Hospitals here might not face the worst-case scenario predicted for Covid-19 cases.
But they've done their best to be ready if they do.
Federal officials have scaled back earlier predictions of 100,000 to 240,000 American Covid-19 deaths.
Senior White House adviser Dr. Anthony Fauci said Thursday the number could be closer to 60,000.
And state officials in recent days have presented encouraging data showing the number of Covid-19 patients requiring hospital treatment has declined, even as the state death toll neared 800 a day.
Early projections suggested as many as 100,000 New Yorkers would need hospital care, Gov. Andrew M. Cuomo said Thursday, when the state had about 18,000 hospitalized Covid-19 patients.
Erie County Executive Mark C. Poloncarz said the region’s health care network has managed to handle the Covid-19 caseload so far. On Friday, 227 Covid-19 patients were hospitalized in the county and 121 of them required intensive care.
And, he said, while those numbers have reached their highest totals during the crisis, the rate of growth is flattening.
“But our projections still show that our peak is a number of weeks out. And so we are afraid of what could happen in a number of weeks,” Poloncarz told reporters late last week.
The challenges for hospitals are finding enough equipment, beds – especially in intensive care units – and staff.
“For most people living, nothing like this has ever happened. So how do you prepare for something that you’ve never experienced?” said John Bartimole, former president of the Western New York Healthcare Association, a hospital trade group.
Nurses and doctors are working under considerable strain and with a shrinking supply of protective equipment, said Larry Zielinski, a former president of Buffalo General Medical Center, who teaches health care management at the University at Buffalo.
“Can they ramp up their ICU capacity in terms of space, in terms of equipment, in terms of supply and, probably most importantly, in terms of staff?” he asked.
Local hospitals must confront the outbreak without mass testing data. "These caregivers have to assume that everybody walking in, unless they’ve been tested, has the disease,” Zielinski said.
They’ve adapted to the challenge, converting space once used for elective surgeries to Covid-19 treatment areas and setting up triage tents where staff and patients can be screened before entering.
The hospitals should apply this lesson of flexibility to planning for future medical crises, Bartimole said.
Here's how they're doing it.
Kaleida Health executives say they believe their Covid-19 caseload has plateaued in recent days.
As of Saturday afternoon, Kaleida Health was treating 69 Covid-19 patients – including 34 in ICUs – in Buffalo General Medical Center and Millard Fillmore Suburban Hospital.
That’s a manageable caseload, said Jody L. Lomeo, president and CEO of the region’s largest hospital system, which submitted a state-mandated surge plan increasing its bed count from 988 to 1,374.
Dr. David Hughes, Kaleida’s chief medical officer, said the system could double its ICU capacity if needed. But he and Lomeo both anticipate a spike in patients from nursing homes who will require critical care.
“We do expect to see a surge there,” Hughes said.
Lomeo said Kaleida Health has searched far and wide to bring in much-needed safety equipment for its workers. The system recently acquired 1 million surgical masks.
But its stockpile of the hard-to-find N95 respirator masks would last only seven to 10 days without replenishment, Lomeo said.
“That one’s a little tighter,” he said, though new supplies come in weekly.
Hughes said fewer employees have caught the virus than he feared, and most employee infections appeared to come from community spread and not from patients.
Employees at Oishei Children’s Hospital, which doesn’t have Covid-19 patients, have tested positive at a comparable rate to employees at Buffalo General, which does, Hughes said.
Marty Boryszak, senior vice president of acute care services and the leader of Catholic Health's Covid response team, said his most optimistic model projects 400 Covid-19 patients in the group's five hospitals, with a peak arriving between April 22 and 24.
But that's a huge jump from the midweek level of 125 Covid patients in Catholic Health facilities, including its Covid-only site at Sisters of Charity Hospital's St. Joseph Campus in Cheektowaga.
CEO Mark Sullivan said Catholic Health workers have distributed about 2,000 health monitoring devices to home care patients who aren't deemed sick enough to require hospital treatment.
