The pace at which people are leaving hospitals in Suffolk County continues to be higher than the rate at which residents are entering, easing the burden on health care workers and on a system pushed close to capacity two weeks ago.
Over the last day, the number of people in hospitals from complications related to Covid-19 declined by 41 to 1,134.
“That’s still a very big number, but is much lower than its peak level,” County Executive Steve Bellone (D) said on his daily conference call with reporters.
The number of people who are using Intensive Care Unit beds fell by 10 to 443.
At the same time, 109 residents have been discharged from the hospital.
“We wish them a speedy, continued recovery,” Bellone said.
Meanwhile, Gov. Andrew Cuomo announced the initial preliminary plans for reopening the state. Phase 1, he said, would include opening it up for construction and manufacturing with “low risk.” Phase 2 would include a matrix of other nonessential businesses. There would be a two-week period in between each phase to monitor the effects. It would also be in coordination with surrounding states.
No large places that would facilitate gathering would open during that time of transition, the governor said. The first businesses to reopen would likely be upstate, which has seen much less impact than the downstate counties have seen.
Suffolk County delivered another 210,000 pieces of personal protective equipment yesterday. The county also received supplies from the Federal Emergency Management Agency, which include 7,100 gloves, 800 face shields, 5,000 surgical masks, hundreds of protective suits, hand sanitizer, Clorox wipes and ice packs.
Bellone offered his thanks to Rep. Lee Zeldin (R-NY-1) on delivering personal protective equipment.
The county executive also highlighted the United Way Covid19 Fund, which provides support to people in need who have lost their jobs or have been furloughed. People interested in seeking support from the fund can go to UnitedWayLI.org.
Bellone highlighted the rescue efforts of Matthew Honce of East Patchogue, who pulled a Medford man who was treading water out of Bellport Bay on Saturday. The man had been treading water for 15 minutes when Honce pulled him out.
“I want to say a big thank you to a good samaritan, who is a great example of the kind of people we have in this county,” Bellone said. “What could have been a tragedy [wasn’t]” thanks to Honce and the Suffolk County Marine Bureau.
Two weeks have made a huge difference for the health care community in the fight against COVID-19.
On April 10, hospitals throughout Suffolk County were struggling as 1,658 residents needed medical help to cope with the symptoms related to COVID-19. At the time, the Army Corps. of Engineers was racing to construct a hospital extension at Stony Brook that might handle more cases if the county continued on its trajectory.
Fortunately, the number of hospitalizations turned around, falling for the first time two days later, beginning a trend, with a few rises here and there, of fewer hospitalizations.
Indeed, over the last day, the number of people in Suffolk County hospitals declined by 143 people to 1,175, which means that, from the peak, the number of people separated from their homes and families has declined by over 29 percent.
This is “ great news,” County Executive Steve Bellone (D) said on his daily conference call with reporters. Bellone has been in the unenviable position of sharing details about the numbers of people who have been sick or who have died each day. The reduction in hospitalizations is a “huge jump, which is much higher than we’ve seen over the past few weeks,” he said.
Indeed, looking back to the dark days when the county became an epicenter for the virus, Bellone said his team had to discuss where to create a makeshift morgue, in the event that those who died exceeded the county’s capacity.
The county had considered using an ice rink as a temporary facility. Bellone nixed that, recognizing that children would eventually skate on that rink again. Instead, the county found an old processing facility, which they hoped they wouldn’t have to use but “unfortunately we have.”
As the Army Corps. of Engineers completed the construction of the Stony Brook Hospital Extension, Bellone again hoped the county wouldn’t need the additional hospital beds. So far, that has been the case, which, the county executive said, is a tribute to the residents who have respected social distancing rules and who have endured economic hardship as they have shuttered their businesses and remained at home.
The hospital extension is “empty today because of what everyone has been doing, because of the sacrifices that are being made right now,” Bellone said. “We have seen the incredible courage and bravery that has been displayed by health care workers and first responder agencies who have put themselves at risk. That is the reason why that hospital stands empty today.”
Gov. Andrew Cuomo announced new testing initiatives for those “essential” employees, including restaurant workers, grocery store workers, banks, laundromats and gas stations, just to name a few examples. The governor added it could be used for health care workers.
Testing of this kind is largely going to be handled by pharmacies. Cuomo said he will be signing an executive order allowing 5,000 independent pharmacies access to the testing.
In the last 24 hours, the number of people who have been discharged from the hospital has increased to 147, which is “another great number and a positive sign,” Bellone said.
The Intensive Care Unit has also experienced a drop in the number of patients, with a decline of 25 to 453.
The number of ICU beds currently available is 179, which is more than four times the number of beds available on April 10th, when the ICU had a low of 43 remaining beds in that unit.
Over the last 24 hours, the number of residents testing positive for Covid-19 has increased by 891 to 32,185, Bellone said. In total, the six hotspot sites have now conducted tests on 1,916 residents.
While the public health trends have been improving, the number of families who have suffered irretrievable losses through the pandemic have also passed a horrific milestone. Over the last 24 hours, the number of people who have died was 49, which means that one Suffolk County resident passed away each half hour. The total number of dead in Suffolk County from complications related to coroanvirus has climbed over 1,000, reaching 1,042.
The number of people who have died “continues to be staggering,” Bellone said, as he offered his thoughts and prayers to those who mourn the loss of family, friends, and neighbors.
Bellone’s office continues to look for personal protective equipment to help first responders and health care workers who are looking to heal and provide comfort to those afflicted with the disease. Bellone’s office has received another 100,000 ear loop masks and 3,000 face shields as a part of the county’s procurement order.
Continuing a process that began yesterday at a Stop & Shop in West Babylon, Bellone distributed cloth face coverings that he received from the federal and state governments to seniors at Leisure Village, Leisure Knolls and Leisure Glen. He was joined by Sarah Anker (D-Mt. Sinai).
