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Leaders from Northwell’s Cancer Institute and its Center for Genomic Medicine celebrate the opening of the Molecular Diagnostic Laboratory. From left to right, Joseph Castagnaro, Jeff Boyd, Dwayne Breining, Richard Barakat, Naima Loayza, Anna Razumova, Angelo Carbone, Rita Mercieca and Kathryn Cashin. Photo courtesy of Northwell Health

By Daniel Dunaief

Northwell Health Cancer Institute and its Center for Genomic Medicine opened a Molecular Diagnostics Laboratory, which will reduce the cost of testing and shorten the time to get test results for cancer tests.

At a cost of $3.2 million, the 2,800 square foot facility will use next generation sequencing to provide tumor and patient genomic profiling and to assist in testing for biomarkers and determining the choice of cancer therapy.

The MDL, which is using the space Northwell Health Labs owned, will offer an array of tests in a phased approach. It is starting with a set of single gene tests to inform precision therapies for lung, melanoma, pancreatic, and colorectal cancer, which can be conducted in 24 to 72 hours.

“We like to get cancer therapy started as soon as possible for patients with metastatic disease,” said Jeff Boyd, vice president and chief scientific officer and director of the Northwell Health Cancer Institute’s Center for Genomic Medicine. When Northwell sent out similar tests to for-profit centers, the results, depending on the test, could take weeks.

The MDL is performing these tests on patients with advanced stage disease and/or recurrent diseases, which increases the need to generate results quickly.

“That makes a huge difference for the ordering oncologist and, most especially and importantly to the patient,” said Boyd. “The sooner they can get on precision therapeutics to treat the disease, the better. Outcomes will reflect wait time until you get therapy.”

Northwell treats more New York residents for cancer than any provider in the state, according to the Statewide Planning and Research Cooperative System, inpatient and ambulatory surgery data. 

The center, which is located in Lake Success, started conducting tests several weeks ago.

The lab is using high-end DNA sequencing to extract and define the genomic details of each tumor. Each patient tumor is different, which affects decisions about the best possible treatment.

“When the diagnosis isn’t totally clear to the pathology team, the genetics of the cancer will often inform the diagnosis,” said Boyd. Some patients with the same type of tumor will respond differently to radiation.

The lab is offering four single-gene tests: EGF for non-small cell lung cancer, BRAF for melanoma, KRAS for colorectal, pancreatic and lung cancers, and BRAF/NRAS for melanoma.The MDL plans to offer a 161-gene NGS panel for solid malignancies, a 45-gene NGS panel for hematologic malignancies, and MSI-H, a genetic test that reveals whether tumors will respond to immunotherapy.

Long road

Northwell recruited Boyd to start a molecular diagnostic lab four years ago. He started working in February of 2020, a month before the pandemic caused local, state, national and worldwide disruption.

While he has other responsibilities, Boyd suggested that his “primary reason” for joining Northwell was to “create and direct a Center for Genomic Medicine.”

Northwell conducted extensive physical renovation of the core lab facility that houses the MDL. Northwell also hired six people for the MDL, which includes a lab director, a lab manager, two certified lab technicians, a director of bioinformatics and an LIMS administrator.

In addition, New York State Department of Health had to certify the tests. Northwell is working through certification for additional tests.

Patients don’t need to go to the Lake Success facility to benefit from the services offered by the lab.The cost to patients for these tests is less than it would be for a for profit lab, Boyd said.

“We are a non profit and all we’re looking for is the sustainability of the lab infrastructure,” he added.

At this point, the lab isn’t conducting any germ line testing to determine if there are genetic predispositions to various cancers.

“That might be one of those tests we role out in the future,” Boyd said.

For Boyd, who earned a PhD in toxicology and biochemistry from North Carolina State University in Raleigh, the work is particularly rewarding.

To see his job “impact care tomorrow” based on a particular genetic alteration, “it doesn’t get much better than that for an individual with my background and profession,” he said.

By Daniel Dunaief

Different name, different location, same mission.

On Monday, April 8, Northwell Health opened its family health center at 1572 New York Avenue in Huntington Station. The center will replace the Dolan Family Health Center in Greenlawn.

The new center, which occupies a space formerly held by Capital One Bank, will provide primary care, as well as multi-specialty care for women.

