A few days ago, we linked to a story on how New York City was considering using hotels for non-critical, non-COVID-19 related care. Twitter shows another example of how hospitals are preparing for the expected deluge of coronavirus cases.
For those who still think this #CoronaCrisis is a joke, this is a picture from a Parking Garage at Vanderbilt University Hospital in Nashville, TN. Let that sink in. #Covid_19 #CoronaVirusUpdate #coronavirus pic.twitter.com/AsR7LSkvhz
— Georgia Lynn (@CureOurCountry) March 20, 2020
A reader forwarded an unusually direct and detailed e-mail from Marc Wais, NYU’s Senior Vice President for Student Affairs, which was sent March 17 just after noon. The university had told students the day before that they needed to leave the dorms and remove their possessions from their rooms by the end of the week or have them locked inside. This e-mail clarified the basis for this move (emphasis original):
I’d like to share with you the thinking behind our decision-making, and provide some clarification based on feedback we have gotten as well as new developments, namely 1) that we are now offering a choice between having your possessions shipped or left locked in your room and 2) that we only want students who are in day-trip range to return to campus to pack up their possessions. Those who are further away or who have medical concerns should consider staying away and following the instructions below concerning their effects…
The short version is: for reasons of your safety and health, and the need to restrict the spread of the virus, we needed as many of our students as possible to leave the city. There is a growing health issue in New York, and the possibility of travel restrictions looms.
So, why ask you to empty your rooms? Why raise the possibility of your returning to New York for that purpose? And why not just have you leave your possessions in your room?
Let me break that down for you.
First, a lot of students—more than is customary—remained in the residence halls during spring break. We had counted on students departing as usual. In addition, we had indications that many students planned to return to campus following spring break, notwithstanding the fact that we anticipated—and wanted—students to carry on their coursework from home. Altogether, this was the opposite of what we were needed.
We want students to go home and stay at home for their own safety and the safety of others. And for those who are here and those who are nearby, spring break week seems like a better, less disruptive time to pack up and head home than a week when classes are being held. And there is a reason for asking students to do it quickly, too (within 48 hours, if possible): in the near future, things are going to get worse rather than better as time goes on….
The reasons we want the rooms clear are based on both short-term and long-term rationales.
First, in the short term, we believe students should return home. We believe that in most cases this course of action is safer for you.
Second, there are significant indications that the State, as part of its contingency planning, is looking at university dormitories as settings for overflow beds from hospitals grappling with a potentially overwhelming numbers of sick patients, and there are other medically-related contingencies for which they are also being eyed.
NYU has an institutional responsibility to help if things come to that here in the city. It will go a lot less well if student possessions remain in the rooms. Let me put it this way: for those of you still here (or within a day-trip) and in a position to pack up your room, your willingness to do so is potentially an important contribution to health measures that may come later. And however distasteful, imperfect, and complicated it may seem to have the University arrange to have your belongings packed up and shipped to you, I can assure you that it will go a lot better now than if we have to respond hastily to an emergency situation.
The e-mail later warns about leaving personal property in the dorm rooms:
To leave your possessions locked in your room and retrieve them at some later appropriate date: We understand the appeal of this option. And there is no certainty that your room will have to be used for another purpose. However, we want you to understand the downside: if you choose this option, you must be prepared that, in the event of a State-mandated or other emergency condition that requires your room to be made available as part of a health response, your possessions will be swept up with everyone else’s in the room. If it is at all possible at that time to arrange for storage, NYU will strive to do so. Students who wish to avail themselves of the option to have their belongings locked in their room to retrieve at a later date will be asked to sign a waiver; those not signing the waiver will have their possessions packed up and shipped to them, as proposed.
The fact that NYU is prepared to pack and ship a lot of goods is another reminder of how badly overloaded hospitals are expected to become, and in a matter of weeks on current trajectories, and sooner in NYC.
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Would it make sense to set up one or more cruise ships as hospital ships?
I suspect that the problem with modern cruise ships is that their air conditioning units may be responsible for spreading airborne virus right through the vessel. So its possible that without retrofitting they might do more harm than good.
your point very likely isn’t wrong.
however if I recall correctly the principal infection vector for the Diamond Princess were untested, but infected, wait staff who spread the virus during their food delivery rounds to the shut-in guests
Just a thought — on the cruise I took — years ago — I remember two people assigned per berth. That should — one can hope — become one person per berth for a CoV-19 ship. The air conditioning systems are probably in bad need of an upgrade in their draw and in their air filtering — your retrofitting I assume. If those changes were made am I wrong to suppose that cruise ships might be as good or better than some of the other options for isolation?
