Before The Deluge, YNHH Prepares

Yale New Haven Hospital is rushing to develop its own COVID-19 tests, open an off-site sample-collection center, and revise rules for how caregivers use N95 respirators in anticipation that the virus is about to hit the city.

Whether or not that spread overwhelms the health care system will rely in large part on how much everyday New Haveners wash their hands thoroughly, keep distance from others, stay home when sick, and practice other preventive methods.

Those were key takeaways Friday afternoon from a press conference with leaders of Yale New Haven Health, which operates seven hospitals in Connecticut and Rhode Island, including Yale New Haven Hospital. The presser took place on the second floor of YNHH’s laboratory testing facility building at 55 Park St.

The hospital leaders updated the community about their efforts to prepare for the local impact of what has become a fast-moving COVID-19 coronavirus global pandemic.

So far only two people in southern Connecticut have required hospitalization in the system, and they’re both home and recovering, reported system Chief Medical Officer Thomas Balcezak.

But as more people throughout the state, and some in the Greater New Haven region, are showing potential symptoms from the virus, city leaders have closed schools and senior centers and libraries and cancelled large public gatherings. Based on the virus’s spread abroad and now coming northeast from New York and Fairfield County, the region is bracing for a flood of cases.

Hospital officials did not reveal an exact estimate of how many urgent cases they expect to have to handle. But they made clear that even with emergency measures, the load will overwhelm the state medical system unless all citizens work hard to slow the spread.

“We can take care of folks when they’re sick,” said Balcezak (pictured). ​“We can’t prevent them from getting sick.”

Around 85 percent of the people who contract COVID-19 have ​“moderate” or ​“mild symptoms,” reported Rick Martinello, YNHH’s medical director for infection prevention. They can recover safely at home.

The other 15 percent get sick enough to need to come to the hospital. ​“Unfortunately about 5 percent of those among the 100 percent sick enough to require intensive care” will likely need treatment with ​“mechanical ventilators or other measures of life-support.”

Yale New Haven has 270 intensive-care rooms that can handle those cases and 270 ventilators, and is in the process of making some more available, said Balcezak and YNHH Vice-President and Chief Quality Officer Steven Choi (pictured).

The state Department of Public Health may be able to make some more available to hospitals. But clearly the supply may be stretched if trends follow those in areas already hit hard by COVID-19’s spread.

The nation is also experiencing a severe shortage of coronavirus tests. YNHH has worked fast to develop a test in-house. It may have one ready as soon as later Friday afternoon and may be able to ramp up to conduct up to 200 tests a day, Balcezak said.

He said that Marie Landry, the hospital system’s head of virology, reported to him yesterday that she was able to successfully test for the disease using hospital equipment. He said she’s taking some final steps to verify and validate the results this afternoon.

YNHH has been in the process of asking the Board of Education to let it use the vacant former Strong School on Legion Avenue as a collection site for test samples, similar to a successful one YNHH has opened at Greenwich Hospital. (See more details below in this story.)

“Throughout our health system we’ve been preparing to meet the challenge of a situation of this nature,” said YNHH President and CEO Marna Borgstrom. ​“The message that we’re sending today is that we are keeping our patients and our caregivers safe and we are ready to care for patients throughout the region should this virus continue to impact Connecticut.”

“There’s no doubt that these are extraordinary times,” she continued. She said the hospital system has set up outposts for specimen collections, activated and prepared negative pressure rooms for those who may be seriously ill, and is working with other health institutions across the country and the globe to develop and implement best practices.

New Policy On N95 Reuse

The nation is also experiencing a shortage of N95 respirator masks for hospital staff to use in treating coronavirus patients. That has left hospitals with a wrenching decision to make about how to make their current supplies last — even as they respond to federal permission to obtain other previously unapproved alternatives to use in airborne isolation rooms.

To that end, YNHH revised its policy for the use of N95 respirators on March 6.

