Coronavirus crisis in New York: As doctors warn of “our Chernobyl,” state government plans Medicaid cuts
Clara Weiss and Ali Elhassan
23 March 2020
Over the past week, New York City has rapidly become the epicenter of the coronavirus outbreak in the United States with a more than twenty-fold increase of confirmed cases. As of Sunday morning, there were 9,654 confirmed cases and 63 deaths in the city, while statewide there were 15,168 cases and 114 deaths.
New York state thus accounts for over half of the cases in the US and roughly 5 percent of the cases worldwide. About half of the confirmed cases in New York state are patients under the age of 50, and roughly 13 percent have been hospitalized. A statewide lockdown went into effect on Sunday, at 8 p.m.
State and city hospitals have been rapidly overwhelmed, even though the pandemic has only started, with the peak expected to be at the end of April or beginning of May. Officials have said the state would need to at least double its available hospital beds from 50,000 to 100,000 and could have a shortfall of as many as 25,000 ventilators.
Governor Andrew Cuomo ordered hospitals to increase their capacity by at least 50 percent and he has ordered the cancellation of elective surgeries in an attempt to free up beds and increase capacity. Most hospitals in New York City, including Presbyterian Hospital and NYU Langone have already canceled elective procedures. The state has also issued an urgent call for retired nurses and volunteers with medical training to join the hospital staff.
In a press conference Sunday morning, New York City Mayor Bill de Blasio predicted that the city is “ten days away” from seeing widespread shortages of medical supplies and that “the worst is yet to come.” In his own press conference the same morning, Governor Cuomo warned that the crisis could last up to nine months and declared that between 40 and 80 percent of the population of New York state (roughly 19.5 million people) would get infected.
Both Cuomo and de Blasio have insisted for over a week that the Trump administration deploy the military to the city. Cuomo has already met with representatives from the Army Corps of Engineers and discussed setting up temporary hospitals.
Most hospitals in New York already report shortages and dangerous conditions for their medical staff. In interviews with the New York Times, doctors at Lincoln Medical Center in the Bronx say they are down to a few remaining ventilators. In Brooklyn, doctors at Kings County Hospital Center are now “reusing masks for up to a week, slathering them with hand sanitizer between shifts” and placing the “masks in brown paper bags labeled with their names.” The Center for Disease Control and Prevention states that N95 masks should be discarded after each patient interaction and become ineffective after eight hours.
In an internal report, NYU Langone, a leading private hospital, informed its employees last Wednesday that it would be “out of surgical masks with attached face shields” by the end of the week. A New York doctor told Vice, “This is our Chernobyl,” referring to the 1986 nuclear disaster.
On March 17, the city health department published a guideline explicitly stating that medical workers who have had “known high-risk exposure to a patient(s) with confirmed COVID-19” should “take extra care to monitor your health but can keep working.” There was “no requirement for 14-day quarantine of health care workers,” the guideline said. This policy is part of a national move toward dramatically loosening even the most basic safety protocols for health care workers in the face of serious shortages.
This policy will endanger the health of medical workers as well as that of their families and their patients, further contributing to the spread of the disease. It also risks contributing to a high rate of infection among health care workers, threatening accelerated staff shortages as the pandemic spreads.
Already, hospital staff are being tested positive at an alarming rate. On Friday, Politico quoted Dr. Conrad Fischer from the Brookdale University Medical Center, “It’s a disaster. We just had a half dozen staff just test positive. We have 17 ventilators left in the institution. Some staff can't come because they’re getting wiped out.”
On Facebook, hospital workers angrily report that they are not being adequately equipped. One New York hospital worker noted, “My hospital has unsafe staffing conditions and refuse[s] to give masks to the workers.” Another wrote, “I work in ICU and we are only allowed 1 N95 mask per shift. Believe it or not we are asked to place the used mask in our pockets and use it throughout our shift for patients on airborne precautions.” Other nurses reported having to work with both COVID-19 patients and other patients, risking exposure of the latter to the virus.
New York state temporarily ramped up testing last week, performing over 30,000 tests, which contributed to the dramatic rise in confirmed cases. Long lines formed in front of hospitals like Elmhurst hospital in Queens, New York City, on Friday with hundreds waiting to get tested. However, on Friday, the city authorities demanded hospitals “immediately stop testing non-hospitalized patients” for the virus, absent specific circumstances that it made medically necessary.
Hospitals are explicitly told not to test “asymptomatic” medical workers. These policies directly contradict the recommendations of the World Health Organization, which has insisted that, along with social distancing, mass testing and the tracing and isolation of confirmed cases are critical to combatting the pandemic.
Nothing about the unfolding disaster, which threatens the lives of hundreds of thousands of people in New York alone, was unpredictable. Health care workers have warned for weeks of immediately impending shortages. A poll conducted among New York hospitals in early March found that 47 percent of all facility plans for protecting employees were inadequate; that 49 percent of all facilities did not have enough N95 masks, and that 36 percent had inadequate screening protocols for patients who may have COVID-19.
According to the New York State Association of Nurses, at least several billion N95 disposable respirators, billions of surgical masks, reusable respirators, protective gowns, face shields, goggles, and other equipment to protect hospital employees will be needed in the US to confront the rapidly spreading pandemic.
While Cuomo and de Blasio, both Democratic Party politicians, seek to shift all the blame for the unfolding catastrophe on the Trump administration, the truth is that savage cuts to social spending and especially health care have been a decade-long, bipartisan policy that is directly contributing to both the spread of the disease and a much higher than necessary mortality. Spending for the CDC Public Health Emergency Preparedness Funding, which covers the preparation to fight outbreaks of infectious diseases like Ebola or COVID-19, has declined dramatically under both Republican and Democratic administrations since 2003.
Even as the number of coronavirus patients in New York has skyrocketed, a special panel appointed by Governor Cuomo called for another $400 million in Medicaid spending cuts for New York hospitals in this fiscal year, starting April 1.
Spending for the NYC Health + Hospitals, the public hospital system of the city, would be slashed by $186 million. The proposed cuts will include a 0.8 percent cut in Medicaid payments to all health care providers, including hospitals; the elimination of indigent-care pool funding, a program which makes it easier for hospitals to cover losses they make by treating uninsured and low-income patients; and lower reimbursement rates for hospital visits that are deemed avoidable.
While officials have indicated that they may delay the cuts due to the coronavirus outbreak, the timing of the vote makes clear their determination to push ahead with the austerity measures.
In February, it was also announced that the federal government will cut $8 billion of funds to New York health care providers. These cuts will affect almost all of the major hospitals of the state, including New York-Presbyterian, Mount Sinai, NYC Health and Hospitals, and the Nassau University Medical Center.
These cuts will come on top of decades of austerity. Sixteen hospitals were closed in New York City alone since 2003. The number of hospital beds has declined by more than 20,000, or 26 percent between 2000 and 2020, from 73,931 to 53,000 hospital beds. The number of Intensive Care Unit (ICU) beds has declined from 3,043 to 3,000.