The retrofits might be a very nice addition for the comfort and safety of future cruise passengers. I suspect similar upgrades to office and shopping area air filtering might be helpful for problems we might most wisely anticipate for the future. Actually tests done on the filters in these enhanced units might give early warning of other infestations we should expect in our future — much like the filters used to measure pollution levels or do pollen and fungal spore counts.
As a side note, in Dublin they are now using a navy corvette moored on the city quays as a drop in testing centre.
Much as I appreciate the capabilities of the U.S. military — I am loathe to make them a goto organization for handling the CoV-19 viral infections [Corona flu]. The precedent posses unpleasant possibilities in its future branches.
The U.S. has a badly broken medical care system. We should fix that.
I don’t see how hospitals can staff a tremendous increased capacity without drawing on help from outside sources. Thats taking into account retired personnel who decide to come back. I saw some else had the same idea in comments yesterday or the day before, but we also might need to eventually beg Cuba for extra doctors.
No, I don’t have data to back my claim, just spitballing what could be worst case scenario.
I agree that U.S. hospitals may not be able to staff up without drawing from outside sources. I have no objection to that whether those sources are military or otherwise. But I do not want the U.S. military to become the back-up “goto” for our badly broken medical care system. I view this CoV-19 virus [Corona flu] as a test case for our medical care systems — a test we are badly failing. I also do not have and do not demand ‘data’ to form and express an opinion. [I believe we are becoming too ‘data’ driven in drawing simple logical conclusions. The ‘data’ is often bound up in statistical and probability theory that collapses when more closely exercised.]
I fully agree that we might — I would go so far as will — eventually need to beg Cuba for doctors AND medical training for more doctors … and nurses … when all is said and done. Whether need ‘Trumps’ reason remains a conundrum for the future.
This sounds like a good idea but will there be the doctors, nurses and ancillary staff to staff it? What about the equipment that will be needed to operate it?Another point. That car park at Vanderbilt University Hospital is one big room essentially and nurses can keep an eye on all the people in those beds at a glance. But in a dorm, the nurses and doctors would have to go from room to room to check on all those patients. Not sure if that is a good idea.
I could also see an awkward situation arising out of using dorm rooms as hospitals and statistically it will happen. Imagine that it is 2031 and a young student hears a knock at the door. The guy at the door asks if he can see that room as back in 2021 he was sick in that room with Coronavirus and spent three weeks there. Then he might mention that he had to share that room and five other people came to that room and left feet first while he was there. That might make some people feel uneasy sleeping there again.
Military…if I had to guess, military medics, doctors, and nurses, are going to be brought in to service.
Dorms strikes me as a very efficient use of space.
It’s just a shame that so many small local hospitals got gobbled up in M & A over the last 20 years.
I suspect any military deployments (which would be mostly Army personnel as the other services have small medical corps) would prefer to use their own deployable field hospitals first over repurposing buildings. Still a dramatic image of imagining a field hospital set up in Central Park.
“It’s just a shame that so many small local hospitals got gobbled up in M & A over the last 20 years.”
Is it a shame … or a crime?
My guess is that hospital conversion would probably consider removing the doors from the hinges and replacing them with a heavy plastic curtain or something along those lines.
I’m a retired RN outside a wealthy beach community in Florida. My license is still current as I volunteer my services. I haven’t received any notice from the state to be prepared to return to work. Of course any for-profit hospital’s worst nightmare is to have to hire more non-management staff. Our ex-governor and current senator engineered the biggest Medicare fraud in history to that point, it is obvious that hospital corporations have huge influence. I’m sure that they will try to bring every possible military person in to staff. And the locals will eat it up. Both from the point of having contact with Our Warriors™ and from the savings that hospital corporations will enjoy.
The problem of staffing you identify is partly a problem related to the remedies required. Hospital respirators require considerable staff experise and both the respirators and the specialized staff are in short supply. How many patients might benefit from oxygen tents? I would guess that oxygen tents require far less specialized medical support. Also oxygen tents would seem easier to make than more respirators — not that we should not be building more respirators also.
The problem of the dead who once lived in the room during CoV-19 [Corona] should worry much less than the dead who stayed there and jumped from the rooftop after finals.
I have a question but I am not sure how to ask so maybe someone will figure out what I am saying and set me straight: I am grateful for the precautions taken to help my friends and everyone in NYC and hope DiBlasio finds the PPE and space he says is so needed.
I’m just having a problem understanding how 20,000 cases (with 54 listed as “serious) nationwide has apparently overwhelmed our hospitals already. There are daily reports on CNN from healthcare workers pleading desperately for PPE and I don’t doubt that in specific places the ;problem is very real…. but 20,000 cases spread out around the USA should not have overwhelmed the system in the way it is suggested has occurred.