All of this should keep pressure off the hospitals, Sullivan said.
Like the Kaleida facilities, Catholic Health's other hospitals have designated floors as Covid-19 units, which eases the strain on caregivers and lets them conserve supplies, Sullivan said.
But St. Joseph's was the key to Catholic Health's surge plan. It accounted for more than a third of Catholic Health's planned increase from 615 beds to 1,075. St. Joseph's has about 100 critical care beds.
And Catholic Health has leased the closed Absolut Care nursing home in Orchard Park, soon to be renamed the St. Joseph Post-Acute Center, where the group can move up to 80 Covid-19 patients who are improving.
"The proactive approach we took in Orchard Park will decompress some of those beds, but 80 beds is not enough for the community," Sullivan said.
Not all nurses are trained to work in intensive care units, but on the weekend of March 21-22, Todd Roland, a physician assistant at Mercy Hospital, created a six-part training program that 600 Catholic Health nurses have taken, Boryszak said.
Every day, Catholic Health uses 1,000 to 1,200 N95 masks and up to 750 face shields, 7,000 surgical masks and 4,000 isolation gowns.
“Depending on how long this goes and as we have more patients present, all of the items will present a challenge," Boryszak said.
Erie County Medical Center
Erie County Medical Center president and CEO Thomas J. Quatroche Jr. also sees the Covid-19 caseload leveling off, with 40 patients as of Thursday.
However, the patients ECMC does have are sicker, with 19 on ventilators, a figure that quadrupled in a week.
"Most of the patients are coming in through the emergency department," said Charlene J. Ludlow, ECMC vice president and chief quality and safety officer. "Most of them are coming in not with minor symptoms. That’s why the majority of them are going into critical care units."
“We’re not sure whether this plateau is a plateau before an increase or a decrease at this point," Quatroche said Thursday."If you have a cluster, at a nursing home for example, you’re going to have a significant, sharp increase in patients.”
ECMC has 232 medical-surgical beds and 62 ICU beds, but as of Thursday, the Grider Street hospital had 106 empty medical-surgical beds and 21 ICU openings.
Thus, there's plenty of room for more patients or to keep recovering patients in-house for a while. In addition, ECMC's surge plan said it could boost the total of medical-surgical beds to 401.
"The bottom line is, we’re prepared for an increase," Quatroche said. "We could handle a 50% increase at this time. Actually, we could double our ventilated patients.”
“Currently we do have enough staff. The issue always is with intensive care staff, and we are currently training staff from the operating room and other areas of the hospital to be able to assist the intensive care staff for a doubling of patients," Quatroche said.
"On procedural masks and gowns we’re doing OK. We currently have about 2½ months of procedural masks and a month and a half of gowns. Our biggest challenge is N95s. We currently have about 20 days on hand of N95s at our current use rate," Quatroche said.
The medical center uses about 700 N95s a day. “Staff are asking for those N95s, so we’re balancing between that need and the fact that we want to make sure we have enough supplies for those caregivers that are taking care of Covid patients," Quatroche said.
He has no objection to using KN95 masks, a nearly-as-good version approved April 3 by the Food and Drug Administration. Ludlow said the staff has been given instructions on how to stretch the N95 supply.
Niagara Falls Memorial Medical Center
Niagara Falls Memorial Medical Center told the state it could increase its capacity from 75 beds to 132.
“We had actually purchased 47 additional beds and are in the process of placing them in various areas for non-Covid patients," President and CEO Joseph A. Ruffolo said. "We would have the capacity for 33 Covid beds."
Niagara Falls Memorial had seven Covid-19 patients at midweek.
“We actually have over 80 physicians who have signed up to volunteer on a moment’s notice if in fact, God forbid, a surge comes," Ruffolo said.
Niagara Falls Memorial used an old connection to directly reach a Chinese manufacturer of KN95 masks.
"Over a six-week time period, we’ll probably go through 30,000 N95 masks, probably 125,000 procedure masks and probably 30,000 isolation gowns," Ruffolo said.