New York City learned best practices to deal with coronavirus by observing outcomes in China, Italy and Seattle, but must continue to pay it forward for health care workers.
The coronavirus disease 2019 (COVID-19) pandemic has brought the intersection of public health and health care delivery into focus, especially in New York City, according to a paper published in JAMA Health Forum.
Authors from New York City Health + Hospitals wrote that over the course of about a month, the US health care system has been transformed by the novel disease.
“The once-boisterous streets of New York City are quiet, while the hospital wards reverberate with the swooshes and beeps usually heard in intensive care units (ICUs),” the authors wrote.
“COVID-19 echoes that duality. There are so many outside the hospital who have been silently infected, while so many are fighting for their lives in the hospital, struggling just to breathe.”
The city has survived other outbreaks, such as yellow fever, cholera, HIV/AIDS, and Ebola. Each of these outbreaks have given health care providers confidence that the city will survive this pandemic as well.
Social distancing measures have been implemented primarily to address health care system capacity and to protect health care workers. Another way to protect health care workers is to protect their morale.
“If clinicians lose trust or motivation, the health care system buckles, no matter how many beds are available,” authors wrote. Administrators in health care systems are responsible for finding and supplying personal protective equipment for their employees, but are also responsible for checking the temperature, so to speak, of their staff. Boosting morale is vital as these health care workers are “risking themselves and their families” during this crisis, the authors explained.
During acute crises, such as 9/11 or Superstorm Sandy, health care workers survived on adrenaline, the authors said. This crisis is different in that it requires more endurance from these workers. Boosting morale can be accomplished through celebrating small victories, such as playing music in the hospital marking each extubation, or tracking the number of recovered COVID-19 patients.
“The strongest possible motivation for health care workers to toil under difficult, sometimes perilous, conditions is knowing that they are saving lives,” the authors wrote.
Health equity is another issue permeating this crisis. Queens, for example, appeared to bear the brunt of the first wave of COVID-19. Queens is a borough with many low-income and immigrant families who may live in multigenerational and sometimes crowded housing. People in these areas can also have a higher rate of underlying comorbidities such as diabetes with fewer beds per capita. These workers tend to be employed in jobs deemed essential, adding to their risk, the authors said.
Another way to help health care workers is to use analytics to make decisions that inform policy, the authors said. At their hospital system, they track COVID-19 patients in emergency departments, inpatient wards, and the ICUs. Half of the patients were admitted through the emergency departments, but another hospital turned an endoscopy suite into an ICU.
“Keeping track of the numbers of patients requires triangulating with rapid changes on the ground, both with physical walkthroughs as well as real-time communication (good old-fashioned telephone calls),” the authors wrote.
“Accurately tracking bed capacity and availability becomes a matter of life and death when one hospital encounters a surge and needs to draw upon others for help with the influx.”
Isolation associated with COVID-19 has been felt throughout the city. But there is much to learn from virtual tools created for health care providers to track clinical observations and best practices across hospitals.
“In the same way clinicians in New York City have learned from experiences in China, Italy, and Seattle, everyone has to continue paying it forward."