Please correct me if I’m wrong about that
Physician here
There is an absolute vicious cycle going on that most non health care folks do not understand. I work in a rural hospital far away from New York and the problems are already quite manifest here.
There are now multiple patients admitted some very ill that have pneumonia and no known obvious cause. All other tests have been negative flu etc. So they have to be assumed to be positive because the testing for Covid is now a week out. So these patients may not even have the disease but because of the testing problem we have to use many cycles of PPE daily on the health care workers taking care of them.
The ER is being slammed with the worried well and sniffles despite our best efforts to keep them home. This requires large amounts of PPE.
My wife has now made my own – now at 5 sets daily that I take home in a paper sack and then they are cloroxed and reused. I never dreamed I would see the day that this would happen in America. She is frantically sewing scores more for the other workers.
The other problem has been the MBA managerial class managers who have had their head up their asses the entire past two months. Instead of preparing, they were following the GOP line that this was an overblown hoax, even firing one of the nurse leaders trying to raise the alarm. There is no amount of money that is going to get PPE now or also several critical drugs. We are well screwed with these people in charge.
Just don’t go in unless you have adequate PPE. The PPE supply will catch up or it won’t, but experienced doctors and nurses should absolutely not risk their lives to cover for the mistakes of the misleadership class. You’re needed for the long haul and will do the greatest good if you’re healthy and able to work, so please protect yourself.
They’ve just announced that when the treatment is the same sick individuals should be treated, regardless of the test outcome. That makes sense.
Thanks so much for your thorough and informed response. Much appreciated.
Thank you for sharing that.
I saw a chart, sorry i don’t have the source, but it showed various materials that were used for masks and their effectiveness. The best alternative material was vacuum cleaner bags. 90% or more compared to a standard hospital mask. I think cotton dish towels were #2, at maybe it was 70 to 80%, which made me think sewing the two together might get close to standard masks???
I don’t think most realize the difference between the US response and the response of other much more attuned and proactive countries. Early testing and epidemiological tracking could – as has been shown – limit the outbreak considerably. Meanwhile, as with GWB Jr and 911, the presidents approval rating is now likely heading to its peak.
Eventually we will need to be doing testing and epidemiology (esp if covid19 mutates as is common with flu viruses I understand). At this point it’s looking like triage but maybe distancing will work to slow it down.
Stay as safe as you can and thank you
@thoughtful person
March 21, 2020 at 11:21 am
——-
That chart was in yesterday’s Links.
Thanks!
Individual viruses can penetrate masks — but how important is that to minimizing the spread of the CoV-19 [Corona flu] virus? The illness seems most viably spread by particles much larger than individual flu viruses and those particles are filtered by existing masks — allowing for leakages around bad fitting and poorly used masks [And having worn masks often when vacuuming — I noticed most inflows to my mask seemed to happen when I exhaled. When I inhaled through my nose the mask collapsed in and around my nose. If I exhaled through my mouth that was when the most leakage seemed to occur.
Mask-making — I would expect the best filtering materials would be whatever is used to make HEPA filters. HEPA filters are commonly available for vacuum cleaners — though in a form factor ill-suited to use in a mask. Perhaps there is some way to disassemble vacuum cleaner HEPA filters to build a procedure mask.
“The other problem has been the MBA managerial class managers who have had their head up their asses”
THIS
I’m a retired RN who worked thirty years in one of the largest public hospital systems in the US. I remember when the hospital was run by doctors and nurses and was horrified as administration started to be filled by business people whose mantra was “if you can run a McDonald’s you can run a hospital”. In the US as our capabilities for treating individual patients and diseases has increased our capabilities for treating large numbers of people has decreased. The US doesn’t have a health care system. The US has a profit making system which produces as much profit as possible while producing as little health care as possible as a byproduct.
Thank you for posting, Doctor. Much needed and much appreciated. Saw a video where I didn’t have to sew a mask might make it easier on anyone interested. I made three already. It’s made using MERV13 material as a filter.
https://www.youtube.com/watch?v=6T787NV6FpA
You confirm what a neighbor who works at SUNY Upstate told me last week. They had been in a planning mode since January, but no resources were forthcoming until the first week in March. Requests fell on deaf ears for 8 weeks.
They have plans to use dorm rooms. Some of the local hospitals already have triage tents.
Testing was hobbled by various certification requirements for methods and personnel. Only this week they have been able to automate testing 100 per run, previously a manual job taking 42 minutes for a single run.
