There was the additional complication that most of our cases were in downstate New York, and many of the hospital beds were in the suburbs and upstate. Planning for an available capacity of fifty-three thousand hospital beds assumed you would be controlling all the beds statewide and that a patient from any area of the state could be placed in an available bed anywhere in the state. That is not how the system worked. Patients picked their hospital. There had rarely been a situation where an individual showed up at one hospital and was sent to a hospital in another region of the state. But we had no choice. I couldn’t just sit there and pray, nor could I continue to ask the federal government for help that I couldn’t count on coming.
I began calling the leaders of the major hospitals. Some of them had been with me during the first virus briefing on March 2. I have known many of the hospital administrators for years; once again, personal relationships are always most important. I explained the situation and the options. I wanted them to understand how dire the potential consequences were. For them to accept state control of the private health-care system would be a major hurdle. When they heard the numbers from the projection models, they understood why we needed to take such dramatic action. They didn’t like it at all, but they couldn’t deny the reality. We were all watching the collapse in Italy and the crushing impact on its health-care professionals. They did not want to be part of an international story of the failure of one of the greatest hospital systems in the world. Their bread and butter was people coming from all over the planet for treatment in their facilities. There were also significant financial concerns. I told them that we would need to agree to work together and get through the crisis and then they needed to trust me that we would work out the finances.
The individual phone calls to the biggest players laid the groundwork for their buy-in so that when we brought in the leaders of other hospitals around the state on group conference calls, every hospital knew its competitors and colleagues were in the same situation.
My first specific request bordered on the insane: Every hospital had to increase its capacity by 50 percent and stop elective surgeries to free up existing bed capacity. The 50 percent increase in capacity would take the entire system from about fifty-three thousand beds to seventy-five thousand beds. Even seventy-five thousand beds was only about 60 percent of the projected need.
The challenge to the individual hospitals was overwhelming. A hospital with two hundred beds would need to create an additional one hundred beds. Hospitals are normally highly regulated with specific requirements as to room size, staffing ratios, and so on. Now we were telling them to double the number of beds in some rooms, convert cafeterias to congregate areas, and find space wherever they could. For them it was an earthshaking proposition.
The second component, ending elective surgery, would begin to reduce the current hospital population to make room for the COVID patients who were just days or weeks away. Elective surgery is also the primary source of income for hospitals. I explained that our plan assumed we had fifty-three thousand beds, all empty, so we had no alternative but to start creating capacity.
While many of the people I talked to said such an increase was impossible, I told them that impossible wasn’t an option. After much discussion, we had consensus support. It was a relief to see that even large institutions, when they understood the consequences, were willing to accept major change. This was critical because if they had sued to stop me, they probably would have been successful, at least in the short run, and that’s all we had—the short run.
MARCH 15 | 131 NEW CASES | 137 HOSPITALIZED | 1 DEATH
“The curve is not a curve, the curve is a wave, and the wave could break on the hospital system.”
THERE ARE SEVERAL MAJOR FACTORS to consider when you close schools. You stop providing food for many students who rely on school lunches. The teachers in the school have concerns for their own health separate and apart from the students’. The teachers’ union is very strong and influential with state and local politicians. At first, the unions were allied with local school districts and the state education department in saying, “You are out of your mind; you cannot close the schools.” Children staying at home for long periods of time raises socialization and mental health issues. School districts are proudly locally run, and when the state or federal government makes a decision concerning schools, they often organize the parents in opposition.
As usual, some people wanted schools open and some wanted schools closed tomorrow. It wasn’t that easy. My grandfather had a great expression: “When you don’t know what you’re talking about, it always seems simple.” Here’s a question that illustrates how complicated the decision is: If the governor concludes that in the middle of a pandemic safety dictates he must close the schools, who does the most pivotal conversation include?
The local politician
The local teachers’ union head
The local PTA
The local health commissioner
The local school board
The local hospital staff
The answer is F.
The most essential conversation around closing schools in the midst of a pandemic is, will the hospital staff show up for