“People were very happy to receive those face coverings,” Bellone said. “It’s important to distribute those out to the most vulnerable in our community.”
Bellone said the distribution plan for those face coverings would also include people who live in hotspot communities.
“We will be working with community-based organizations to identify need,” Bellone said.
For those looking to get back on the links, Bellone said golf courses will reopen starting on Monday, in line with the state policy. Golfers will be expected to follow social distancing guidelines and will need to spread out tee times by 15 minutes. Golfers can not use carts.
“If you want to come out, you have to walk the course, follow the additional guidance that is in place to reduce contact and help prevent transmission of the virus,” Bellone said.
In his ongoing effort to provide temporary property tax relief, Suffolk County Executive Steve Bellone (D) spoke with Treasury Secretary Steve Mnuchin last night.
Bellone said the conversation was “positive” and he hopes to hear back soon about whether Suffolk County, which is short of the required population size, can access the municipal liquidity fund.
Bellone thanked Rep. Lee Zeldin (R-NY-1) for facilitating the call and supporting the county’s bid to tap into short term borrowing created by the federal CARES Act.
Bellone also announced that former County Attorney Dennis Cohen would return to his former role.
“This is even more critical to us now because of he crisis and because of the long road ahead on recovery we know we will have,” Bellone said on his daily conference call with reporters.
As testing continues throughout Long Island, including at hotspots including Coram which began today, the number of people who have a positive diagnosis for COVID-19 has continued to climb. For the first time in several days, that number rose by over 1,000, bringing the total to 31,294.
“That is higher than what we’ve been seeing over the last week,” Bellone said.
Bellone also announced that the county was piloting a food assistance program at the Brentwood testing site.
On the state side, Gov. Andrew Cuomo (D) said he would soon be making a decision whether schools will be closed for the rest of the school year. The question will depend on where they see the resiliency of the virus, and also ongoing fears for another peak somewhere later in the year. Doctors are concerned that peak could come at a time when the nation would be going through its regular flu season as well.
On the positive side, total hospitalizations continue to decline, driven down by another triple digit number of discharges.
The total hospitalizations fell by 22 to 1,318. The number of people in Intensive Care Unit beds also declined by 16 to 478.
The ICU decline “is very good news,” Bellone said.
The number of people who have left the hospital over the last day was 132.
The number of people who died rose by 34 to 993. That includes the first Long Island Railroad Employee who passed away from complications related to coronavirus.
“I want to acknowledge and thank the employees of the Long Island Railroad today,” Bellone said. They have “stood up and met the challenge” created by COVID-19 and have “done an amazing job.”
Several weeks after viral hotspot testing sites in Suffolk County opened, the percentage of positive tests is coming back higher than for other areas.
After 1,077 people were tested in six sites, including Huntington Station and Wyandanch, 577 people tested positive for the virus that causes COVID-19.
“That is definitely a lot higher than the overall number in the county, which stands at 40 percent,” County Executive Steve Bellone (D) said on his daily conference call with reporters.
By testing in these communities, the county hopes not only to get an idea of the rate of infection in these areas, but also to communicate the importance of social distancing and isolating for people who have positive tests.
“By doing the testing, we have the direct one-on-one contact with patients and it is with Spanish speaking health professionals who can have an effective dialog,” Bellone said. The communication is “well-received by the patients.”
For some residents who live in more densely populated areas or who share a home with others who might have underlying medical conditions or whose age makes them vulnerable to the virus, the county has offered housing on a case-by-case bases, Bellone said. That has included hotels and shelters.
These situations could include people who are “coming out of a hospital where there is an issue in a home with vulnerable people,” Bellone said. “It’s not just with hotspot areas.”
Bellone also shared the results of broader testing throughout New York that Gov. Andrew Cuomo (D) has conducted to determine the rate of infection, which could include people who were asymptomatic or who had mild symptoms that dissipated quickly enough not to merit testing.
Based on preliminary data, Suffolk County could have about 250,000 people who have the coronavirus that causes COVID-19.
If that’s the case, “that tells us that there are a huge number of people who have had the virus and didn’t know they had it,” Bellone said. A scaled up testing program to detect the presence or the virus or of antibodies, along with an aggressive contact tracing program, could enable the county to contain the virus.
That could mean that Suffolk County could “reopen our economy with protective measures in place,” Bellone said. The testing and contact tracing, which former New York City Mayor Michael Bloomberg and Johns Hopkins University committed to supporting, are “very good news,” with the caveat that the county needs to “see those full results,” Bellone added.
The number of people who tested positive in the county in the last day was 709, which means that more than 30,000 people have received positive tests for the coronavirus.
The closely-watched hospitalization number dropped again in the last day, falling by 37 to 1,340 residents. The number of people in Intensive Care Unit beds has also declined by five to 494.
For the second straight day, about 10 percent of the population of people with COVID-19, or 131 people, have been discharged from the hospital.
The death toll also continues to climb towards 1,000, with 33 people dying from complications related to COVID-19, bringing the number for the county to 959.
On the supply front, the county executive’s office distributed over 24,000 pieces of personal protective equipment yesterday. The county also received 80,000 ear loop masks from New York State.
The procurement team in Bellone’s office received 27,000 isolation gowns, which have been in short supply and high demand.
The Stony Brook University Hospital extension, which was an all-out effort as the hospitalization was climbing dramatically, is completed. The beds at the facility are not occupied.
“I don’t think there are plans right now” to use those beds, Bellone said. “We are working to prevent a second wave rom happening. We know that has happened in past pandemics.”
Dr. Bettina Fries and her neighbor Agjah Libohova holding new face shields that will soon be put into the PPE pipeline at Stony Brook Medicine and many metro area hospitals. Photo from SBU
Her forecast calls for a better summer and a difficult fall and winter.