Easily accessible by bus lines, the center is “in the heart of the community we serve” with the majority of the expected 30,000 patient visits each year coming from Huntington Station, said Lee Raifrman, Assistant Vice President of Operations for Huntington Hospital and the Northwell Family Center Health Center. Instead of having patients travel to the center, “we’re moving to them.”

The center anticipates around 30,000 visits per year.

“The new location, nestled in the heart of the neighborhood it serves and conveniently close to bus lines, ensures that our care remains accessible to all,” Stephen Bello, regional executive director of Northwell’s Eastern region, said in a statement.

The almost 18,000 square-foot building will provide pediatric care, adult/ family medicine, OB/GYN, ophthalmology, podiatry, gastroenterology, orthopedics and infectious disease care specific to HIV.

The center’s prenatal care assistance program, which offers expanded Medicaid coverage for pregnant women and children under the age of 19, will continue to operate. The center also provides outreach through its Women, Infants and Children program, a supplemental nutriton offering that features nutritious foods for low-income pregnant, breastfeeding and postpartum women, infants and children through the age of five.

The center also features a Nutrition Pathways Program, which is a collaboration dating to 2020 with Island Harvest that offers personalized nutrition counseling sessions with a registered dietician, access to nutritious foods from the on-site healthy food pantry, referrals to community resources and assistance with SNAP enrollment.

Through Nutrition Pathways, the center screens patients for social determinants of health.

“One of the areas we found that’s becoming more prevalent, unfortunately,” said Raifman. The center directs patients who are food insecure to a registered dietician, who can not only help balance food intake, but who can also manage the financial aspect of finding food.

“Better eating equals improved outcomes,” said Raifman.

Staff at the center reflects the diversity of the patient population.

About 19 percent of the patients are self pay, while a small percentage are on medicare. The center accepts many insurance plans, including all types of medicaid.

Staff at the Family Health Center will reflect a staff that reflects the patient population.

“Our mission is clear: to elevate the health of the communities we serve,” Nick Fitterman, Executive Director of Huntington Hospital said in a statement. “From our homeless to immigrant patients, we open our doors to all, offering care that’s not just accessible but compassionate.”

The hours for the center will be the same as they were in the previous location, opening 8:30 am to 5 pm on Monday and Wednesday and 8 am to 8 pm on Tuesdays and Thursdays.

Northwell executives would like to build similar healthcare facilities in other places within its geographic range.

The health care provider “anticipates replicating this model throughout the system in other under-served communities,” said Raifman.

Nicole Hoefler, director for cardiac cath services at Mather Hospital in the new cardiac catheterization lab. Photo by Julianne Mosher

It’s finally here. 

Mather Hospital announced this week its new cardiac catheterization lab is completed and is ready to serve patients — as soon as it receives its final Department of Health inspection and approval in the upcoming weeks.

According to Nursing Director for Cardiac Cath Services Nicole Hoefler, Mather Hospital in Port Jefferson is joining the few places on Long Island in hosting a cardiac catheterization lab to provide less invasive heart-related services to patients who need it. 

“We’re here to basically help prevent serious heart attacks,” Hoefler said. “And prevent heart attacks that might be evolving.”

The labs specialize in using X-ray guided catheters to help open blockages in coronary arteries or repair the heart in minimally invasive procedures. These range from stenting to angioplasty and bypass surgery — that are less traumatic to the body and speed recovery. 

Photo by Julianne Mosher

“Sometimes, if a patient had a positive stress test, they’ll come in here so we can see what’s causing that pain they might have been having,” she noted. “Sometimes they need to have it for surgery clearance, like if they saw something on their EKG.”

The two new state-of-the-art rooms were approved by Northwell Health last year, alongside three other Northwell facilities. Construction began on the new spaces in August 2020, completing and turning over to the clinical staff on April 19. 

By adding the two labs into Mather, Hoefler said they can help save a life.

“Every minute that passes when you’re having a heart attack slows your heart muscle,” she said. “So not having to transfer the patient out, and just bring them in from upstairs will be life changing.”

Both rooms will be able to accommodate approximately 20 patients per day with the 12 hours the labs are open. 

The addition of the more than 3,000 square foot space is just another space that Mather can now provide patients better.

“I think the community just loves Mather,” Hoefler said. “Having this service
is just another reason to come here.”