Previously nurses would use the mask once when seeing a patient in an airborne isolation room, then throw out the mask. They might go through 50 to 80 in one day with a single tuberculosis patient, Martinello said in an interview before the press conference.

The new policy directs staff to reuse N95 respirators —not with other patients, but in ​“multiple encounters with the same patient, but removing it after each encounter.”

Caregivers now get a single N95 respirator at the beginning of a shift for a patient. In between contacts with the patient, the caregiver is to ​“label the strap with the wearer’s name and hang in a dedicated storage area” or “[p]lace in a paper bag labeled with the user’s name in a manner to ensure they do not become damaged or deformed.”

Click here to read the full policy.

“It’s not what we want to do. It’s what we have to do,” Martinello said in the interview.

“We have to change what we’re doing now. Otherwise this resource will not be available.”

The Centers for Disease Control has offered guidance to hospitals weighing the pros and cons involved in N95 reuse choices. Click here to read the guidance.

Learning From Other Communities

Dr. Steven Choi, chief quality officer for the Yale New Haven Health System (YNHH) and an associate dean of Yale Medical School, and his team are overseeing efforts across the system’s Connecticut and Rhode Island hospitals to prepare for the spread of the virus.

Choi said in an interview Thursday with the Independent that the YNHH team has learned from the public-health disasters in other nations, where hospitals have run out of beds and supplies for thousands of people with potentially fatal cases.

“I am confident that we are ready. We learned a lot from our fellow professional colleagues overseas in China, South Korea, Japan, Iran, and Italy,” Choi said. ​“We’re actively engaged through both professional outlets and even social media to share experiences, both successes and failures, so we can optimize our management of this pandemic.” 

He noted the global shortage of protective equipment for hospital personnel, especially N95 respirator masks.

“We have backup plans for if and when we run out of respirator masks. As with all things, we prepare for the worst and expect for the best,” Choi said. He noted that the federal Centers for Disease Control have published new guidelines for alternatives that may be used for the N95 masks and even for negative pressure rooms.

YNHH has set up a public hotline for anyone to call, from New Haveners confused about their symptoms or seeking basic information, to people and organizations around the world seeking policy guidance. The number to call is 203 – 688-1700 or 833-ASKYNHH.

“There is a public misconception that because you have any symptoms that you should get tested. But the reality is that with community transmission, we have to assume everyone will be or has been exposed, and that there are clear guidelines for who should get tested, and clear guidelines for how those who test positive should be managed, whether they are symptomatic or asymptomatic,” Choi said.

YNHH has already set up a separate ​“ambulatory specimen collection center” at Greenwich Hospital where the fourth Connecticut coronavirus case was reported Thursday.

It is working on plans to set up similar stand-alone facilities at its New Haven campus and possibly at other sites. (YNHH Vice-President Vin Petrini said a rumor that such a center would be set up on Yale’s West Haven campus is untrue.)

The hospital formally asked the Board of Education Thursday for permission to use the former Strong School in Legion Avenue as the site. At an emergency meeting Thursday evening, board members expressed openness to the idea but put off a vote until receiving more information. (More on that meeting lower down in this article.)

The state Department of Health needs to certify such stand-alone centers before they open, which has happened in Greenwich.

At stand-alone collection centers, doctors and nurses collect samples from patients on site; then the samples are sent either to the state laboratory in Rocky Hill (in the cases of patients already ill enough for hospital admission), commercial laboratories, or the University of Washington virology lab. In the latter case, it takes about a day for the sample to arrive in Washington, then about 10 hours for validating results, according to Choi. He said the hope is that Quest Laboratories will soon open a lab on the East Coast, in Virginia.

And not everyone who tests positive then comes to the hospital for treatment. In fact, most don’t. Less than approximately 20 percent of COVID-19 patients will require hospitalization, those with moderate/severe symptoms. Most people are directed to stay home and self-quarantine.

