TWO VERY DIFFERENT HOSPITALS. The inequities of New York City’s health care system are clear at a public hospital in a section of Brooklyn.

NY TIMES

University Hospital of Brooklyn, in the heart of the city hit hardest by a world-altering pandemic, can seem like it is falling apart.

The roof leaks. The corroded pipes burst with alarming frequency. On one of the intensive care units, plastic tarps and duct tape serve as flimsy barriers separating patients. Nurses record vital signs with pen and paper, rather than computer systems.

A patient in Room 2 is losing blood pressure and needs an ultrasound. A therapist is working to calm a woman in Room 4 who is intubated and semiconscious and who tried to rip out her breathing tube when her arm restraints were unfastened.

Every hospital in New York has struggled to cope with the pandemic, but the outbreak has laid bare the deep disparities in the city’s health care system. Hospitals serving the sickest patients often work with the fewest resources.

Wealthy private hospitals, primarily in Manhattan, have been able to marshal reserves of cash and political clout to increase patient capacity quickly, ramp up testing and acquire protective gear. At the height of the surge, the Mount Sinai health system was able to enlist private planes from Warren E. Buffett’s company to fly in coveted N95 masks from China.


University Hospital, which is publicly funded and part of SUNY Downstate Health Sciences University, has tried to raise money for protective gear through a GoFundMe page started by a resident physician.

Most of the hospital’s patients are poor and people of color, and it gets more than 80 percent of its revenue from government programs like Medicare and Medicaid.  The virus is killing black and Latino New Yorkers at about twice the rate of white residents, and hospitals serving the sickest patients often work with the fewest resources.

The central Brooklyn neighborhoods where most of University Hospital’s patients live, East Flatbush and Prospect Lefferts Gardens, have higher-than-average concentrations of chronic diseases like diabetes, hypertension and obesity, which preliminary studies have shown make Covid-19 most deadly.


University Hospital doctors wore plastic bags as bootees to protect themselves while treating patients who had contracted the coronavirus.

Signs inside the hospital are written in English, Spanish and Creole, a reflection of the large number of immigrants in the area, particularly from the West Indies.

Many of the patients work but are poor or receive government assistance. Many are uninsured and use the hospital for emergencies and primary care. They come from a men’s shelter up the street or from a nearby home for domestic violence survivors to fill prescriptions or to have their diabetes checked.

“The day-to-day stress on these communities is just incredible, and that is driving these conditions,” said Dr. Moro Salifu, the chairman of the hospital’s department of medicine.

The hospital opened in 1963 and it was meant to accommodate about 60,000 visits a year. Despite having almost no physical improvements, it now handles about 200,000 visits annually. The bunkerlike concrete building is crumbling from within. Earlier this year, a leaky roof forced a temporary evacuation of premature babies from a neonatal intensive care unit.

The hospital has been in financial disarray for years. A 2013 audit by the state comptroller’s office found that it was on a path toward insolvency. It was bleeding millions of dollars every week, the audit found, and only infusions of state money were keeping it afloat.

Last July, the hospital suspended its transplant program after a review uncovered high mortality rates and serious safety concerns. Two doctors, the surgery department’s former chairman and another surgeon, filed wrongful termination lawsuits, accusing hospital officials of firing them as retaliation for their complaints about lax safety standards. The program has since been reactivated.

Even so, the hospital is vital to the community. Together with its affiliated teaching university, it is Brooklyn’s fourth-largest employer. The university, which is part of the State University of New York system, is the largest medical college in New York City, and it produces a large percentage of the doctors working here.

Dr. Robert Foronjy, the hospital’s chief of pulmonary and critical care medicine, oversees the unit with the plastic tarps and duct tape. He said the “aged and crumbling” facilities had made the job of caring for patients much harder.

Although the rate of new infections is dropping in New York, the intensive care units at University Hospital are full. Nearly 50 patients remain in serious condition, attached to ventilators. Some have been hospitalized for weeks, their limbs nestled in yellow foam cushions to prevent bed sores.

The hospital came close to running out of ventilators. Julie Eason, the director of respiratory therapy, said she had to “get a little bit creative” as she tried to ration resources while keeping up with all of the Code 99s, the term used when a patient needs to be intubated. “It was just endless,” she said. “Code 99s would come in three, four different rooms all within a few minutes of each other, all day long.”

Nurses on the units said they were overworked and understaffed. In normal times, their jobs are so demanding that they are required to care for no more than two patients at once. Now, they are tending to three or four at a time, increasing the risk of mistakes.

