Eric Wang

As current projections show that COVID-19 cases in New Haven are set to overwhelm hospitals’ capacities for treatment, Yale New Haven Hospital has taken emergency measures to minimize the predicted damage.

A wave of the pandemic is just now starting to hit New Haven, according to Richard Martinello, YNHH medical director for infection prevention. Two weeks ago, YNHH was treating three patients for COVID-19 cases. As of Thursday evening, the number has grown to more than 60. YNHH is actively considering crisis measures like searching for potential sites to add intensive care units and has already taken steps to clear space for coronavirus patients.

“It’s starting now,” Martinello said about the outbreak of cases coming to New Haven. “We don’t really know how big it’s going to be and how impactful, and a lot of that to an extent depends on how well individuals in our community are able to practice social distancing and other measures to slow down the spread of coronavirus.”

 

Warning Signs

In New York, the coronavirus outbreak has overwhelmed the health care system. New York Governor Andrew Cuomo anticipates a shortage of life-support machines and hospital staff to treat patients in need. More than 23,000 people have been diagnosed with the virus in New York City alone. Some New York hospitals, dealing with the influx of cases, have diverted patients to YNHH. At one Brooklyn hospital, doctors are reusing masks for up to a week, disinfecting them with hand sanitizer between shifts, the New York Times reported. 

YNHH could face a similar reality: Mayor Justin Elicker warned on Friday afternoon that current projections suggest the infection and death toll in New Haven could exceed on a proportional population basis the more than 8,000 deaths Italy has reported if residents do not socially distance.

 

Avoiding the Worst

Sten Vermund, dean of the Yale School of Public Health, explained that epidemics can overwhelm the health system because the Connecticut Department of Public Health does not ordinarily retain the excess capacity necessary to treat the number of patients infected during a pandemic.

“When you have an epidemic … they need help,” Vermund said. “They can’t handle all of the emergent cases and do the kind of contact tracing that informs people who have been in close contact with documented cases that they should self-isolate for 14 days.”

The School of Public Health has recruited its employees who have prior CDC training in contact tracing to instruct students, faculty and staff on how to assist the Connecticut and New Haven Departments of Public Health with contact tracing. Contact tracing is the process of finding people who have had contact with someone with the virus and instructing them to self-isolate for 14 days and monitor themselves for symptoms.

But contact tracing is only effective if officials can warn people that they may be contagious before they develop symptoms. At a press conference last week, state epidemiologist Matthew Cartter said that the period of contact tracing would not last much longer as the number of cases in Connecticut grows.

 

Crisis Measures

If someone is suspected to have the virus, the hospital isolates the patient in a negative pressure room, so if the virus is in the air it is not released outside the room. YNHH has emptied the top three floors of its cancer hospital, according to Thomas Balcezak SPH ’03, chief medical officer of YNHH. The hospital is now using its 60 negative pressure rooms for COVID-19 patients, adding to the 140 negative pressure rooms the hospital had already designated for general use before the outbreak.

Balcezak told the News that — based on modeling from China, South Korea and Italy — YNHH projects to run out of ICU beds during the second week of April and to run out of all beds around the second week of May.

“We’re doing everything we can to increase our capacity,” Balcezak said. “But at some point, there is just a fixed constraint above which we just can’t get. There are just so many ventilators. There are just so many medical staff that we have.”

Yale health care providers are working in close collaboration with state and local public health authorities whose resources are extremely strained, Yale Health Director Paul Genecin wrote in an email to the News. YNHH, specifically, is working with state and local authorities to find other, off-site locations to create ICU units to increase its capacity. Balcezak declined to discuss possible sites, but Yale has set up a subacute overflow facility in Payne Whitney Gymnasium for Yale community members.

YNHH is trying to increase the number of personnel combating the coronavirus. The hospital has postponed many elective surgeries and reassigned workers who may not be needed in their usual roles in the coming months.

But the hospital still has to manage the difficulty of protecting patients being treated for other health issues from contracting COVID-19. Yale-affiliated health providers are “addressing the challenge of balancing patient care needs for non-COVID-19-related issues including maternity and newborn care and acute and chronic disease management,” Genecin told the News. Specifically, Yale Health is transitioning visits to telephone or telemedicine where appropriate.

Genecin told the News that Yale Health, YNHH, Yale Medicine, Yale School of Nursing, Yale School of Public Health and Northeast Medical Group are recruiting physicians, nurses and others who can transition from academic activities to direct patient care.

Genecin also noted the need to protect medical personnel treating coronavirus patients. There is a nationwide shortage of personal protective equipment for nurses and doctors. Lab investigators are working to make personal protective equipment available for clinical use. In addition, YNHH is taking steps to limit waste and theft of any protective equipment, and is working with the government to tap into strategic supplies, according to Balcezak.

YNHH currently has enough personal protective equipment, Martinello said, but has turned to novel sources to sustain its supplies through the next few months. Some local New Haven companies have shifted their production to making protective equipment. Martinello pointed to a local plastic company that has reoriented some of its production to develop face shields.

Despite its precautions, some hospital staff have contracted the virus, Martinello said. YNHH has devoted a testing area for staff use only to ensure infected health care workers quickly stop treating patients.

 

Projections

“We’re right now on a trajectory that we think is going to be about as bad as what we were concerned about,” Martinello said. “What we’re hoping is that our experience is going to be better than what New York is experiencing now.”

Vermund explained the virus will likely follow the general pattern of doubling the number of Connecticut cases every six days. Both he and Martinello underscored the importance of social distancing and personal hygiene. If social distancing measures work, Vermund said, the number of cases could peak in 24 days and decrease by summer. But if after 36 days the virus is still spreading rapidly, the outbreak would likely continue well into the summer.

“I think a large percentage of the population will eventually get the virus,” Brett Lindenbach, associate professor of microbial pathogenesis and of comparative medicine, said. “We’re subject to the laws of nature, and I think that sometimes humans forget that. Now we’re trying to sort of avoid the worst.”

As of Thursday evening, there were more than 82,000 confirmed cases of the coronavirus in the United States, making it the most infected country in the world, according to the Johns Hopkins Coronavirus Resource Center.

 

 

 

Rose Horowitch | rose.horowitch@yale.edu

Jose Davila IV | jose.davilaiv@yale.edu