Those who do come to the hospital need to be kept in specially isolated units — ​“negative pressure rooms” that keep germs from seeping out — so they don’t infect other patients or staff. Choi said YNHH has been preparing these rooms for a surge of COVID-19 admissions.

Our Part: Flu Shots, Hand Washing

Around the world, hospital crises have occurred where the the spread of virus has suddenly exploded rather than ​“flattening out,” in part because of a lack of preventive measures by the public, from social distancing and closing events to testing.

Edward Kaplan (pictured) has been studying how the virus has spread, beginning with the first 425 confirmed cases in Wuhan, China. Among his findings: People can help by getting … flu shots. (Read his paper here.)

No, flu shots don’t prevent people getting coronavirus, Kaplan said. But they prevent many people from contracting serious cases of the flu that require hospitalization — and therefore fill beds needed for coronavirus patients. Also, they help people who come down with flu-like systems realize sooner that they in fact have coronavirus.

Kaplan discussed those findings Thursday during an interview on WNHH FM’s ​“Dateline New Haven” program. He said he ended up conducting his coronavirus study by chance, when the editor of a journal asked him six weeks ago to contribute an article on a current public health topic. It turns out Kaplan was uniquely qualified for diving into how conoravirus spreads: He has written extensively and edited books on how HIV/AIDS spread, for instance. And he has expertise in statistics, public health, and operations research as a professor at Yale’s public health, management, and engineering schools. He is currently advising YNHH on its COVID-19 planning.

On one level, the current crisis reminds Kaplan of the early attempts to stem AIDS/HIV, and New Haven’s early successful experiments with needle-exchange programs: Both then and now, all sectors of society, from clergy to cops to public health officials, have needed to work together.

But coronavirus is qualitatively different in its incredibly rapid spread across all sectors of the population, Kaplan said.

His study has convinced him that while communities like New Haven may not be able to stop the spread of the virus, it can slow it down considerably. And that can make an enormous difference in the death toll.

Identifying a coronavirus victim within five days of infection can limit the spread by 80 percent, he said. So early and self-detection is a big factor.

“We need to prepare. We don’t have a lot of time. This thing is explosive. The way we live is likely to change over the next two months,” Kaplan said.

He noted that ​“we really are far behind the curve in testing and our ability to identify potential cases” in the U.S. He expressed confidence that in New Haven, YNHH has succeeded in doing needed advance planning to avoid some of the horror scenes that occurred in, say, China and northern Italy.

In the meantime, besides getting flu shots, New Haveners need to take all the steps officials keep advising: Thorough hand washing, ​“social distancing,” avoiding large gatherings, staying home when sick.

Click on the video below to watch the full interview with Edward Kaplan on WNHH FM’s ​“Dateline New Haven.”

Board Of Ed Considers YNHH Request

Yale-New Haven Hospital’s request to use the former Strong School site in the Hill for the collection center was the subject of an emergency Board of Education meeting Thursday evening.

The former elementary school was cleared out in January when its classes move into the new Barack H. Obama Magnet University School, and it’s currently being used only to warehouse science kits.

At the meeting, district COO Pinto said Strong School is a convenient location for a collection center, about midway between the hospital’s two campuses on York Street and Chapel Street. He said the hospital would not be doing the testing there, just packaging the samples to send off to other labs.

Wouldn’t Hill Regional Career High School, right across the street from Strong School, be a better alternative, with its bigger parking lot and driveway that goes right up to the back entrance? asked Darnell Goldson, an elected school board member.

Pinto said that he wasn’t sure if the hospital would need the collection site to keep running into next fall, when some health experts say there could be another wave of infections. ​”We don’t know how long this is going to last,” he said.

Goldson said that, after recently visiting an emergency room with a family member, it looked like the hospitals were already ​“absolutely overwhelmed.” While board members didn’t formally vote to turn over Strong School to the hospital, most of them said they were interested in pursuing it.