Hospitals Hustles; Elective Surgery Canceled; Some Tests Move On-Site

Expanded coronavirus testing will help public-health officials prevent new infections in New Haven, especially within apartment complexes and nursing homes.

But whether that will be enough to limit the COVID-19 pandemic’s spread and not overwhelm the hospitals will all depend on city residents doing their part.

Steven Choi, Yale-New Haven Health’s (YNNH) and Yale School of Medicine’s chief quality officer, gave that updated status on Wednesday afternoon, a day after nearly 50 patients (with a doctor’s order) were swabbed for COVID-19 at the hospital’s new ​“drive-through” sample collection site at 150 Sargent Dr. in New Haven.

“We’re still at the early stages of transmission here in this community,” Choi said. ​“We’re working on the assumption that a lot more people have been infected and therefore a lot more people do need to get tested.”

The testing results will help public-health officials better understand how the virus is moving throughout Connecticut and where they should target containment strategies.

That will be especially important if they find a confirmed case in a crowded living situation, like an apartment building or a nursing home, to make sure the patient minimizes all physical contact.

“First and foremost, it allows us to identify patients that are infected and contact them, whether through our physicians, their own or the local and state health departments,” Choi said. ​“While we cannot force quarantine, but we can inform infected COVID-19 patients to self-isolate from their household and the community at large.”

YNNH is planning to double its capacity starting on Wednesday, taking nose and throat swabs from up to 100 patients a day, Choi said.

Those will be placed in vials and sent off to a Quest Diagnostics lab, where technicians look for a sequence of viral DNA from the swabs, he said. Patients can expect results to be available within two to three days, he said.

YNHH also has a lab within the hospital where it can conduct a limited number of its own tests with a quicker turnaround. But because it has a limited supply of chemicals, equipment and manpower, it’s reserving those for ​“the most ill patients” who’ve been admitted through the emergency room and for its healthcare workers, Choi said.

Choi said that there are not currently plans to open another sample collection site in New Haven, but that could change ​“based on the volume,” if it can’t increase the capacity of its current site. He added that there are also sample collection sites in Greenwich, Bridgeport and New London.

Responding to concerns about the Long Wharf site’s accessibility — for those who can’t drive there or pay for a doctor’s consultation — Choi said that YNHH had added some flexibility to make sure the testing’s more widely available. 

If they can get to Sargent Drive on foot or a bike, patients can now walk between the two tents without a car, Choi said. But they should not hop on a bus or call a ride-share, he added.

“I realize that’s a lot easier said than done,” Choi said. ​“If you have symptoms consistent with coronavirus and are at high risk to be infected, it’s a danger for you to take mass transit. Even Uber or Lyft is risky: You might transmit it, or the driver might be sick.”

Asked how those with limited mobility, like seniors, could be tested, Choi said that YNHH does not yet offer home-testing services.

“That is something we already started discussing,” he said.

When it comes to affordability, Choi said that patients will not have to pay any out-of-pocket costs for the coronavirus test.

“Any portion that insurance doesn’t cover is free,” he said.

Choi added that patients do still need a doctor’s authorization in order to schedule an appointment at the sample collection site, as there are many residents who do not understand the criteria for who gets tested.

Those who don’t have a primary-care doctor can call the hospital’s coronavirus hotline at 1 – 833-ASK-YNHH, where those who meet the criteria can be routed to a physician for a clinical assessment over the phone.

“What you cannot do is just show up and ask for testing,” Choi said.

Many are still being turned away from testing, like Valerie Horsley, a Hamden Legislative Council member and a Yale University biologist who came down with a mild fever, who called YNHH’s hotline and was told she’s too ​“low risk” to get the tests.

Choi said that residents should call up their doctor once they start developing symptoms that might suggest a coronavirus infection, like fever, cough, shortness of breath, muscle pain and headaches. He added that they should also contact their doctor if they’ve been in close contact with a laboratory-confirmed COVID-19 patient.

“I would err on being more conservative: Call your doctor sooner rather than later,” Choi said. ​“If you’re not self-isolating early on, the risk of transmission to your loved ones, household members and people you happen to be in contact with is increased.”

“The only way to win this battle,” he added, ​“is if we slow down the infection rate.”

Plans B & C

If COVID-19 spreads exponentially throughout the city, YNNH might not be able to keep up. That’s why there have been calls for residents to ​“shelter in place” to slow the transmissions.

In 2018, YNHH had only about 2,535 beds available across the entire system, including at its acute-care centers in Bridgeport, New London, Greenwich and Milford, according to state utilization data. New Haven had 1,550 hospital beds, about 78 percent of them already in use, the report said.

To make room, YNHH has cancelled all elective surgeries, but even that move only freed up about 10 percent of the beds, Choi said.

“Every little bit helps,” he added.

Augie Lindmark, a hospital resident at the Yale School of Medicine, said that insurance companies also aren’t making it any easier to open up space.

He said they haven’t changed the way they require ​“prior authorization,” by which hospitals check to make sure insurers will cover the recommended treatments. That pre-approval has long been known as one of the biggest administrative burdens for hospital staff, but those delays could now put lives at stake, he said.

“Every day in America, health care clinicians waste time arguing with private insurers. A prior authorization essentially asks, ​‘Are you sure you know what you’re doing?’” Lindmark tweeted. ​“We do. Let us do our job.”

“[M]ultiple patients of mine can’t leave the hospital because they’re awaiting prior [authorizations] from commercial insurers,” he added. ​“Right now, we can’t afford to waste time. There is no place for frivolous delays so health insurers can solidify their bottom line.”

There are even fewer negative-pressure rooms in intensive care units: about 300 across the system, Choi estimated. He called them ​“our most valuable physical resource right now,” because they limit the spread of pathogens like coronavirus that spread through air and respiratory droplets.

If sick COVID-19 patients overwhelm New Haven’s intensive care units, they’d have to make do with regular beds and take other precautions recommended by the U.S. Centers for Disease Control and Prevention (CDC) so the coronavirus doesn’t sweep through the hospital, Choi said.

Because there is no vaccine yet, the only way to prevent more COVID-19 infections from reaching what Choi called a ​“breaking point” is following through on what public-health experts call ​“social distancing.”

That means following the now-familiar CDC guidelines about limiting contact with other people: avoid large gatherings with more than 10 people; keep a distance of six feet from other people, far enough away to avoid breathing in droplets from cough or sneeze; and stay home in ​“self-isolation” if you’re feeling sick.

Choi added ​“responsible traveling” to the list, which, he explained, ​“at this point in the pandemic means no traveling, at least not through mass travel.”

He added to please think twice before hoarding food, toilet paper and disinfectants from the supermarkets, when others might not be able to afford marked-up prices as the shelves clear.

Everyone has to also keep washing their hands with soap and water for at least 20 seconds; covering their sneezes; cleaning frequently touched surfaces daily, like door knobs, light switches, faucets, phones, keyboards and tables.

Choi said those preventive efforts would be ​“absolutely crucial” to making sure that the hospital is not overwhelmed with patients, as the healthcare system has been in Italy.

“This may be the first time where we’re going to ask the American public to help us fight a healthcare crisis that will be won or lost in the community, not within the hospitals,” Choi said. ​“This is where people outside the hospitals are going to make a much bigger difference than those of us working inside the hospitals.”