WSJ. 6/12/2020. By Shalini Ramachandran , Laura Kusisto and Honan
Hasty expansion of facilities by state, city and hospital leaders led to grave mistakes.
New York leaders faced an unanticipated crisis as the new coronavirus overwhelmed the nation’s largest city. Their response was marred by missed warning signs and policies that many health-care workers say put residents at greater risk and led to unnecessary deaths.
In the first few days of March, Gov. Andrew Cuomo and Mayor Bill de Blasio assured New Yorkers things were under control. On March 2, Mr. de Blasio tweeted that people should go see a movie.
Only after the disease had gripped the city’s low-income neighborhoods in early March did Gov. Cuomo and Mayor de Blasio mobilize public and private hospitals to create more beds and intensive- care units. The hasty expansion that ensued, led by New York government leaders and hospital administrators, produced mistakes that helped worsen the crisis, health-care workers say.
The virus has hit New York harder than any other state, cutting through its densely populated urban neighborhoods and devastating the economy. New York state’s death toll of 30,575 accounted for 7% of the world’s deaths and 27% of American deaths as of June 11, according to Johns Hopkins University data.
The Wall Street Journal talked to nearly 90 front-line doctors, nurses, health-care workers, hospital administrators and government officials, and reviewed emails, legal documents and memos, to analyze what went wrong. Among the missteps they identify:
• Improper patient transfers. Some patients were too sick to have been transferred between hospitals. Squabbling between the Cuomo and de Blasio administrations contributed to an uncoordinated effort.
• Insufficient isolation protocols. Hospitals often mixed infected patients with the uninfected early on, and the virus spread to non-Covid-19 units.
• Inadequate staff planning. Hospitals added hundreds of intensive- care beds but not always enough trained staff, leading to improper treatments and overlooked patients dying alone.
• Mixed messages. State, city government and hospital officials kept shifting guidelines about when exposed and ill front-line workers should return to work.
• Overreliance on government sources for key equipment. Hospitals turned to the state and federal government for hundreds of ventilators, but many were faulty or inadequate.
• Procurement-planning gaps. While leaders focused attention on procuring ventilators, hospitals didn’t always provide for adequate supplies of critical resources including oxygen, vital-signs monitors and dialysis machines.
• Incomplete staff-protection policies. Many hospitals provided staff with insufficient protective equipment and testing.
A spokeswoman for Mr. de Blasio, Freddi Goldstein, and a member of Mr. Cuomo’s virus task force, Gareth Rhodes, said the city and state did everything they could to increase hospital capacity and enhance social distancing once the risk became clear. “Ultimately our hospitals withstood the pressure,” Ms. Goldstein said. Kenneth Raske, president of the Greater New York Hospital Association, defended the state and hospitals’ response as remarkable considering the “wartime conditions,” adding: “We have a large, very sophisticated hospital system. It took us to the breaking point.”
One planning lapse showed up in improper patient transfers. More than 1,600 largely Covid-19 patients in two of the state’s largest hospital systems were moved from overloaded hospitals to ones less hit, according to spokespeople for those systems. Some patients arrived in worse condition than when they left, sometimes without names and treatment information, said doctors and nurses at several hospitals. Under normal protocol, only stable patients typically would be transferred, but these people came in with “one foot in the grave,” said Dr. David Buziashvili, who worked many shifts at Bellevue hospital, part of the city’s public system, NYC Health + Hospitals. On one shift there, he was alarmed to see 10 new transfers in beds with little medical information, he said. “That is not how it should be done.”
A Health + Hospitals spokeswoman, Stephanie Guzmán, said the city’s 11-facility hospital system provided “the highest quality care to all New Yorkers.” Only the least-sick patients were transferred between hospitals and their personal information was in a centralized system, she said.
Avery Cohen, a City Hall spokeswoman, blamed the state for denying a request from the city to establish a centralized hub, called a Healthcare Evacuation Call Center, that would have helped better coordinate transfers between hospitals, whether they were private or public. “We were grasping for every tool at our disposal to save as many lives as possible,” Ms. Cohen said. “The state was not interested.” Dani Lever, a spokeswoman for the governor, said that system wasn’t designed for individual patient transfers. She said a state transfer system was created in late March after hundreds of open beds near harder-hit New York City hospitals had gone unnoticed.
The New York state outbreak was extraordinary, and much of the disarray in its hospitals from mid-March on traced to impacts few had anticipated, including the federal government.
The impact was made worse because the city went into the pandemic less prepared than it could have been. The city hospital system has long been considered underfunded. Private hospitals in the outer boroughs, particularly Queens, had closed over the years. New York hospitals had long ignored alarms by the nurses’ union and respiratory therapists about insufficient staffing levels, according to nurses and respiratory therapists at several city hospitals.
A contributing factor was New York leaders’ delayed reaction. Early signs of the virus’s arrival—including a rise in patients with flulike symptoms visiting hospitals—went largely un-investigated by hospital, state and city officials. Throughout February in calls with hospitals, the city health department played down the possibility the virus could spread through the air or by asymptomatic people.
In early March at Health + Hospitals’ Elmhurst, Dr. Chad Meyers and his colleagues in the emergency room worried they were missing community spread of Covid-19. But when they called the city’s health department to get patients tested, it rejected for testing even many patients who satisfied the criteria, Dr. Meyers said, leading to “often protracted and unproductive calls” with the department.
Hospital, city and state officials said they were relying on the federal government for testing capability and were limited by criteria set by the Centers for Disease Control and Prevention on whom they could test. Jason McDonald, a CDC spokesman, said: “CDC testing guidance has always allowed for clinical discretion. So, while we set guidelines, states and health-care providers have had the flexibility to determine who to test.”
In an April interview, Health + Hospitals Chief Executive Mitchell Katz said the system prepared as best it could, given the difficulties of building additional space in already-full hospitals. In a May 15 city council meeting, he said he should have acted quicker.
While leaders in states like California and Ohio acted quickly to contain the spread, Messrs. Cuomo and de Blasio delayed taking measures to close the state and city even as the number of cases swelled, despite warnings from doctors, nurses and schoolteachers. California issued a statewide lockdown with 1,005 cases as of March 19, while New York remained open with 5,704 cases, according to updated Johns Hopkins data.
Even after New York announced its first coronavirus case on March 1, the city health department was advising New Yorkers they were more likely to get the flu. “I speak for the mayor also on this one—we think we have the best healthcare system on the planet,” Mr. Cuomo said at a March 2 news conference.
Five days later, Mr. Cuomo declared a state of emergency, but medical and emergency-response experts worried the city and state administrations still weren’t taking matters seriously enough. Richard Serino, an adviser to the city, told a senior aide to Mr. de Blasio early on March 13 that he was “concerned about the cavalier attitude of the hospital community” in the city, especially compared with other cities like Boston, according to an email. Officials with the city’s emergency-management agency agreed, according to people familiar with the matter. Mr. Serino in April said he didn’t recall the email and praised the city’s response.