Bettina Fries, the Chief of the Division of Infectious Diseases at Stony Brook Renaissance School of Medicine, sees improvements in the battle against COVID-19 over the next few months, and then a return of stormy weather in the winter.
There will be “much, much less cases in the summer. The reason is that people are more outside and there is less tightness together, but we have to be careful.”
Indeed, a decline in cases of COVID-19 won’t signal a victory over the virus. As the fall approaches, a second wave could exacerbate the typical arrival of the seasonal flu.
“We have a hard winter ahead of us,” Fries acknowledged. As one of several principal investigators involved in efforts to develop an effective treatment for the virus, Fries is working to mitigate the effect of the pandemic.
Fries is overseeing Stony Brook’s involvement in a trial of Regeneron’s drug Sarilumab, which blocks the binding of interleukin-6 to its receptor. The Food and Drug Administration has already approved the drug to treat juvenile rheumatoid arthritis and for the cytokine storm brought on by the treatment of acute leukemia with CAR-T cells.
The work at Stony Brook is a part of Regeneron’s tests in 50 medical centers. At this point, Fries has recruited three of the six patients who will receive the treatment.
Stony Brook is also involved in other studies of potential therapeutics. Sharon Nachman, the chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, has given Remdesivir to two patients with severe symptoms. The drug, which was developed to treat Ebola and Marburg, targets and inhibits the RNA polymerase.
Meanwhile, Elliot Bennet-Guerrero, the Medical Director for Perioperative Quality and Patient Safety for Stony Brook Medicine plans to start a clinical trial of donated, post-convalescent plasma from COVID-19 patients. This approach dates back over 100 years, when serum made from immunized animals helped treat diphtheria.
While each of these approaches could provide relief and extend the lives of people suffering from the virus, Fries doesn’t expect a return to some semblance of normal until the development of a reliable vaccine, which could take another year or more.
Fries sees a potential legal battle developing as countries race to produce a vaccine. She believes the World Health Organization is the group most likely to succeed in ensuring that any effective treatment benefits all of humanity and not just the company or country in which it originated.
“The only organization in my opinion that would be able and have international support to oversee this and make sure this vaccine becomes accessible to everyone and is not getting hung up in patent or licensing disputes is the World Health Organization,” Fries said.
Fries said she believes the international community needs to come to an agreement well before scientists develop an effective vaccine.
“We need everybody in this world to become vaccinated,” Fries said. “It’s really important before we have a vaccine that the international community starts agreeing on what we are going to do if company XYZ in South Korea has the super vaccine first.”
Fries suggested that the American withdrawal from the WHO could prove to be a costly mistake to public health and to global efforts to combat the pandemic.
“Chances are high that the Chinese or Germans or South Koreans will have a vaccine before we do,” Fries said.
As for COVID-19, Fries said the consensus for the infection rate has changed over the last few months, as the virus has spread throughout the world. Indeed, each person who gets the virus now spreads it to about 5.7 other people, which is considerably higher than the rate of between 2.2 and 2.7 researchers had expected from earlier information.
While people who have endured life-threatening symptoms can become infectious, people are generally infectious before they are symptomatic.
As states and countries consider reopening from quarantines, lockdowns and shelter-in-place mandates, Fries said the most effective approach would likely involve a modified reopening with behavioral changes.
Hospitals and urgent care centers can and have changed the way they interact with residents who come into the emergency rooms. The longer-term transition for other businesses and enterprises is more challenging.
Bringing students back to colleges remains a difficult decision that schools around the country face over the next few months, particularly amid a situation in which information about hospitalization, mortality, and testing change by the day.
Sports like swimming and tennis may be able to resume without too many public health alterations, while opera and movie theaters may be more limited in how they can entertain audiences.
Separately, many people have already altered their health care routines, avoiding practices and procedures that could extend the quality and years of their lives. People may not have gotten their chemotherapy and may have missed the chance to get bypass surgery or stents.
“There’s collateral damage we don’t even know yet,” Fries said, “That’s going to be huge.”
Even if the mortality rate is closer to 0.5 percent, the overall number of infections and hospitalizations have “hijacked” the health care system, which can lead to a lower level of care for everyone else, Fries said.
The health care system has been “completely emergency-based for the last 50 days,” Fries observed.
As the country and world approach what might be more of a summer reduction in the numbers, Fries urged ongoing vigilance, even if there are no new cases for an entire month. She suggested that governmental oversight and regulation in connection with a strong health department can help manage through the next wave of cases.
The health care system has had to conquer the seemingly intractable problem of viral deaths, such as from the human immunodeficiency virus, or HIV.
COVID-19 is “very similar in the sense that there was so much despair at the beginning,” Fries said. “When you don’t have a cure, you need to attack a disease with different methods and be okay that you’re not going to cure it, but that you’re going to contain it.”
Fries urged patience as people confront the uncertainty ahead. The ongoing use of masks can help people confront the public health threat that she hopes a vaccine helps conquer.
One of the many clear lessons from this crisis, Fries said, is that those dealing with the public health threat needed to approach it with an understanding of the disruption to the supply chains, with everything from personal protective equipment shortages to ventilators in the right places to adequate staffing of doctors, nurses and other health care professionals.
The garment industry in New York is starting to make plastic coats, Fries said. “Why didn’t we start making that eight weeks ago?”
The same approach also applies to medicines. A multi-disciplinary approach using artificial intelligence could anticipate what hospitals and urgent care centers need, bringing the necessary and vital field of supply chain logistics into this enormous effort.
Ultimately, Fries expects a balance between best practices to keep people safe and the human need for interaction and full engagement professionally and socially.
“We can’t have everybody stay at home,” Fries said. “We have to find a new way of interacting and seeing each other.”
This article was amended April 24 to change the nature in which the drug Remdesivir works.
