in downstate hospitals. One of every five needed intensive care. | By the end of March, the new state system was in place. It may have had its biggest impact during eight consecutive days starting April 7, when more than 18,000 Covid-19 patients were in downstate hospitals. One of every five needed intensive care. |
| During those peak days, records show, the state directly transferred 900 sick people. Others were moved by the hospital systems themselves: Northwell Health, for instance, transferred 800 patients, and the city hospitals moved a total of about 850. | During those peak days, records show, the state directly transferred 900 sick people. Others were moved by the hospital systems themselves: Northwell Health, for instance, transferred 800 patients, and the city hospitals moved a total of about 850. |
| The people who managed those logistics, said Nick Caputo, an emergency physician at Lincoln Hospital in the Bronx, “saved countless lives.” | The people who managed those logistics, said Nick Caputo, an emergency physician at Lincoln Hospital in the Bronx, “saved countless lives.” |
| In the past, the hospital systems have had spasms of cooperation during hurricanes, blackouts and mass casualty events. They normally operate as independent duchies. | In the past, the hospital systems have had spasms of cooperation during hurricanes, blackouts and mass casualty events. They normally operate as independent duchies. |
| Led by boards of wealthy and influential people, the five biggest private systems — NYU-Langone, NewYork-Presbyterian, Northwell, Mount Sinai and Montefiore — invest heavily in their brands. Their most recent tax filings show they spent a total of $149 million on advertising. | Led by boards of wealthy and influential people, the five biggest private systems — NYU-Langone, NewYork-Presbyterian, Northwell, Mount Sinai and Montefiore — invest heavily in their brands. Their most recent tax filings show they spent a total of $149 million on advertising. |
| On March 20, heads of every hospital, public and private, were summoned to a telephone meeting with Howard Zucker, the state health commissioner, and Larry Schwartz, a lawyer who has been in and out of government for decades and often delivers messages from Governor Cuomo. | On March 20, heads of every hospital, public and private, were summoned to a telephone meeting with Howard Zucker, the state health commissioner, and Larry Schwartz, a lawyer who has been in and out of government for decades and often delivers messages from Governor Cuomo. |
| Updated June 24, 2020 | |
| Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles. | |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| The executives were told by Dr. Zucker to add space for at least 50 percent more patients, and they did, eventually adding 35,000 beds. In addition, they were ordered to provide the department of health with daily inventories of beds, critical supplies and ventilators so the state could ration its own stockpiles by need. | |
| There was some quiet grumbling about lengthy surveys in the middle of an emergency, but Mr. Schwartz reminded the executives that the state controlled certificates of need that hospitals must seek when they want to buy expensive equipment. | There was some quiet grumbling about lengthy surveys in the middle of an emergency, but Mr. Schwartz reminded the executives that the state controlled certificates of need that hospitals must seek when they want to buy expensive equipment. |
| “Basically, the message was that we have to submit the surge plan, or you will never get anything approved,” said an executive with a large private hospital network who spoke on the condition of anonymity. “It was, ‘Do this or you are dead.’” | “Basically, the message was that we have to submit the surge plan, or you will never get anything approved,” said an executive with a large private hospital network who spoke on the condition of anonymity. “It was, ‘Do this or you are dead.’” |
| In addition, Mr. Schwartz said, executives for each hospital had to attest to the truthfulness of the daily report, essentially making false statements a potentially criminal matter. Given the urgent circumstances, no arm-twisting was necessary, said Kenneth Raske, president of the Greater New York Hospital Association, the industry’s politically potent trade association. | In addition, Mr. Schwartz said, executives for each hospital had to attest to the truthfulness of the daily report, essentially making false statements a potentially criminal matter. Given the urgent circumstances, no arm-twisting was necessary, said Kenneth Raske, president of the Greater New York Hospital Association, the industry’s politically potent trade association. |
| “The issue of their power never became a question,” Mr. Raske said. “The moral authority supersedes everything.” | “The issue of their power never became a question,” Mr. Raske said. “The moral authority supersedes everything.” |
| In regular conference calls, Mr. Cuomo and Michael Dowling, the chief executive of Northwell who was deputized by the governor to oversee moving patients to military hospitals at the Javits Convention Center and the U.S. Navy ship Comfort, implored the hospitals to “decant” their most crowded wards. | In regular conference calls, Mr. Cuomo and Michael Dowling, the chief executive of Northwell who was deputized by the governor to oversee moving patients to military hospitals at the Javits Convention Center and the U.S. Navy ship Comfort, implored the hospitals to “decant” their most crowded wards. |
| Leaders of the five largest private networks have been meeting every other day — "unthinkable” before the pandemic, Mr. Raske said — and major academic laboratories associated with hospitals are sharing strategies on tests and modifying equipment. | Leaders of the five largest private networks have been meeting every other day — "unthinkable” before the pandemic, Mr. Raske said — and major academic laboratories associated with hospitals are sharing strategies on tests and modifying equipment. |
| The coordination was abnormal, but, Mr. Dowling said, “It was necessary for the protection of the community.” | The coordination was abnormal, but, Mr. Dowling said, “It was necessary for the protection of the community.” |
| If this seems like no more than common sense, history shows that commodity can be in lethally short supply during a crisis. | If this seems like no more than common sense, history shows that commodity can be in lethally short supply during a crisis. |
| On the morning of Sept. 11, 2001, police officers, firefighters and emergency medical workers all responded to the cataclysmic fires at the World Trade Center, where hijackers had flown airliners into two 110-story towers. | On the morning of Sept. 11, 2001, police officers, firefighters and emergency medical workers all responded to the cataclysmic fires at the World Trade Center, where hijackers had flown airliners into two 110-story towers. |
| But as was the rivalrous custom, their departments set up separate command centers, blocks from each other. Starting at 9:59 a.m., pilots in police helicopters radioed warnings that the second of two towers at the trade center appeared on the verge of collapse. “It’s inevitable,” one pilot reported. | But as was the rivalrous custom, their departments set up separate command centers, blocks from each other. Starting at 9:59 a.m., pilots in police helicopters radioed warnings that the second of two towers at the trade center appeared on the verge of collapse. “It’s inevitable,” one pilot reported. |
| That alarm, and others, were relayed to police officers inside the tower, most of whom managed to escape. | That alarm, and others, were relayed to police officers inside the tower, most of whom managed to escape. |
| But firefighters never heard them. They operated on different radio channels. The police and fire commanders did not talk to each other. Scores of firefighters, many in striking distance of safety, died when the tower fell 29 minutes after the police warnings began. | But firefighters never heard them. They operated on different radio channels. The police and fire commanders did not talk to each other. Scores of firefighters, many in striking distance of safety, died when the tower fell 29 minutes after the police warnings began. |
| The marshaling of medical resources was heartening for Lincoln Hospital’s Dr. Caputo and his colleagues. | The marshaling of medical resources was heartening for Lincoln Hospital’s Dr. Caputo and his colleagues. |
| “You knew you weren’t alone in the fight, and that people were listening,” Dr. Caputo said. “That was great for the soul.” | “You knew you weren’t alone in the fight, and that people were listening,” Dr. Caputo said. “That was great for the soul.” |