Suffolk's own data shows areas with large numbers of black and latino populations have been impacted greatly by the ongoing pandemic. Photo screenshot from Suffolk data map

Black and Latino communities have been disproportionately impacted by the coronavirus pandemic, and on Long Island where communities are as segregated as they are, much of it comes down to geography.

COVID-19 cases in Suffolk County have an identifiable curve. Data on maps provided by Suffolk County show a darkening red on a path rolling from the eastern end of the Island toward the west, homing in on the western center of the Island — Wyandanch, Brentwood and Huntington Station. In such areas, data also shows, is also where many minority communities live.

Suffolk County health services commissioner Gregson Pigott shares COVID facts in Spanish online April 8. Photo from Facebook video

Data from New York State’s Department of Health maps shows the coronavirus has disproportionately harmed black and Latino communities. Brentwood in particular has shown 3,473 cases, or nearly 55 per 1,000 persons. New York State Education Department data shows the Brentwood school district, as just an example, is nearly 85 percent Latino and almost 10 percent black. Huntington Station, another example of a location with large black and Latino populations, has just over 1,000 cases, or 33 persons per 1,00 have the virus. As testing continues, those numbers continue to grow.

Though data showing the numbers of COVID-19 deaths is out of date, numbers from New York’s Covid tracker website show the percent of black residents who died from the virus was 12 percent, higher than the 8 percent share of the overall Suffolk population. For Latino residents, the fatality percent was 14 percent, lower than their population of 19 percent.

While whites make up 81 percent of the population, their proportion of residents confirmed with the virus is only 64 percent. If the white population were suffering the same proportionate death ratio higher than their overall population, then dozens more white people would have already perished from COVID-19.

“I’m not surprised by the information given,” said Brookhaven town Councilwoman Valerie Cartright (D-Port Jefferson Station). “We need to be testing as much as possible, we need to be tracing, we need to make sure once we get that under control, we need to make sure people get treated.”

The COVID Hot Zones

Toward the beginning of April, Suffolk County established three “hot spot” testing centers in Wyandanch, Brentwood and Huntington. Those sites quickly established a higher rate of positive cases compared to the county’s other sites, especially the testing center at Stony Brook University. A little more than a week ago, such hot spot sites were showing 53 percent of those tested were positive. On Tuesday, April 29, that number dropped slightly to 48 percent hot spot positive tests compared to 38 percent for the rest of the county.

Though such testing centers didn’t arrive until more than a month into the crisis, county leadership said plans for such sites developed as data slowly showed where peak cases were. 

“When we started working with the IT department to find the addresses where these cases were, Southold was leading,” said Dr. Gregson Pigott, the Suffolk Department of Health Services commissioner. “Then Huntington Station became the hot spot. Then Brentwood became the leader in cases, and to this day Brentwood has the most cases.”

Suffolk County has also started plans for recovery after things finally start to open up. The Recovery Task Force is being headed by multiple partners, including Vanessa Baird Streeter, an assistant deputy county executive.

The task force will need to provide aid, but Suffolk County Executive Steve Bellone (D) said there needs to be emphasis on addressing the glaring inequities, and put an emphasis on “coming back stronger.”

“There’s no question the issue is we know there have been disparities,” he said. “The crisis like this is only going to exacerbate those issues and have those disparities grow.”

But as it became clear to officials the virus was greatly impacting the majority of minority communities harder than others, said communities were watching day by day how the virus was upending lives, infecting whole households and leaving many without any chance of providing for their families.

Latino Community During Coronavirus

Martha Maffei, the executive director for Latino and immigrant advocacy group SEPA Mujer, said Latino communities are hit so hard especially because of many people’s employment. Either they were effectively let go, or they are working in jobs that if they tried to take time off, they would be out of a job. Instead, such workers, even in what has already been deemed “nonessential business,” are still going to work even in places where workers have already gotten sick.

“We were receiving calls of jobs they know the workplace has been infected, they continue to ask employees to come to work,” she said. “They don’t have the option to say no, because they’re basically forcing them and they don’t want to lose their jobs.”

A survey conducted by the Pew Research Center in early April found approximately 41 percent of Latinos have lost their jobs since the start of the pandemic, compared to just 24 percent white and 32 blacks being laid off or furloughed. This jives with research showing about 50 percent of people on the lower income scale have either lost their job or had to take a pay cut.