The US will almost certainly be worse than Italy. Just wait another 2 weeks.
Be safe Dagan!
Is that a supply shortage not actual cases? If I remember correctly, from a recent article, next week is anticipated to be when a large swell in cases is supposed to start to hit NYC. It was said that things were quiet just the week before.
Calculated Risk had a link to stats at COVID Project, that shows 35,000 have been tested. He said the US needs to test 100,000 a day to identify carriers as quickly as possible if there is to be any hope in containing the spread.
https://covidtracking.com
I’m currently reading this story about a single medical facility in New Orleans. I haven’t heard a word about N.O. although it should’ve occurred to me to ask the question because of Mardi Gras. And of course if you can’t test, you don’t count as a case.
So the question is what are the real numbers of patients moving through these facilities including the numbers who are negative or have the flu? How much time does it take to diagnosis vs. what was done prior to the crisis? “Normal” world each patient would’ve required a fresh set of PPE for the medical personnel. So what would the PPE requirements be on a daily basis now? How do those numbers compare with the confirmed COVID infection charts?
If we can’t test, then can we write an algorithm to do analysis of these numbers (or other numbers) to help determine the spread of the virus? There must be a way to leverage the data to help with planning or assumptions or….
eta: The US needs to move these patients to separate facilities for testing. Not the ERs or Urgent Care or vice versa.
https://www.propublica.org/article/a-medical-worker-describes–terrifying-lung-failure-from-covid19-even-in-his-young-patients
My wife has a former student who is a nurse here in Memphis. Workers at a minor medical place. Been doing 12 hours shifts this week. Starting last week the place got busy. Mild coronavirus symptoms. No tests so can’t confirm, but medical professionals here know it is widespread and getting worse. I can’t imagine how bad it will get in New York. Memphis at least has low population density and crappy public transportation. Our healthcare system will be overwhelmed like everywhere else in the country. Our poverty and food insecurity will make Memphis different. The school system still makes lunches for kids. Pull up in car and everyone in it gets a bag lunch. The food system is centralized though and a worker tested positive. Nutrition center had to shutdown. No more lunches. Also, so far the clearing out of grocery stores have mostly been white areas who have more resources to buy in bulk. SNAP payments went out early Friday morning. There were long lines of black women at the grocery stores when they opened.
I noticed the class elements of the hoarding immediately. The suburban zones are the worst. Lots of people who depend on takeout suddenly need to stock their subzero fridge for the first time. They have no idea how to do it. Pasta was gone. Giant tubs of nuts, one of the best sources of calories, were fully stocked. Skim milk, the type with the shortest shelf life was gone. Whole milk, the longest, stocked up. The people in those grocery stores are not handling things well. Nasty. I think NC had a tweet from a whole foods employee who was crying everyday because of how mean these people were. Given where these stores are located, I’m not surprised. Exactly the demographic to try to avoid now.
In the more urban areas, people are much more low key and handling things better. Lots more smiles.
You don’t want to be in suburbia now.
I was thinking that whole foods customer demographic might mean early exposure to covid19 (due to travel).
At this point it’s everywhere though. I suspect that there are scared and desperate poorly behaved shoppers everywhere, though granted, entitled ones are particularly annoying.
Maybe shopping as little as possible and at off times is a smart idea?
“You don’t want to be in suburbia now.”
Although one might think the suburbs were BUILT to facilitate social distancing…
The good news for upstate NY is that the wealthy in NYC have been heading to the Hamptons and Montauk on Long Island to heedlessly spread C-19. https://nypost.com/2020/03/19/we-should-blow-up-the-bridges-coronavirus-leads-to-class-warfare-in-hamptons/
I think Andrew Cuomo was watching the footage of the partying in Florida and realized that many of those people were heading back to NYS. Shutting the state down probably had some of that in mind.
I just got to say that I can certainly see that some might think that the pandemic is overblown, or more likely that the the lockdown is too strict; however, going out into gigantic crowds for days, so close to them that you can see their tonsils is just pleading for a Darwin Award.
Skepticism is fine. Complete denial of reality. Besides, being trapped in my small apartment is making me bananas and really want to take some classes this Fall.
Out in our suburbs the higher end grocery stores have police in their cruisers parked across the doors. So far the bad behaviors in the fancy stores have been fighting in the aisles inside the stores and muggings in the parking lots for bags of food.
Makes getting supplies if one is a senior or disabled a real issue. I’m 67 and use a wheelchair. A wonderful man has become my body guard. We go together in full masks and latex gloves, and he protects me.
I used to think having been somebody was worth something. In his younger days he was a sports professional and then a professional coach. I was a high end attorney. Means not two beans when the shelves are bare.