Ventilators require constant calibration to keep patients’ oxygen levels just right. Nurses must monitor endotracheal tubes, which can get clogged and block airways. In Covid-19 patients, the heart or the kidneys can fail without warning.

Medical workers began to get sick, and several nurses ended up intubated in the hospital’s I.C.U. Doctors and nurses complained that the conditions put them at greater risk than colleagues at other hospitals.

Dr. Foronjy, the I.C.U. physician, said he knew a doctor at a well-funded Manhattan hospital who walked around without a mask, assured that the sealed-off negative-pressure rooms there would protect him from the virus-infected patients inside.

A lack of protective gear remains a problem. Much of what the nurses are wearing is mismatched, donated from friends and neighbors or brought from home. One nurse complained that she had bought her mask herself and had been wearing the same bootees on her feet for the past three days.

“As you know, we are a state facility. We don’t have a lot of money,” said Rose Green, a nurse who was helping to staff the unit on her day off.

The hospital has begun to celebrate some successes. Recently, a nurse and a nursing assistant were taken off ventilators. On April 16, the hospital posted a video on Twitter of another nurse who had been intubated after coming down with Covid-19. She was being wheeled out of the emergency room to applause from colleagues.

On a recent day, a man in his 50s who had just come off a ventilator was sitting up in his room drinking a bottle of juice. A nurse passed by and waved excitedly.

13 Deaths in a Day: An ‘Apocalyptic’ Coronavirus Surge at an N.Y.C. Hospital

Hospitals in the city are facing the kind of harrowing increases in cases that overwhelmed health care systems in China and Italy.


NY TIMES

By Michael Rothfeld, Somini Sengupta, Joseph Goldstein and Brian M. Rosenthal
March 25, 2020

In several hours on Tuesday, Dr. Ashley Bray performed chest compressions at Elmhurst Hospital Center on a woman in her 80s, a man in his 60s and a 38-year-old who reminded the doctor of her fiancé. All had tested positive for the coronavirus and had gone into cardiac arrest. All eventually died.

Elmhurst, a 545-bed public hospital in Queens, has begun transferring patients not suffering from coronavirus to other hospitals as it moves toward becoming dedicated entirely to the outbreak. Doctors and nurses have struggled to make do with a few dozen ventilators. Calls over a loudspeaker of “Team 700,” the code for when a patient is on the verge of death, come several times a shift. Some have died inside the emergency room while waiting for a bed.

A refrigerated truck has been stationed outside to hold the bodies of the dead. Over the past 24 hours, New York City’s public hospital system said in a statement, 13 people at Elmhurst had died.

“It’s apocalyptic,” said Dr. Bray, 27, a general medicine resident at the hospital.

Across the city, which has become the epicenter of the coronavirus outbreak in the United States, hospitals are beginning to confront the kind of harrowing surge in cases that has overwhelmed health care systems in China, Italy and other countries. On Wednesday evening, New York City reported 20,011 confirmed cases and 280 deaths.

More than 3,922 coronavirus patients have been hospitalized in the city. Gov. Andrew M. Cuomo on Wednesday offered a glimmer of hope that social-distancing measures were starting to slow the growth in hospitalizations statewide. This week, the state’s hospitalization estimations were down markedly, from a doubling of cases every two days to every four days.

It is “almost too good to be true,” Mr. Cuomo said.

Still, hospitals are under siege. New York City’s hospitals run the gamut from prestigious teaching institutions catering to the elite to public hospitals providing care for some of the poorest communities in the nation. Regardless of whom they serve, few have been spared the impact of the pandemic: A flood of sick and fearful New Yorkers has besieged emergency rooms across the city.

Working with state and federal officials, hospitals have repeatedly expanded the portions of their buildings equipped to handle patients who had stayed home until worsening fevers and difficulty breathing forced them into emergency rooms. Elmhurst, among the hardest-hit hospitals in the city, is a prime example of the hardships medical centers and their staffs are facing across the country.

“Elmhurst is at the center of this crisis, and it’s the number one priority of our public hospital system right now,” the city’s public hospital system’s statement said. “The front line staff are going above and beyond in this crisis, and we continue surging supplies and personnel to this critical facility to keep pace with the crisis.”

Dr. Mitchell Katz, the head of the Health and Hospitals Corporation, which operates New York City’s public hospitals, said plans were underway to transform many areas of the Elmhurst hospital into intensive care units for extremely sick patients.

But New York’s hospitals may be about to lose their leeway for creativity in finding spaces.