LI State Veterans Home has gone through much hardship since the start of the coronavirus pandemic. Image from Google Maps
By Rich Acritelli
“Never was so much owed by so many to so few.”
Fred Sganga, right, hands a plaque to Battle of the Bulge veteran Tom Struminski at an event last year. File photo by Kyle Barr
These words of heroic national service by Winston Churchill Aug. 20, 1940, have been surely witnessed by U.S. citizens since the start of the COVID-19 health crisis. Feeling immensely proud of his staff and echoing these powerful sentiments is Executive Director Fred Sganga of the Long Island State Veterans Home at Stony Brook. He stated just how thankful and proud he was of his 675 employees who have done everything possible to treat the veterans of this facility. From the moment that this virus hit the nation, these health care workers and support staff are on the front lines to ensure that this nursing home has taken care of their patients through the terrible rise of COVID-19.
Currently, there are five New York State Veterans Homes that are facing staggering difficulties since the initial spread of the virus. While this pandemic has impacted all age groups, older generations are the most susceptible from being impacted by the ferocity of this sickness. For over 19 years, Sganga has led the vets home through many difficult moments, but it’s possible this scenario could be the most challenging point of his career. On March 10, Sganga ordered the complete lockdown of operations the nursing home, restricting access from the outside. Looking at the website of this hospital, it has been a transparent effort by Sganga and his staff to speak about the daunting issues that has faced both the workers and residents of the veteran’s home.
Covered in protective gear from head to toe, masks and shields, the staff has been working in hazardous conditions to treat veterans who have greatly sacrificed for this nation. Sganga said he is incredibly proud of his faculty’s ability to not only take care for their patients, but to serve as surrogate family members. For over 40 days, many of these residents have not seen their loved ones and the doctors, nurses, aides, housekeeping and maintenance cadre have engaged these older men and women with a consistent foundation of love and support.
One of the biggest concerns that Sganga’s staff must handle with the patients who are already battling serious ailments and respiratory problems. The sickness has impacted the COVID units of this nursing home with 57 residents to date that have tested positive. Sganga identifies how this hospital has dealt with the positive cases by not allowing cross contamination between the various health care units. He considers this a deadly “chess game” where he’s made to use every possible strategy to contain the expansion of the virus within the hospital.
These heavy health strains on the elderly population are apparent as the vets facility, which as of press time has lost 41 people, according to Sganga. While this is a tumultuous time, Sganga has continually stressed the determination of his staff to show up to work every day and to help those men and women residents that have sacrificed for the defense of the nation. Like that of the families, these staff members grieve at the loss of residents that they have grown to known through many special bonds. They have had to adapt to the many unknowns of the virus and decipher through the multitudes of guidance coming from the state and federal government. And through the spirit of cooperation amongst the team, every person plays an important role in carrying out these policies to protect the residents during these harrowing times.
Much can also be said about the wonderful job that Sganga has done during his tenure at this home for almost two decades. Vietnam vet and Rocky Point VFW Post Commander Joe Cognitore said, “Sganga demonstrates the highest traits that a leader of any major organization can exhibit to lead and care for others. During the height of this crisis, he has the pulse of every staff member and the people that reside in this home. He is a self-starter and a delegator of plans to properly guard against this massive epidemic. Words are not enough to express his strength as a decisive figure to always assist others.These sentiments are presented through my experiences as a patient that was flawlessly treated by this hospital. His spirit is easily seen through the endearing qualities of all his personnel that are always motivated to do their duty.”
Once this tragic virus began to escalate in widespread positive cases and deaths, the vets home has followed many directives from the U.S. Center for Disease Control, New York Department of Health, the Veterans Administration and Center for Medicare and Medicaid Services. Almost every day, Gov. Andrew Cuomo (D) speaks at daily press conferences outlining the risks of the elderly in the nursing homes and the devoted care in places like that of Stony Brook that has continually met their growing needs.
Presently, there are over 45,000 deaths from COVID-19 in the U.S., with New York making up a third of these figures by nearly 15,000. Out of these numbers, experts say nearly a fifth of virus deaths have come from nursing facilities, and the fear is that more could to be taken from the brutality of the virus. Right now, there are health care workers and patients that have deteriorated quickly and passed away without any major signs of this sickness.
Until recently, there were not enough testing kits for nursing homes like that of the Long Island State Veterans Home to even test their own workers. Cuomo recently stated that the goal of New York was to start testing 40,000 people every day, but there are many workers that were unable to know if they were safe from this virus. Through the entire interview, Sganga could not thank his staff enough for the absolute determination of his colleagues to stay the course in helping the elderly fight this illness. It has been a hard time for this staff, but they never shied away from their ultimate mission of protecting these men and women that sacrificed greatly for this nation. According to Cognitore, “even during the darkest moments of this crisis, Sganga’s employees and volunteers have diligently worked above and beyond the call of duty to protect the veterans against this uphill medical war to defeat the ongoing spread of COVID-19.”
Rich Acritelli is a social studies teacher at Rocky Point High School and an adjunct professor of American history at Suffolk County Community College.
From left, John Brittelli, Jon Longtin, and Dimitris Assanis, who are working on an early prototype of the CoreVent 2020. Photo from Stony Brook University.
Working against time and a potential shortage of life-saving ventilators, Stony Brook University scientists designed their own version, which they hoped no one would have to use.
In the course of 10 days, a team led by Jon Longtin, College of Engineering and Applied Sciences Associate Dean of Research and Entrepreneurship and professor of mechanical engineering, designed, built and tested a cheaper and easier ventilator, which they called CoreVent2020. They have spoken with a company in Shirley called Biodex Medical Systems, which could make as many as 30 of the originally crafted machines per day.
“It was an all-encompassing task,” Longtin said. “When we started this, COVID-19 cases were growing exponentially in the New York area. By following the curve at that point, we were going to run out of ventilators in a matter of one or two weeks.”
