Vulnerable in the Coronavirus Hot Spots

https://www.nytimes.com/2020/05/22/opinion/letters/coronavirus-vulnerable.html

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To the Editor:

Re “The Victims: One-Third of Those Who’ve Perished in U.S. Are Nursing Home Residents or Workers” (news article, May 13):

Statistics about Covid-19 deaths in nursing homes are sobering, but they don’t tell the whole story. A large proportion (up to 80 percent) of nursing home residents have Alzheimer’s disease.

Alzheimer’s patients, especially those with advanced dementia, require intimate, hands-on care. Staff must feed, dress, bathe and toilet these patients. Even with proper personal protective equipment, this close contact increases the risk of virus transmission.

Frail, elderly nursing home Alzheimer’s patients who contract respiratory infections face a grim reality. They have weaker immune systems, increasing the risk of infection and even death. Nursing homes generally don’t have the capacity or mission to offer ventilators and other forms of intensive care.

Many long-term-care patients specify in their advanced directives that they do not want aggressive care, including hospitalization and ventilators, but prefer palliative care.

There is no doubt that long-term facilities face challenges in preventing Covid-19 from entering and spreading in their buildings. However, let’s not lose sight in the statistics of apparent “excess” nursing home deaths of the above realities. Working within these challenges and constraints, the health care workers providing nursing home care during the Covid-19 pandemic are just as much “heroes” as the first responders.

Howard FillitNew YorkThe writer is the chief science officer of the Alzheimer’s Drug Discovery Foundation and a clinical professor of geriatric medicine at the Icahn School of Medicine at Mount Sinai.

To the Editor:

Re “Rikers Guards Fear Outbreak Will Hit Home” (front page, May 20):

Keeping those who live and work in New York City’s jails safe amid a global pandemic has required us to transform the Department of Correction. It’s the challenge of a lifetime, and we’ve worked tirelessly to do it.

The toll has been heavy. From the beginning of this crisis, we have followed the guidelines from the Centers for Disease Control and Prevention and the city’s Health Department to protect our officers.

We began distributing personal protective equipment on March 11 for prescribed situations, and by April 3 — two weeks before the state issued the same requirement — we mandated masks for everyone. We also partnered with Northwell Health to provide quick access to testing for all personnel. We screen everyone entering our facilities, separate them appropriately, and constantly seek to improve our response. Department of Correction first responders are also eligible for free voluntary antibody testing.

This crisis has tested New York’s Boldest like never before. But we’ll stop at nothing to get through this together and emerge from it stronger.

Cynthia BrannNew YorkThe writer is commissioner of the New York City Department of Correction.

To the Editor:

Re “After Elmhurst Buckled, State Forced Rare Teamwork Among Hospitals” (About New York column, May 15):

Jim Dwyer is right to point out that the Covid-19 pandemic underscored the need for hospital cooperation during a public health crisis, but the focus on filling hospital beds is misleading. Hospital beds alone are not enough.

As one of the hospitals at the epicenter of the Covid-19 pandemic, we experienced firsthand the value of being part of a large integrated health system that planned together and redeployed additional equipment, doctors, nurses and other staff when we needed it most. That was the correct first line of defense and a strategy we continued as we quadrupled I.C.U. capacity for Elmhurst Hospital and tripled capacity systemwide.

NYC Health + Hospitals’ own large-scale internal patient transfer and transport program was activated in March and proved vital to our system’s ability to transfer nearly 1,000 patients across our 11 hospitals to level load volume and demand from across the city. We moved patients knowing that we had the right team of physicians and staff ready at the other end to provide the right level of care our patients needed.

It was also reassuring to know that the receiving team was informed about our patients thanks to our shared electronic medical record system.

Many elements had to come together to successfully transfer patients stricken with this horrible virus: staff, space, supplies, infection control protocols, transportation systems and technology.

I will be forever grateful for the support we received from our sister public hospitals and to our fearless front-line staff for the many lives they saved.

Israel RochaElmhurst, QueensThe writer is chief executive of NYC Health + Hospitals/Elmhurst.