All of the more than 1,800 intensive care beds in the city are expected to be full by Friday, according to a Federal Emergency Management Agency briefing obtained by The New York Times. Patients could stay for weeks, limiting space for newly sickened people.



Mr. Cuomo said on Wednesday that he had not seen the briefing. He said he hoped that officials could quickly add units by dipping into a growing supply of ventilators, the machines that some coronavirus patients need to breathe.

The federal government is sending a 1,000-bed hospital ship to New York, although it is not scheduled to arrive until mid-April. Officials have begun erecting four 250-bed hospitals at the Jacob K. Javits Convention Center in Midtown Manhattan, which could be ready in a week. President Trump said on Wednesday on Twitter that construction was ahead of schedule, but that could not be independently confirmed.

Officials have also discussed converting hotels and arenas into temporary medical centers.

At least two city hospitals have filled up their morgues, and city officials anticipated the rest would reach capacity by the end of this week, according to the briefing. The state requested 85 refrigerated trailers from FEMA for mortuary services, along with staff, the briefing said.

A spokeswoman for the city’s office of the chief medical examiner said the briefing was inaccurate. “We have significant morgue capacity in our five citywide sites, and the ability to expand,” she said.

In interviews, doctors and nurses at hospitals across the city gave accounts of how they were being stretched.

Workers at several hospitals, including the Jacobi Medical Center in the Bronx, said employees such as obstetrician-gynecologists and radiologists have been called to work in emergency wards.

At a branch of the Montefiore Medical Center, also in the Bronx, there have been one or two coronavirus-related deaths a day, or more, said Judy Sheridan-Gonzalez, a nurse. There are not always enough gurneys, so some patients sit in chairs. One patient on Sunday had been without a bed for 36 hours, she said.

At the Mount Sinai Health System, some hospital workers in Manhattan have posted photos on social media showing nurses using trash bags as protective gear. A system spokesman said she was not aware of that happening and noted the nurses had other gear below the bags. “The safety of our staff and patients has never been of greater importance and we are taking every precaution possible to protect everyone,” she said.

With ventilators in short supply, NewYork-Presbyterian Hospital, one of the city’s largest systems, has begun using one machine to help multiple patients at a time, a virtually unheard-of move, a spokeswoman said.

Elmhurst Hospital Center opened in 1832 and moved to its current Queens location in 1957, making it one of the oldest hospitals in New York City.

In the neighborhood it serves, Elmhurst, more than two-thirds of residents were born outside of the United States, the highest such rate in the city. It is a safety-net hospital, serving mainly low-income patients, including many who lack primary care doctors.

Queens accounts for 32 percent of New York City’s confirmed coronavirus cases, more than any other borough and far more than its share of the city’s population. It also has fewer hospitals. Elmhurst is one of three major hospitals serving a large population and is centrally located, which in part explains why it is busy in normal times and even busier now.

Medical workers said they saw the first signs of the virus in early March — an increase in patients coming in with flulike symptoms before the alarm had been fully raised in the city and the country. Tests results were taking longer then, but they eventually confirmed that many of these patients had coronavirus.

In the weeks after, the emergency room began filling up, with more than 200 people at times. Every chair in the waiting room was usually taken. Patients came in faster than the hospital could add beds; earlier this week, 60 coronavirus patients had been admitted but were still in the emergency room. One man waited almost 60 hours for a bed last week, a doctor said.

The patients coming in now are sicker than before because they were advised to try to recover at home, doctors said.

Like other hospitals, Elmhurst has come perilously close to running out of ventilators several times; other hospitals have replenished its supply.

Despite the more optimistic projections by the state about hospitalization rates, the crowds outside of Elmhurst have not thinned out.

The line of people waiting outside of Elmhurst to be tested for the coronavirus forms as early as 6 a.m., and some stay there until 5 p.m. Many are told to go home without being tested.

Julio Jimenez, 35, spent six hours in the emergency room on Sunday night after running a fever while at work in a New Jersey warehouse. He returned on Monday morning to stand in the testing line in the pouring rain. On Tuesday, still coughing, eyes puffy, he stood in line for nearly seven hours and again went home untested.

“I don’t know if I have the virus,” Mr. Jimenez said. “It’s so hard. It’s not just me. It’s for many people. It’s crazy.”

Rikki Lane, a doctor who has worked at Elmhurst for more than 20 years, said the hospital had handled “the first wave of this tsunami.” She compared the scene in the emergency department with an overcrowded parking garage where physicians must move patients in and out of spots to access other patients blocked by stretchers.

