Although cases of Covid-19 have plateaued on the South Fork over the last couple of weeks, and Stony Brook Southampton Hospital is discharging as many people as it is admitting over a similar period, the number of new cases being reported has not dropped.
“Based on what we’re seeing, the disease is still out there in the community,” said Robert Chaloner, the chief administrative officer of the hospital on Monday. “Clearly, people are still getting sick.”
As of yesterday morning there were 33,363 confirmed cases of Covid-19 in the county — 622 in Southampton Town, 176 in East Hampton Town, 425 in Riverhead, and 7 on Shelter Island.
With May beginning tomorrow, the odds for a return to normal this summer are slim. He said the numbers would need to drop off to a very few new cases of the disease. “Then, as soon as it pops up, we could quickly identify and quarantine the people who are exposed to keep it from spreading.” The risk of it spreading quickly through the population is still high. “Until we have that capacity, we’re not going to be back to normal for a while.”
For other communicable diseases, he said the protocol is to report when it is found, isolate patients and their contacts, and vaccinate people in the area. “We don’t have any of that capability yet.”
“Even though everybody is optimistic that the number is going to go down. . . . The big question is when are we going to see a full decline.” That may not occur until there is widespread testing and tracking of people who have been exposed through contact tracing, he said. “But what it’s really going to take is a vaccine.”
Responding to data collected so far from new antibody testing in the county, he was wary of making too much of the early findings suggesting how many people were exposed in Suffolk. He said he would want an “epidemiologist to sign off on what those numbers are and how widespread the testing is in various populations. If they concentrated in western Suffolk and not eastern, the rates would be very different. And the antibody testing is so new, I’d rather give that a few more weeks before we have a sense of how many people were exposed in the county.”
Diagnostic testing will become more available in the coming months. His goal is to have tests at all of the hospital’s clinical sites by summer. This “is becoming more realistic every week” as new test equipment and supplies arrive and their use is approved by the Food and Drug Administration. Those providers would include the emergency room, walk-in clinics, and doctors’ offices. He wants the test to become routine. “If you have the symptoms, we will test for it,” just like they do now for the flu.
He noted how cases have bounced back in places in Asia that have relaxed their restrictions. “A lot of the people I’ve spoken to think there’s going to be a big wave, and then a slightly smaller wave, then a slightly smaller wave,” eventually easing out in that way.
As to the timing on that, he said it would be unrealistic to think that life would get back to normal this summer. Next summer is more likely to resemble a regular Hamptons high season.
That said, the hospital’s patient load is “staying in a fairly narrow band right now” — around 20 patients below its highest levels of occupancy, which was 55 patients, according to figures reported to Suffolk County. That leaves the current inpatient population with coronavirus fluctuating around 30 to 35 with 13 patients in the intensive care unit.
He said the numbers of cases on the South Fork, which are relatively low compared to the other places in the county, are likely due to the lack of congestion and much less public transportation use. “People have space to spread out.” They can take walks on the beach and still be isolated. He said it was the elderly population that makes the area more vulnerable and brings those case and hospitalization numbers up.
Having worked through the first wave of the pandemic, Mr. Chaloner said the hospital and medical staffs around the country have learned how to better navigate an outbreak.
If the disease bounced back after a decline, doctors and public health officials could intercede faster with quarantines and isolation with the knowledge that the disease is already in their midst. By that point, testing should be better, with more tests available. With personal masks now at the ready and social distancing already in practice, a lockdown may not be necessary for those future incidents, he said.
From a clinical perspective, “We’ve learned how to better navigate the day-to-day management of patients from the emergency department, to the I.C.U., to a regular floor, and discharge.” When to discharge patients was one of the biggest early challenges. It raised questions of how many times to test them, and how many times did it need to be negative before it was safe to let them go home. As more patients were treated, the Centers for Disease Control and county and state health departments were able to develop those protocols. “Now, we’re more confident in understanding the way the disease progresses and when we can discharge.”
Doctors have also gained a better understanding of early signs of patient distress. “Sometimes patients look really healthy and as if they’re not struggling with the disease. Then, you put a pulse oximeter on them and their oxygenation rates are very low. They’re sicker than they feel.” The coronavirus is “deceptive that way, so we’re a lot more attuned to that than we were in the early days. Doctors are learning more every day.”
Mr. Chaloner said that hospital officials now know they can mobilize increased I.C.U. capacity quickly. For the current wave, they rapidly tripled the I.C.U. beds from 7 to 21. They could increase them to as many as 50, if needed, and know exactly what they would need in terms of nurses, medical residents, intensive care specialists, and respiratory therapists, he said.
With supplies “there were a few close calls,” he said. “I don’t think anyone thought hospitals would run out of masks and gowns previously. Now we know. I hope the country and all providers will do a better job at stockpiling.” He said the hospital’s procurement people did a great job of finding supplies. “We’ve never had to do without and we’ve got an adequate supply at this point.”
They were also well staffed at the height of the outbreak. “We were able to jump on staffing needs early on and remained well-staffed.” He said that was important. “Some people would say we opened too much capacity. It’s easy to play armchair quarterback with that. I don’t think we could have had too much capacity.” Not knowing what was coming and wanting to have adequate resources to provide the needed patient care, made such decisions obvious. “If all of the healthcare workers were stressed out, they would be more likely to make mistakes. We’ve been fortunate that our staff and supplies have been adequate to the task at hand.”
Having to ramp up quickly and cut off access to income from elective surgeries and other non-emergency diagnostic care will have a significant impact on the hospital’s bottom line. “The March numbers are not closed out, but it’s not going to be pretty. . . . We will take a huge hit.” Mr. Chaloner said he was pleased that workers were redeployed and not furloughed during the crisis. “You do what you have to do to deal with an emergency. Hopefully we will get some support.”
He noted there may be some money coming from the federal government’s stimulus plan and that private donors have stepped up to help along with many in the community. The board chairman made gowns for the workers, restaurants donated money and meals, kindergarten students made pictures, and the Southampton Inn provided accommodations for agency nurses at cost, to name just a few. “I don’t think we could have done this without them. It won’t make up for the losses, but it has softened the blow.”