Eric Wang, Senior Photographer

Health care systems across the country have seen COVID-19 hospitalizations multiply over the last couple of weeks, sounding the alarm that the pandemic might get worse before it gets better. In the meantime, cases have also climbed to record-high levels, topping numbers observed when lockdowns were first instituted in March.

In a press conference on Nov. 11, Yale New Haven Health System CEO Marna Borgstrom, Chief Clinical Officer Thomas Balcezak and Chief Policy and Communications Officer Vincent Petrini shared their concerns about the present moment in the pandemic. According to Balcezak, if this steep surge in cases continues to rise, the current situation could become dangerous. As of last week, YNHH and Bridgeport hospital reactivated Code D — a disaster response designation — and the same could soon be true for other hospitals in the system. 

“We are heading into what is going to seem like a long, cold and dark winter,” Balcezak said. “Some of our forecasting models are showing that, if this trend doesn’t reverse itself, we will be seeing a peak some time toward the end of December or the first [months] of the new year. That’s daunting considering that it’s only the first part of November.”

As of last Wednesday, according to Borgstrom, there were 210 hospitalized COVID-19 patients across the YNHHS –– more than double the number from two weeks prior, similar to numbers from early March and over one-quarter the number from the peak on April 21. 

Among current patients, as of last Wednesday, 33 patients — 15 percent of all hospitalized patients — were in the ICU, 15 of whom were in ventilators.

However, the sickest COVID-19 patients are less numerous now than they were earlier in the spring, Balcezak said. While approximately 5 percent of hospitalized COVID-19 patients were on ventilators last Wednesday, back in the spring, that statistic was 15 percent.

An Oct. 8 YNHH newsletter that was sent to employees and published on their website stated that, after YNHH admitted its first COVID-19 patient on March 16, it activated code D –– the designation used in situations of disaster. The code was deactivated six months later on Sept. 21 when COVID-19 patient counts dwindled and hospital operations returned to normalcy, wrapping up a record-long state of alert.

In the same newsletter, April Alfano, manager of disaster preparedness and response at YNHH, explained that code D is typically only activated for hours or days at a time in response to events such as blizzards or loss of power. Earlier in the pandemic, however, the code D alert was maintained for 190 days, the newsletter read. In September, according to the newsletter, the decision to terminate code D was contingent on factors such as resource and staff availability.

But as of last week, YNHH and Bridgeport Hospital have activated code D once again –– a decision that Balcezak estimated other hospitals could follow if current COVID-19 hospitalizations trends persist. This decision reflects rising COVID-19 cases and hospitalizations within the community, as well as the strain on YNHHS capacity to tend to both this new influx of patients and others who were delayed care in the spring, when elective procedures and outpatient services were shut down.

“Our capacity is being stretched,” Balcezak said. “It’s stretching our staff, it’s stretching our facilities and each one of our hospitals and our physician groups are working hard to try to be able to extend our ability to care for patients both in physical locations and … using telehealth and all of our tools in our toolbox to try to make sure that we can accommodate patients.”

According to Balcezak, part of what sets this moment in the pandemic apart from the spring are the important lessons health care systems have learned along the way. New treatment protocols and a more developed understanding of the virus, for example, have added to the arsenal of tools currently available to fight against the virus.

But the bleak months this past spring cast a shadow of complications on patients struggling with other diseases. Balcezak said that because elective screening and in-person consults had to be suspended, national data has shown that people with other diseases, such as cancer and heart disease, have progressed to later stages of their illness.

“We don’t want to go back to where we were when we really closed down virtually everything that was on an outpatient perspective,” Balcezak said. “Instead, we have taken a tiered approach across the health system and coordinated this with our physicians … to stratify emergency, urgent and elective procedures and make clear definitions about what falls into each of those three categories.”

Both Balcezak and Borgstrom mentioned that federal financial support will be important for health care systems preparing to face the next months of the pandemic –– which could be an uphill battle.

They also described the depleting stimulus coming from Washington, D.C., and the fact that there is not “as much local support for what our heroes have been through” as challenging, considering the extraordinary effort that healthcare workers have been, and still are, pouring into their service.

“Our staff has been there throughout this time,” Borgstrom said. “When we were all terrified of the unknown in February, March, April [and] May, they came and they cared for unprecedented numbers of ill patients with this virus, and they did a phenomenal job.”

As of Nov. 18, over 11.5 million cases of the coronavirus have been identified in the United States.

Maria Fernanda Pacheco | maria.pacheco@yale.edu