Ana in Sacramento Calif (living downtown 4 blocks from the Capitol)
In China, I believe dorms were used primary as quarantine centers for non critical cases and they make a lot of sense for that use. The closely packed rooms promote efficient delivery of services and some privacy for the residents. They can be established as mandatory intake centers to lighten burdens on hospitals and urgent care facilities.
I would imagine that overflow critical care facilities would be set up in larger spaces such as garages, gyms, and meeting halls near the existing hospital infrastructure.
That is a good observation that and makes a lot of sense. Yeah, dorms as quarantine centers for non-critical cases. That would take a lot of the strain off the system that.
Dorms are a very good place for this. They are built to have lots of people for lots of time. Water and sanitation facilities are prevalent. They have lots of electricity too. Normally with some sort of backup systems in place.
This is not the case with arenas/stadiums. They are meant to have lots of people for a short amount of time. No showers, etc. See the superdome during katrina.
Office type buildings are also not of much use because of this.
Sacrament State University and the University of California at Davis (10 miles west of Sacramento) tossed all their students out of their dorms a few weeks ago when they shut in person classes for the remainder of the academic year. The students had 3 days to get out.
No one has said the dorms will become non critical care, but that is the whisper here. The local hospitals now have started to put up triage tents and one is converting one of its parking garages.
Ana in Sacramento
Perhaps future office building should be required to include shower facilities. It would encourage joggers and bicyclists … and might prove of value when the real disease we must fear manifests. The CoV-19 virus [Corona flu] is a serious health problem … but only a ‘test’ of our readiness … a test I feel we have sorely failed.
If permitted — I’ll toss out an elliptical idea. Dialysis machines filter a patient’s blood … do they handle enough blood to serve as a way to oxygenate blood for patients whose lung function is marginal? The respirators have many drawbacks that complicate their application and require special training. Of course so do the kidney machines — although it is different training and expertise. We don’t have enough kidney machines and nurses trained to operate them — but might be beneficial to have more?
Admittedly this is a wobbly idea … but does it inspire any other more creative and knowledgeable imaginations?
Not a clinician, but as far as I know dialysis machines can’t oxygenate blood. I think the device that does that is called ECMO. Those are rarer and take more resources than ventilators I think.
Dialysis machines cannot oxygenate blood. Not can they truly be sterilized. Viral infections are regularly spread by dialysis machines. My ex is a nurse, and he is also diabetic.
Ana in Sacramento
Somewhat off topic but since everyone is sharing anecdotes about what is happening in their area, etc. I wanted to point out an overlooked topic. Patients are dying every day now because of lack of blood. Blood donations have fallen off a cliff. Major hospital here in Columbia SC had only 50 units left as of last night. An ICU friend told me today that she knows for a fact of at lest one patient who they could have saved if they had had blood to give. Surgeon general came out Thursday and issued an appeal for blood donations. So its not just covid-19 patients dying from the virus. I am so angry about this whole pandemic and how our govt and so called leaders have handled it.
I share your anger and add my sadness, i have been reluctant to give blood — something I often did in the past — after suffering the ministrations of many poorly trained phlebotomists [my veins almost jump out of my arms!] and hearing of the profits my freely given blood bring to many supposedly profit-free organizations — who most ably pay huge sums to their management. Please allay my trepidation. While I would freely offer my blood to help others I have little desire to give my blood to pay some executive’s bonus.
Well, I would assume that worst case scenario your blood will be used to help people AND produce a profit for someone. That still seems worthwhile. Unless of course they’re pumping and dumping it heh.
Your worst case scenario ignores my risk in going to a locale to give blood — I am older — and doesn’t alleviate my distaste for enduring poorly trained phlebotomists injuring my arm while killing an hour or so to help some business produce a profit for someone, and add to the debt for medical services owed by another. By not giving blood I leave the poor have one means to earn a few dollars. To take up any slack let the military order soldiers to give blood. At least they could take comfort in knowing the blood they give will be serving some useful purpose.
Although Covid might be an event that would change my behavior temporarily, I have refused to give blood to the Red Cross in recent years because of MBA profiteering and the destruction of their volunteer base. I just can’t support such a corrupt organization.
Per Cuomo, the four sites under consideration are:
-Javits Convention Center
-SUNY Stony Brook
-SUNY Westbury
-Westchester Convention Center
https://twitter.com/NYGovCuomo/status/1241382712646275074
Comments in the thread show that students were “kicked out” of SUNY campus dorms around the state in similar fashion to NYU.
(Not sure this will be seen as this late hour, so am sending a heads-up to Yves and Lambert.)