Many who relied on their jobs to support their families have now lost them completely, and since many are undocumented, they have no access to any kind of federal assistance. In homes that are often multigenerational and cramped, workers out on the front lines come home and have very little means of sequestering themselves.

SEPA Mujer shows their support for immigrants by donning yellow bracelets. File photo by Sara-Megan Walsh

SEPA Mujer also advocates for women in violent domestic situations, and Maffei said its crisis hotline phone has been ringing daily. Bellone has told reporters the incidents of domestic violence are up 3.5 percent from early to mid April.

At issue is the immigrant community’s trust in local government and law enforcement, and that same government’s ability to get the life-saving and virus-mitigating information to them.

The hot spot testing centers now include Spanish-speaking translators, at least one per each, according to Pigott. Bellone also announced, working with nonprofits Island Harvest and Long Island Cares, they are providing food assistance to visitors at the testing sites. Brentwood is already seeing those activities, and Wyandanch will also start providing food April 30.

When the first hot spot site opened in Huntington Station, Maffei said she had clients who were struggling to schedule an appointment. Though she suspects it has gotten better with more sites opening up in western Suffolk, true help to the community should come in the form of facilitating access to information. 

“We’re trying to do the best we can, but a lot of people don’t have access to the internet, don’t have Facebook,” Maffei said. 

Pigott related the county is providing multi-language information via their website and brochures at the testing sites, but community advocates argue there is a demand for such details of where people can get tested and how they can prevent infection, straight into the hands of people, possibly through mailings or other mass outreach.

Why Minority Communities are Vulnerable

Medical and social scientists, in asking the first and likely most important question, “why?” said the historic inequities in majority minority populations are only exacerbated by the SARS-CoV-2 virus. 

Dr. Johanna Martinez, a physician with Northwell, is in the midst of helping conduct a research project to work out the variables that are leading to how the pandemic has deepened and exacerbated existing inequities.

“It’s not something biological that is different between black and Latino people. It really is the historical inequities, like racism, that has led to the patients being marginalized,” Martinez said. “It is most closely linked to social determinants.”

The links are plain, she said, in socioeconomic status, and perhaps most importantly, one’s access to health care. Immigrant communities are especially likely to lack insurance and easy communication with doctors. It’s hard for one to know if one’s symptoms should necessitate a hospital visit if one also doesn’t have a doctor within phone’s reach. It also means an increased spread of the virus and a potential increased load on hospitals.

“If you’re uninsured, the place where you’re going to get health care from is the emergency room,” the Northwell doctor said. “Right now, we’re trying to use telemedicine, but if you don’t have an established primary care doctor, you don’t have the ability to speak to the doctor of the symptoms you’re having and if this is something you can stay home for or go to the hospital.”

Current data released by New York State has mostly been determining age, as its well-known vulnerable people include the elderly, but Martinez’ data is adjusting for other things like comorbidities. Data shows that diabetes, hypertension and obesity put one at a higher risk for COVID-19-related death, and studies have shown poorer or communities of people of color are at higher risk for such diseases. 

“It’s almost like a double whammy,” she said. “It’s something that makes them even more vulnerable to a very serious disease.”

“It’s not something biological that is different between black and Latino people. It really is the historical inequities, like racism, that has led to the patients being marginalized.”

— Dr. Johanna Martinez

Housing is also a factor. Once one leaves the hospital, or on recommendation from a doctor, it’s easy to tell people who are showing symptoms to isolate a certain part of the house, but for a large family living in a relatively small space, that might just be impossible.

Whether Suffolk’s numbers detailing the number of confirmed COVID patients is accurate, Martinez said she doubts it, especially looking at nationally. Newsday recently reported, upon looking at towns’ death certificates compared to New York’s details on fatalities, there could be many more COVID deaths than currently thought.

“We need more testing to see the prevalence in certain communities,” she said.

Cartright, who works as a civil rights attorney, said these factors are what the government should be looking at as the initial wave of COVID-19 patients overall declines.

“We know black people are dying at a disproportionate rate,” she said. “We need to look at how many people are living in the same household, how many people actually have health care, how many are undocumented who were scared of going to the emergency room. There are so many factors we need to be able to take a look at.”