Indeed, just a few weeks ago, Suffolk County and New York State were still climbing the curve, without knowing when the peak would arrive. That meant that each day, the number of people hospitalized increased dramatically, as did the number of people who needed ventilators in the Intensive Care Unit.
The parts for the system Longtin, John Brittelli, a clinical professor in the Respiratory Care Program, and Dmitris Assanis, an assistant professor of mechanical engineering at Stony Brook, created cost about $2,000. This includes the cost for the arduino control panel, which is a computer board people have programmed to run their washing machines and to turn on lamps. The total cost compares with a price tag of about $30,000 for a regular ventilator.
The CoreVent 2020 favors a hospital setting, Longtin said, because it runs on medical compressed oxygen and compressed air.
“Most hospitals have compressed air, which we were able to use to make the design much simpler,” Longtin said.
Chris Paige, an anesthesiologist at Stony Brook University Hospital who worked on the ventilator, coined the term CoreVent, which suggests a “core” set of needed capabilities, but nothing more, Longtin explained in an email.
The researchers wanted to create a machine that didn’t have any proprietary parts, which would make the manufacture and distribution of the system considerably easier. The researchers wanted to make sure they could get the parts they needed and could still move forward even if a particular part from a specific manufacturer wasn’t available.
“Anything we used, we could buy from a number of different suppliers,” Longtin said. “As long as the specifications were the same, the design was simple and reliable.”
Longtin said the limits of time and resources, akin to the engineers at the National Aeronautics and Space Administration who helped bring home the damaged Apollo 13 rocket with its three-member crew, were omnipresent in designing and building the alternative ventilator system.
Longtin was grateful for the help and support of people in the engineering and medical side.
Longtin said he appreciated the opportunity to work together with his colleagues in the medical community and not only to build this alternative ventilator but also to build relationships across the Stony Brook community.
“I look forward to building upon these new relationships for other projects,” Longtin said. “Engineering and medicine will take a serious look at this and ask how we can work together to be more prepared in the future.”
St. Charles Hospital in Port Jeff plays "Here Comes the Sun" every time a patient is discharged during the coronavirus pandemic. Photo by Kyle Barr
St. Charles Hospital ICU nurse Kacey McIntee, walking through the halls of a hospital in the midst of a pandemic, is just one ofscores of RNs who have watched their world flip the wrong way around.
Where once the hospital had one Intensive Care Unit, now it has three. Every time she gets to work, she slips into hospital-issued scrubs and she’s assigned to one of the three units. Every single bed is housing a patient on a ventilator, nearly 40 in all. She’s bedecked in a mask, hair covering and face shield.
Nursing Assistant Martha Munoz is working at St. Charles Hospital during the pandemic
Typically, the ratio is two ICU patients to one ICU nurse. However, now there are cases where she cares for up to three patients, alongside a helper nurse. She starts her day by looking at her assigned patients’ charts, and then spends the rest of her 12-hour shift doing her best to keep these patients, many in such dire straits, alive.
“A lot of times you can kind of expect something is going to go bad just based on blood values alone,” she said. “We mentally prepare ourselves for the worst-case scenario with our patients.”
It’s a common story among many medical centers, but local hospitals St. Catherine of Siena Medical Center in Smithtown and Port Jefferson’s St. Charles, both in the Catholic Health Services system, have been on the front lines of fighting the virus for longer than others, having seen their first COVID-19 positive patients March 8.
Jacquelina VandenAkker, a 33-year veteran respiratory therapist at St. Charles and Port Jeff resident, said while the past week has shown what seems to be a plateauing in the number of new cases, the first 10 days of the virus “was hell. You didn’t know the end of it.”
“We felt it was literally such a war zone. You knew you could be a victim to it because you don’t understand it,” she said.
Hospital officials confirmed there were a number of staff who have contracted COVID-19, but declined to release the number of employeeswho have been infected, citing that staff did not want it known if they’ve been previously infected.
“We see a lot of deaths,” the respiratory therapist said. “I take the same unit. I know my patients. We start to understand the disease a lot more.”
McIntee, a Sound Beach resident, knows the pain and suffering of the COVID-19 patients suffering. It’s hard not to become entangled in the lives of these people, knowing the pain of suffering when the family can only communicate via tablet computer and online video chats.
“Nurses are really, really good at coping mechanisms,” she said. “One of the most useful ones is humor and the other is detachment. We cannot picture our loved ones in the bed — if we hear that one of our loved ones is sick with COVID, all bets are off, we are a mess.”
When it comes to that, when what has universally been the once inconceivable is happening moment to moment, McIntee said they rely on their fellow nurses.
“It’s almost as if we’re all in war together, and we have this bond for life that we will always be connected together, that we had these experiences that really nobody else in the world can experience except during this time,” she said.
The Initial Wave and Beyond
Jim O’Connor, the president of St. Charles and chief administrative officer of St. Catherine of Siena, said hospitals faced initial difficulties but hope things continue to look up.
“Both St. Charles and St. Catherine had their first COVID-19 patient on the same day,” he said. “We struggled to keep up with it and the personal protective equipment we needed in that first week. Thankfully we seem to have gotten our sea legs.”
Dr. Jeffrey Wheeler, the director of St. Charles Hospital Emergency Department
Only about 25 percent of patients who are diagnosed require hospitalization, but of that 25 percent, 50 percent require ICU care, and many of them require a ventilator, O’Connor said.
Even before Gov. Andrew Cuomo’s (D) mandates shutting down all essential businesses, hospital admin said they saw what they call a “surge” of patients.
Bonnie Morales, the director of infection prevention for St. Catherine, said she and other specialists at hospitals around Long Island had started preparing for the “what ifs” a few weeks before it finally came, but even then, it was hard to estimate just how much it would overtake the entire health care system.
