Why surviving the virus might come down to which hospital admits you (via nytimes) COVID19
NEW YORK — In Queens, the New York City borough with the most coronavirus cases and the fewest hospital beds per capita, hundreds of patients languished in understaffed wards, often unwatched by nurses or doctors. Some died after removing oxygen masks to go to the bathroom.
Now, evidence is emerging of another inequality affecting low-income city residents: disparities in hospital care. “If we had proper staffing and proper equipment, we could have saved much more lives,” said Dr. Alexander Andreev, a medical resident and union representative at Brookdale University Hospital and Medical Center, a struggling independent hospital in Brooklyn. “Out of 10 deaths, I think at least two or three could have been saved.”
Overall, more than 17,500 people have been confirmed to have died in New York City of COVID-19, the illness caused by the coronavirus. More than 11,500 lived in ZIP codes with median household incomes below the city median, according to city data. “We are one health care system,” Cuomo said on March 31. The same day, he described the coronavirus as “the great equalizer.”
“The governor said COVID was the ‘great equalizer’ in that it infected anyone regardless of race, age, etc. — not that everyone would receive the same the level of health care,” she said. “The governor said we are one health system in terms of ensuring that everyone who needed it had access to a hospital.”
Today, most beds in the city are in hospitals in five private networks. NewYork-Presbyterian, which has Weill Cornell Medical Center and Columbia University Irving Medical Center; NYU Langone; the Mount Sinai Health System; Northwell Health; and the Montefiore Medical Center. At the safety-net hospitals, only 10% of patients have private insurance. The hospitals provide all the basic services but often have to transfer patients for specialty care.
These areas have lower median incomes — $38,000 in the Bronx versus $82,000 in Manhattan — and are filled with residents whose jobs have put them at higher risk of infection. When he arrived at the towering campus just east of Central Park, he was surprised to see fewer patients and more workers than at Elmhurst, and a sense of calm.
In the emergency room, where best practices call for a maximum of four patients per nurse, the ratio hit 23-1 at Queens Hospital Center and 15-1 at Jacobi Medical Center in the Bronx, both public hospitals, and 20-1 at Kingsbrook Jewish Medical Center, an independent facility in Brooklyn, workers said.
Research has shown that staffing levels affect mortality, and that may be even more true during this pandemic because many COVID-19 patients quickly deteriorate without warning. Dr. Dawn Maldonado, a resident doctor at Elmhurst, described a worrisome pattern of deaths on its understaffed general medicine floors. She said at least four patients collapsed after removing their oxygen masks to try to walk to the bathroom. Workers discovered their bodies later — in one case, as much as 45 minutes later — in the bathroom or nearby.As the coronavirus raged, Lincoln Medical and Mental Health Center in the Bronx kept running into problems with ventilators.
While many interventions for COVID-19 are routine, like supplying oxygen through masks, safety-net hospital patients also have not had much access to advanced treatments, including a heart-lung bypass called extracorporeal membrane oxygenation, or ECMO. Many factors have affected those numbers, including the severity of the patients’ illnesses, the extent of their exposure to the virus, their underlying conditions, how long they waited to go to the hospital and whether their hospital transferred healthier patients, or sicker patients.“It’s hard to look at the data and come to any other conclusion,” said Mary T.
“I’m not going to say that the quality of care that people got at my 11 hospitals wasn’t as good or better as what people got at other hospitals,” he said. “Our hospitals worked heroically to keep people alive.” At the same time, another conversation was happening. It began in late March, when doctors at the Lower Manhattan Hospital concluded their mortality rate for COVID-19 patients was more than twice the rate at Weill Cornell, a prestigious hospital in its same network, NewYork-Presbyterian.
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