Family members are not permitted inside, she said.

Dr. Lane recalled recently treating a man in his 30s whose breathing deteriorated quickly and had to be put on a ventilator. “He was in distress and panicked, I could see the terror in his eyes,” she said. “He was alone.”

Other doctors said they had tried to resuscitate people while drenched in sweat under their protective gear, face masks fogging up. Some patients have been found dead in their rooms while doctors were busy helping others, they said.

Sometimes doctors try to call patients’ families when it is clear they will not recover.

That is what Dr. Bray said she tried to do before the man who reminded her of her fiancé died on Tuesday. As it turned out, his mother, also stricken with the coronavirus, was a patient at another hospital.

“We weren’t able to get in touch with anybody,” Dr. Bray said.

TRANSCRIPT OF VIDEO:
‘People Are Dying’: 72 Hours Inside a N.Y.C. Hospital Battling Coronavirus

An emergency room doctor in Elmhurst, Queens, gives a rare look inside a hospital at the center of the coronavirus pandemic. “We don’t have the tools that we need.”

[Machine beeping] “The frustrating thing about all of this is it really just feels like it’s too little, too late. Like we knew — we knew it was coming. Today is kind of getting worse and worse. We had to get a refrigerated truck to store the bodies of patients who are dying. We are, right now, scrambling to try to get a few additional ventilators or even CPAP machines. If we could get CPAP machines, we could free up ventilators for patients who need them. You know, we now have these five vents. We probably — unless people die, I suspect we’ll be back to needing to beg for ventilators again in another day or two. There’s a mythical 100 vents out there which we haven’t seen. Leaders in various offices, from the president to the head of Health and Hospitals, saying things like, ‘We’re going to be fine. Everything’s fine.’ And from our perspective, everything is not fine. I don’t have the support that I need, and even just the materials that I need, physically, to take care of my patients. And it’s America, and we’re supposed to be a first-world country. On a regular day, my emergency department’s volume is pretty high. It’s about 200 people a day. Now we’re seeing 400 or more people a day. At first, we were trying to isolate patients with cough and fever and be more careful around them, but we weren’t necessarily being extra careful around all the other patients. And then we started to realize that patients who were coming in with no fever but abdominal pain actually had findings on their X-rays and chest CTs that were consistent with this coronavirus, Covid-19. So someone in a car accident gets brought in and we get a CT scan of them, and their lungs look like they have coronavirus. We were seeing a lot of patients who probably had Covid, but we didn’t realize. Ten residents and also many, many of our nurses and a few of the attending physicians got sick. The anxiety of this situation is really overwhelming. All of the doctors, it’s hard for us to get tested even if we want to, even if we have symptoms. We’re exposed over and over again. We don’t have the protective equipment that we should have. I put on one N95 mask in the morning. I need to have that N95 mask on for every patient I see. I don’t take it off all day. The N95 mask I wore today is also the N95 mask I wore on Friday. We’re always worried that we’ll be out of N95 masks. What’s a little bit scary now is the patients that we’re getting are much sicker. Many of the young people who are getting sick don’t smoke, they’re healthy, they have no co-morbidities. They’re just young, regular people between the ages of 30 and 50 who you would not expect to get this sick. So many people are saying it’s going to be OK, everything’s fine, we have what we need. And if this goes on for a month or two or three or five like it did in China, and we’re already this strained, we don’t have what we need. I don’t really care if I get in trouble for speaking to the media. I want people to know that this is bad. People are dying. We don’t have the tools that that we need in the emergency department and in the hospital to take care of them, and — and it’s really hard.”

Reporting was contributed by Jesse McKinley, Jesse Drucker, Eileen Sullivan and Michael Schwirtz. Susan C. Beachy contributed research.

Michael Rothfeld is an investigative reporter on the Metro desk and co-author of a book, "The Fixers." He was part of a team at The Wall Street Journal that won the 2019 Pulitzer Prize for national reporting for stories about hush money deals made on behalf of Donald Trump and a federal investigation of the president's personal lawyer. @mrothfeld

Somini Sengupta is an international climate correspondent. She has also covered the Middle East, West Africa and South Asia for The Times and received the 2003 George Polk Award for her work in Congo, Liberia and other conflict zones. @SominiSengupta • Facebook

Joseph Goldstein covers health care in New York. He has been a reporter at The Times since 2011. @JoeKGoldstein

Brian M. Rosenthal is an investigative reporter on the Metro Desk. Previously, he covered state government for The Houston Chronicle and for The Seattle Times. @brianmrosenthal