“I would have to say we were prepared, but that line list [of staff procedures] I went back to in the beginning, has grown from a page to three pages long,” she said.
The precautions for reducing infections became one of the most supreme considerations with both patients and staff, she said. Morales, a Selden resident, said the average patient on “transmission-based precautions” which were before only meant to help patients and staff avoid contact, has now gone from 20 to 30, up to over 100 that are currently on these transmission-based precautions because of the virus.
The hospitals had what the admin called a surge plan, but as the St. Charles president put it, “a man plans, and God laughs.” Learning just how many beds they would have to increase to was staggering, but he thanked the admin team who worked with barely little notice to start the process of acquiring more beds and space.
After Cuomo announced an executive order mandating hospitals increase their bed capacity by at least 50 percent, St. Charles and St. Catherine have boosted the number of beds to 243 in St. Charles and 296 beds at St. Catherine.
Mike Silverman, the COO at St. Catherine, said early on the hospitals decided to close access to the public. It was something that was unpopular to start, but in hindsight has been a smart decision.
Silverman only joined the hospital little more than two months ago and has had a trial by fire in the truest sense of the phrase.
“I don’t think anybody thought this was going to happen,” he said. “There was no playbook for this … It’s a lot of people doing what needs to be done,” he said.
O’Connor said the hospitals hit a high in the number of patients in the previous weeks, but since they have been climbing, inch by strenuous inch, off of that peak. Since the start of the outbreak, St. Charles has gone from eight ventilators to nearly 37 at peak. St. Catherine had 35 at peak. Each hospital has transformed its space to accommodate the massive number of critical patients by creating two new ICUs in each. All elective surgeries have been suspended and those workers have been moved to aid COVID-19 patients.
“There’s definitely some angst,” Silverman said. “We know how many people are dying in the state, and we would see this many deaths in a week. It’s tough, whether it’s at work, whether its friends or friends’ families.”
Michelle Pekar, in purple scrubs, is part of the St. Charles Emergency Department. Photo by Marilyn Fabbricante
Both admin and health staff agreed the community has done an incredible amount of support for the health care workers. There have been consistent donations of meals, snacks and drinks. There have been a rollout of homemade masks and PPE supplies as well, along with cards and notes thanking the health care workers for all they do.
Still, to say it hasn’t taken an emotional toll would be wrong.
“It has been very tough on the staff because there is a very high mortality rate for people on ventilators,” O’Connor said. “What compounds it we weren’t allowed to have visitors so that really adds a whole different isolation for the patient and the families.”
The hospital has been using tablet computers to connect patients with family members at home, but it has also meant having to give them difficult news about those family members remotely.
“They have their own fears understandably about it. They have their own families they go home to that they worry about spreading it to,” he said. “I give them so much credit for them to put themselves at risk to be in a room with someone with a contagious disease.”
There have been moments of hope throughout the day in between the darkness. Every time a patient comes off a ventilator, the hospital plays “Breathe” by Faith Hill over the loudspeaker. When a patient is dismissed from the hospital, they then play the classic Beatles song “Here Comes the Sun.”
Hospitals’ PPE
O’Connor said the hospitals sterilize the PPE used by hospital workers at the end of each shift, and after the N95 is used three times then it is discarded, though if it becomes “soiled or contaminated” then it is discarded before that. Normally, such masks are not designed to be reused, but with supplies tight, hospitals and other medical centers have been looking to get as much use out of equipment as possible.
Susie Owens of St. Charles Hospital delivered a special message to her colleagues in chalk. Photo from St. Charles Facebook
“We know it is not a perfect system,” O’Connor said. “Nobody expected to have this patient volume, but I think we’ve done a good job, but is it perfect? No.”
The federal Office of Emergency Management has added to supplies, along with donations from companies and other local individuals. The U.S. Centers for Disease Control has made guidelines for decontaminating such equipment, and hospital administration said they are following those guidelines. Catholic health systems announced earlier this month they had created an ultraviolet light sterilization system for masks in CHS hospitals.
The New York State Nurses Association has taken issue with the hospital’s practice of reusing such PPE as N95 masks after they’ve been sterilized. The union points to mask manufacturer 3M, who said there were no disinfection methods that would kill the virus and maintain effectiveness, though the CDC’s website cites numerous sources related to the positive results of disinfecting such masks.
Though a union representative could not be reached by press time, nurse representatives have spoken to other news outlets saying that both hospitals lacked PPE supplies, and that unlike systems, nurses in St. Charles and St. Catherine were made to wear gowns for an entire shift that are meant to be disposed of after one patient encounter.
McIntee said at the start of the pandemic, things were confused with PPE, with the CDC changing its guidelines constantly. Regarding gowns, she said hospital workers have a choice, they can either spray down reusable gowns with a cleaning solution in between patients, use disposable blue/plastic gowns, or the so-called bunny suits, the full-body white suits with a hood. With face shields, there are no other choices than rinsing it with solution.
Now, McIntee said if a worker wears an N95 mask continuously throughout the day in a 12-hour shift, they can discard them. If they wear them intermittently throughout the day, then they are bagged and sent to be sterilized at night. Sterilized masks then can be worn intermittently three more days before they are discarded.
“Not once have I ever had an issue with the N95 masks being told ‘no, you can’t have one,’” she said. “I’ve always been able to have access to any PPE I wanted … Now I think we have a system down, and it’s less anxiety.”
St. Catherine April 22 accepted a donation of gowns and masks from the Kings Park Chamber of Commerce, and Morales said the bevy of donations they have received have truly helped in the fight against COVID-19. The hospital has received donations of tie back and bunny suits.
Regarding St. Catherine staff reusing gowns, Morales said “We are giving out supplies for the staff to utilize and they have what they need in order to take care of their patients.”
