N.Y. Hospitals ‘Redline’ While Virus Cases Hint at a Plateau
New York Governor Andrew Cuomo said the virus-related death rate was effectively flat for two days.
(Bloomberg) -- Financial markets and the White House latched on to new figures suggesting that New York’s coronavirus cases may have plateaued for now.
The estimate from state officials was heavily qualified, however. If daily patient admissions remain steady, the level of deaths and intensive-care demands will require hospitals in the metropolitan area to operate at what state officials called an unsustainable pace.
The benchmark S&P 500 Index jumped after New York Governor Andrew Cuomo said the virus-related death rate was effectively flat for two days, finishing up 7%, its highest closing level since March 13. That built on what Vice President Mike Pence on Sunday called “glimmers of progress” in the virus battle in the U.S. Italy reported the lowest number of new coronavirus infections in nearly three weeks, helping to send European and Asian shares higher.
Cuomo said that social distancing policies begun two weeks ago in New York appear to have led to the rough leveling of deaths at under 600 a day, down from 630 on Friday. However, he cautioned that infections could easily rise with less social distancing.
As it is, New York City is stretched. It is reviewing options for taking in many hundreds of dead daily, which could include using city land for temporary mass graves. And the city’s hospitals are on the edge, even after expanding capacity in recent weeks by adding thousands of beds and clearing patients out of existing ones.
“If we are plateauing, we are plateauing at a very high level and there is tremendous stress on the health-care system. This is a hospital system where we have our foot to the floor, and the engine is at redline and you can’t go any faster,” Cuomo said in a briefing Monday. “People can’t work any harder. The staff can’t work any harder. Staying at this level is problematic.”
Hospitals are moving patients between facilities and working on transfers to largely untapped facilities at the Javits Center and the USNS Comfort. An additional relief valve was presented on Monday evening, when the federal government agreed to allow the Comfort, originally sent to take in non-coronavirus cases, to treat Covid-19 illnesses.
In neighboring New Jersey, deaths from the new coronavirus topped 1,000, but the increase was less than 10% for a second straight day -- down from double that level about a week ago. The curve is “beginning to flatten,” Governor Phil Murphy said, adding that it’s too early to pronounce a clear trend.
New Modeling
Nationwide, one group of researchers also lowered the severity of its projections. The Institute for Health Metrics and Evaluation at the University of Washington in Seattle said over the weekend that demand for hospital beds, intensive care and ventilators -- and the total number of deaths -- will be lower than its model originally anticipated. It based its analysis on information gathered as the pandemic moves across the world, giving a more robust view of how the virus responds to different situations. Social distancing efforts are turning out to be more powerful, and take effect more quickly, than originally anticipated, the researchers said.
“The trajectory of the pandemic will change -- and dramatically for the worse -- if people ease up on social distancing or relax with other precautions,” said Christopher Murray, director of IHME at the University of Washington’s School of Medicine. “Social distancing is crucial,” he said; the group’s forecast assumes that it remains in place until the end of May.
The number of deaths in the U.S. is still expected to peak on April 16, though the cumulative number of Americans likely to die from Covid-19 was revised downward to 82,000, from an estimate of 94,000 less than a week ago. But its apex, 3,130 Americans will die per day, up from the previous estimate of 2,644.
‘Second Wave’
With most New Yorkers having been under orders to stay home and practice social distancing since Cuomo ordered the statewide closure of nonessential businesses starting March 22, the hope is that new Covid-19 diagnoses will begin to drop as shelter-in-place efforts extend beyond the estimated 14-day incubation period for the virus.
“The models show that social distancing is working” in New York, said Chris Bauch, research chair in the department of applied mathematics at the University of Waterloo in Ontario, Canada. “We would have many more cases than we currently do if we weren’t doing it. If we let our guard down, there is the risk of a second wave.”
Still, no one knows how many New Yorkers have been infected, making it impossible to say how much risk is ahead, said Marc Lipsitch, director of the Center for Communicable Disease Dynamics and professor of epidemiology at Harvard T.H. Chan School of Public Health. While 130,000 patients have been diagnosed among the state’s 20 million residents, there could easily have been 1 million infections, he said. That’s less than 5% of the population, far too low for herd immunity to be offering protection.
“It’s premature to say whether we have reached the peak of the first wave, or the overall peak,” he said. If cases are peaking, “it means social distancing is working, because cases are going down before herd immunity has kicked in. But then people are still vulnerable. That’s the fundamental dilemma of social distancing. The better it works, the more susceptible people remain in the population.”
The rate of new infections in New York is slowing -- now doubling about every 10 days, compared with a peak of every two. The rate of hospitalizations has generally begun to trend downward for several days now, with Sunday’s 358 admissions being the lowest since mid-March. Hospital discharges after patients recover have also been on an upswing -- averaging about 1,200 patients per day over the last week, providing hope for recoveries and freeing up crucial bed space for new incoming patients.
Hospitals across the city are adapting to try to ease specific pressure points. The 20,000 patients with Covid-19 in Queens are more than double the number in Manhattan, though Queens has only 1.5 hospital beds for every 1,000 people there compared with 6.4 beds in wealthier Manhattan.
USNS Comfort Capacity
Manhattan’s Bellevue Hospital has been taking 20 or so patients a day from Elmhurst Hospital, one of he most overwhelmed facilities in Queens, according to a person familiar with the moves. Other hospitals are also working to transfer patients to the temporary facility at the Javits Center and to the 1,000-bed Comfort, docked on Manhattan’s west side.
The Javits convention center, which was built out by the Army Corps of Engineers, has only 44 coronavirus patients in treatment so far, and will have a 1,700-bed capacity by Friday, the Pentagon said. The Comfort has treated 41 patients, with 31 still on board, officials said.
While the Defense Department initially said the Comfort could take on non-coronavirus patients to ease pressure on city hospitals, it said Monday that it would respond to New York’s needs. The ship has the ability to isolate a limited number of people with the virus, said Brigadier General Paul Friedrichs, the staff surgeon for the Joint Chiefs.
Early Monday evening, Cuomo tweeted: “I spoke to the president and he has agreed to our request” to treat Covid-19 patients on the USNS Comfort. “This will provide much-needed relief to our over stressed hospital systems,” he wrote. Trump, in his evening briefing, confirmed the move.
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