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THE FOLLOWING ARE SUMMARIES of “game plan” protocols the state of New York implemented during COVID—one for testing, and the other for our Surge & Flex program. I hope these program details can be helpful to other states or to federal policy makers in the fight against COVID and in preparation for the next pandemic.
NEW YORK STATE SURGE & FLEX HEALTH COORDINATION SYSTEM
In early March, New York State’s 213 private, public, and independent hospitals had approximately 53,000 total beds, of course many occupied by patients receiving care for non-COVID reasons. Starting early in the COVID crisis, to determine the effect of the virus on New York’s hospital system, the State Department of Health required every hospital in the state to report daily how many beds in its facility were available, as well as how many were occupied, including by patients with COVID, those in the ICU, and patients requiring intubation.
Normally, these hospitals operate individually, competing with one another for patients, and rarely coordinating, particularly with hospitals outside of their “system.” (Most hospitals are part of a network, such as Columbia-Presbyterian, Mount Sinai, Northwell, NYC Health + Hospitals [H&H], and the University of Rochester Medical Center). There has never been a single statewide public hospital system or even a coordinating entity to help these 213 individual facilities work together in times of crisis. The situation at Elmhurst hospital in Queens during the third week of March demonstrated that a new, innovative coordinating system would be needed to bring every hospital in the state under one true statewide public health system that effectively balanced patients, staff, supplies, and equipment across all facilities.
Elmhurst is a public hospital operated by the New York City Health + Hospitals system. Early in the fourth week of March, Elmhurst was overwhelmed with COVID patients experiencing serious symptoms—a startling situation that happened very quickly and was well documented in the media. However, at the time Elmhurst was under siege, there were only about 4,000 patients hospitalized with COVID-19 in the entire state—just one-fifth of what our eventual peak would be, at nearly 19,000. At the same time, the H&H system reported to New York State having 900 open hospital beds across the eleven hospitals in its network. Likewise, of the more than 21,000 total hospital beds in New York City, including all hospitals, more than 3,500 beds were vacant. Why were patients from Elmhurst not transferred to these nearby vacant beds? The situation at Elmhurst made clear that coordination between hospitals and hospital systems was just as important as—if not more important than—increasing hospital capacity.
Elmhurst revealed what was needed. The question was how to build and operationalize a real public health system overnight that could act quickly and have the logistical capability to ensure that no single hospital was overwhelmed or in need of additional staff or supplies while hospitals in the vicinity, or anywhere else in New York State, had vacant beds and available supplies, staff, or equipment. Unless such a system was in place, building new hospital capacity at the Javits Center and other temporary sites would be essentially meaningless and New York State would be unable to effectively care for even close to the number of patients that might require hospitalization at what experts believed would be our peak in late April.
A few days after the Elmhurst situation, New York State launched what we called “Surge & Flex,” an effort that effectively built one statewide, coordinated public hospital system. Surge & Flex included four key elements that are each detailed below: (1) building hospital capacity; (2) mobilizing additional staff; (3) balancing equipment and supply needs; and (4) establishing an operational command center to coordinate the entire system.
There is no question that Surge & Flex saved lives. Nearly 1,500 patient transfers between hospitals and hospital systems occurred as a result in just weeks. Millions of pieces of PPE were delivered to hospitals in need. A twenty-four-hour hotline in the command center helped address hundreds of logistical requests, managing ambulance transfers, staff travel and accommodations, and much more vital support. As a result, no other hospital was inundated to the extent that Elmhurst was during those days in late March, and New Yorkers in need of care had access to hospital beds, helping New York avoid the tragic collapse of the health-care system that we witnessed in Italy.
New York State has, via regulation and Department of Health guidance, institutionalized the Surge & Flex system that now gives the state the ability to quickly activate each component of the operation during a future wave of COVID cases or another public health emergency, and ensure hospitals know what is expected of them so they can properly prepare.
Four Elements of Surge & Flex 1. Increasing Hospital Capacity
In early March, epidemiological projections showed that New York needed between 110,000 and 140,000 hospital beds to meet the expected influx of COVID cases. This required New York State to effectively double the number of hospital beds available in the state’s 213 hospitals. To increase this capacity, three steps were quickly taken. First, an executive order was issued for hospitals to postpone or cancel most elective procedures, freeing thousands of beds that would otherwise have been filled by patients seeking treatment for non-COVID and non-life-threatening conditions. Second, an additional executive order was issued that required all hospitals to increase their own capacity by at least 50 percent. This could be accomplished by adding a bed to single rooms, converting cafeterias and meeting rooms into patient care centers, and other measures. Third, the state deployed inspection teams to underutilized or vacant health-care and other facilities statewide in order to build temporary hospitals. These inspection teams also created detailed reports and plans to convert specific college dorms and hotels that were located near existing hospitals into temporary health-care facilities, if needed.
Remarkably, these three