O’Connor said the hospitals have been doing multiple things to aid the front line workers, including bringing in agency staff and repurposing staff from outpatient to inpatient services to add more hands on deck. The hospitals have developed quiet rooms for staff to catch their breath, and Silverman said St. Catherine has a service where staff can purchase basic items, they have little time to get from working long days during the pandemic.
“It would be very foolish for us to not keep our staff safe,” O’Connor said. “Why would we possibly not be doing anything we can to keep them safe?”
Immune system regulation is complex and involves over 1,000 genes
By David Dunaief, M.D.
Dr. David Dunaief
Autoimmune diseases affect more than seven percent of the U.S. population, most of them women. More than 80 conditions have autoimmunity implications (1). Among the most common are rheumatoid arthritis (RA), lupus, thyroid (hypo and hyper), psoriasis, multiple sclerosis and inflammatory bowel disease.
In all autoimmune diseases, the immune system inappropriately attacks organs, cells and tissues of the body, causing chronic inflammation. Chronic inflammation is the main consequence of immune system dysfunction, and it is the underlying theme tying these diseases together. Unfortunately, autoimmune diseases tend to cluster (2). Once you have one, you are at high risk for acquiring others.
Drug treatments
The mainstay of treatment is immunosuppressives. In RA, where there is swelling of joints bilaterally, a typical drug regimen includes methotrexate and TNF (tumor necrosis factor) alpha inhibitors, like Remicade (infliximab). These therapies seem to reduce underlying inflammation by suppressing the immune system and interfering with inflammatory factors, such as TNF-alpha. Disease-modifying anti-rheumatic drugs (DMARDs), a class that also includes Plaquenil (hydroxychloroquine), may slow or stop the progression of joint destruction and increase physical functioning.
However, there are several concerning factors with these drugs. First, the side effect profile is substantial. It includes the risk of cancers, opportunistic infections and even death, according to black box warnings (the strongest warning by the FDA) (3). Opportunistic infections include diseases like tuberculosis and invasive fungal infections.
It is no surprise that suppressing the immune system would result in increased infection rates. Nor is it surprising that cancer rates would increase, since the immune system helps to fend off malignancies. In fact, a study showed that after 10 years of therapy, the risk of cancer increased by approximately fourfold with the use of immunosuppressives (4).
Tangentially, there is also concern that these drugs might make those who contract COVID-19 more susceptible to severe symptoms and consequences. On the flip side, some are being studied to determine whether they can improve outcomes for others by suppressing immune system overreactions.
Second, these drugs were tested and approved using short-term randomized clinical trials, but many patients are prescribed these therapies for 20 or more years.
So, what other methods are available to treat autoimmune diseases? These include medical nutrition therapy using bioactive compounds, which have immunomodulatory (immune system regulation) effects on inflammatory factors and on gene expression and supplementation.
Nutrition and inflammation
Raising the level of beta-cryptoxanthin, a carotenoid bioactive food component, by a modest amount has a substantial impact in preventing RA. While I have not found studies that specifically tested diet in RA treatment, there is a study that looked at the Mediterranean-type diet in 112 older patients where there was a significant decrease in inflammatory markers, including CRP (5).
In another study, participants showed a substantial reduction in CRP with increased flavonoid levels, an antioxidant, from vegetables and apples. Astaxanthin, a carotenoid found in fish, was shown to significantly reduce a host of inflammatory factors in mice, including TNF-alpha (6).
Fish oil
Fish oil helps your immune system by reducing inflammation and improving your blood chemistry, affecting as many as 1,040 genes (7). In a randomized clinical study, 1.8 grams of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) supplementation had anti-inflammatory effects, suppressing cell signals and transcription factors (proteins involved with gene expression) that are pro-inflammatory, such as NFkB.
In RA patients, fish oil helps suppress cartilage degradative enzymes, while also having an anti-inflammatory effect (8). When treating patients with autoimmune disease, I typically suggest about 2 grams of EPA plus DHA to help regulate their immune systems. Don’t take these high doses of fish oil without consulting your doctor, since fish oil may have blood thinning effects.
Probiotic supplements
The gut contains approximately 70 percent of your immune system. Probiotics, by populating the gut with live beneficial microorganisms, have immune-modulating effects that decrease inflammation and thus are appropriate for autoimmune diseases. Lactobacillus salvirus and Bifidobacterium longum infantis are two strains that were shown to have positive effects (9, 10).
In a study with Crohn’s disease patients, L. casei and L. bulgaricus reduced the inflammatory factor, TNF-alpha (11). To provide balance, I recommend probiotics with Lactobacillus to my patients, especially with autoimmune diseases that affect the intestines, like Crohn’s and ulcerative colitis.
Fiber
Fiber has been shown to modulate inflammation by reducing biomarkers, such as CRP. In two separate clinical trials, fiber either reduced or prevented high CRP in patients. In one, a randomized clinical trial, 30 grams, or about 1 ounce, of fiber daily from either dietary sources or supplements reduced CRP significantly compared to placebo (12).
In the second trial, which was observational, participants who consumed the highest amount of dietary fiber (greater than 19.5 grams) had reductions in a vast number of inflammatory factors, including CRP, interleukin-1 (IL-1), interleukin-6 (IL-6) and TNF-alpha (13).
Immune system regulation is complex and involves over 1,000 genes, as well as many biomarkers. Dysfunction results in inflammation and potentially autoimmune disease. We know the immune system is highly influenced by bioactive compounds found in high nutrient foods and supplements. Therefore, bioactive compounds may work in tandem with medications and/or may provide the ability to reset the immune system through immunomodulatory effects and thus treat and prevent autoimmune diseases.
*Especially in this time of COVID-19, do not alter your medications, in other words, stop or start medications, without discussing it with your physician first. It is much more important to control the autoimmune disease than tot worry about drug effects on the immune system.
Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.
Centerport Resident Among First to Donate Convalescent Blood Plasma
Dr. Elliott Bennett-Guerrero is leading the clinical trial at Stony Brook Medicine which is expected to enroll up to 500 patients who are hospitalized with COVID-19. Photo from Stony Brook Medicine
Stony Brook Medicine has launched a research study in the hopes of developing a treatment for those severely suffering from the coronavirus.
On April 2, SBM began a U.S. Food and Drug Administration-approved research study to determine if convalescent blood plasma from those who’ve recovered from COVID-19 can help treat currently hospitalized patients. One of the first volunteers was Mark Goidell, a litigation attorney from Centerport.
COVID-19 survivor Mark Goidell donates blood plasma for a research study at SBU. Photo from Stony Brook Medicine
The Research Study
Dr. Elliott Bennett-Guerrero, vice chair of Clinical Research and Innovation in the Renaissance School of Medicine Department of Anesthesiology, is heading up the research study. He said the hospital needs approximately 100 volunteers who have recovered from the coronavirus to donate blood plasma, possibly once a week or every other week. Subjects must have contracted COVID-19 and be free of symptoms for 14 days. As of April 22, the doctor said they have received a large number of inquiries leading to 180 people being screened and 90 have been identified as having high levels of antibodies. Currently 25 have either donated blood plasma or are scheduled to do so.
Bennett-Guerrero said researchers are looking for those with high antibody levels of the virus and testing takes about 15 minutes. The donors must also meet regular criteria to be a blood donor, the doctor said, which includes being at least 17 years old, weighing more than 100 pounds, and having no infections Certain travel outside of the U.S. will also be reviewed.
“We’re very fortunate that we can run this protocol independently, because we have access to a very good test for antibodies, and we also have a licensed blood collection facility already in our hospital,” the doctor said. “So we have those two main ingredients to help us to collect blood plasma and unfortunately have a large number of patients who are in desperate need of help.”
Bennett-Guerrero said the trial will include 500 hospital patients ranging from those who are intubated and those who are not. A higher percentage of patients will receive convalescent serum on a random basis compared to other trials which tend to have 50 percent of patients serve as a control group who receive a placebo.
“Our protocol is unique in that while we want to help as many people as possible, we also want to determine if it’s safe and effective,” the doctor said. “It’s a randomized trial where 80 percent of the patients will receive the convalescent plasma because we hope to benefit as many patients as possible, and there will be a small group of 20 percent of patients that will serve as the control group and get standard plasma. It’s the only way we can rigorously determine if it’s safe and effective to do this.”
Plasma, which is the liquid portion of the blood, helps with clotting and supporting immunity. The hope is the plasma from those who have survived COVID-19 will contain antibodies which in turn can kill the virus in seriously ill patients. According to SBM, convalescent serum therapy is a century-old treatment that has been used in patients during the Spanish Flu pandemic of 1918, the diphtheria epidemic in the U.S. in the 1920s, and more recently, the Ebola outbreak in 2014.
The doctor said it’s too early to determine if giving convalescent blood plasma to a COVID-19 patient will help.
“It’s very early in the stage with this pandemic,” he said. “We’re only beginning to learn what are the patterns of antibody formation in people who had the COVID-19 infection. In general it’s believed that antibodies to COVID-19 will probably persist for a while, perhaps months or years, and likely be protective. However, we don’t know yet if the antibodies that we are measuring actually mean, ‘quote-unquote,’ one is immune and can’t be reinfected. We think that’s probably the case but it’s not proven yet.”
Blood plasma donor Mark Goidell and his wife, Lynn, recently recovered from the coronavirus. Photos from Stony Brook Medicine
The Donor
The doctor said Goidell was a good candidate because he was free of symptoms for a couple of weeks, had high levels of the antibodies in his system and met blood donation criteria.
Both Goidell, 64, and his wife Lynn, 62, came down with the virus. The attorney said he was sick toward the end of February and in early March, and his symptoms included being lethargic and feverish, and at times during the night he would frequently wake up and try to catch his breath, many times going outside to do so.
His wife was admitted to Huntington Hospital March 13 due to having double pneumonia and was discharged a few days later. Goidell said he did have a relapse where he said his symptoms felt like a sinus infection, with a loss of smell and taste. He said he has recovered about 70 percent of those senses.
While his symptoms didn’t initially lead to testing, he said, once his wife was hospitalized he was tested March 17 at an urgent care facility. After reading about the Stony Brook study on the News12 website, Goidell said he was more than willing to participate in the trial.
“It’s heartbreaking to see what’s happening and all the tragedy and anguish that is being brought about by the virus,” Goidell said. “I’m grateful for the fact that I’ve recovered, and I’m able to do something to help.”
He said he feels fortunate to live in close proximity to Stony Brook Medicine. Between his experience with the study so far and his wife’s hospital stay at Huntington Hospital, he has gained an even greater respect and admiration for health care workers. He called those who treated his wife “heroes.”
He added the two of them are now back to working remotely, joking that he has put on some weight due to his wife’s good cooking, and he has been playing a lot of basketball in his driveway to burn off the pounds.
He said he hopes that others who have recovered will donate their plasma, and that others will “stay inside and help each other out.”
“I wish Dr. Bennett-Guerrero and the researchers at Stony Brook the best of luck, and I have the most gratitude for the work they are doing,” he said.
People who have recovered from COVID-19 and want to donate blood plasma can visit www.stonybrookmedicine.edu/COVID_donateplasma where they will be required to fill out an online survey. Potentially eligible people will be asked to participate in a screening visit at a Stony Brook Medicine facility, which will take approximately 30 minutes. You do not need to be a Stony Brook University Hospital patient to participate, but you must meet the required criteria for plasma donation and have high levels of antibodies to the virus that causes COVID-19.
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