The Silent Wave

Inside the city’s hospitals fighting COVID, scores of doctors and nurses are suddenly out sick.

A medical worker walks inside Mount Sinai Hospital in East Harlem in 2020. Photo: Noam Galai/Getty Images
A medical worker walks inside Mount Sinai Hospital in East Harlem in 2020. Photo: Noam Galai/Getty Images
A medical worker walks inside Mount Sinai Hospital in East Harlem in 2020. Photo: Noam Galai/Getty Images

Last Wednesday, a group of executives at the largest private downstate New York hospital systems held a conference call to discuss their own private projections about how fast Omicron would spread. The highly contagious variant’s arrival in the city was first traced back to a Minnesota man who attended an anime conference at the Javits Center in late November. Omicron looked like it was spreading slowly, and the executives predicted it would continue that way until after Christmas. By the end of that day, however, COVID cases started a rapid surge that has continued to accelerate, with the city reporting nearly 23,000 new cases on Thursday, another record.

Like the city they serve, hospital workers were caught off guard by Omicron and rocked by a sudden wave of infections that has sidelined scores of doctors and nurses, ahead of an unknown number of new COVID patients expected to arrive in coming weeks. Staff across the city’s private hospitals described in interviews stressful conditions where they had to cover for their colleagues, especially nurses who were already short-staffed. They also voiced concern that leaders are not taking testing and quarantine seriously, expressing unease with new guidance that can be interpreted as working while still sick or contagious. The situation in the city’s public hospitals is less clear: New York City Health + Hospitals, which oversees them, directed questions to the state’s health department, which said it does not track COVID cases by occupation, including health care.

While hospitals say they can handle the shortfall, the sudden, if temporary, reduction in staff has made for a tense environment for workers stretched to their limits after two years of the pandemic. Currently there are 54 COVID patients in public hospitals across the city, officials said. “It’s still not anywhere near the previous surges,” a doctor at North Central Bronx, a city-run hospital, said. “I just worked in the ICU last night, and maybe a 10th of the patients were COVID. That’s a super small percentage.” The Omicron surge is barely a week old and hospitalizations lag new cases. Nevertheless, physicians and nurses said they are hopeful any such surge would be muted by the city’s high vaccination rate. Those who worked through previous surges said they are not only prepared for another influx of the sick, but that hospitals are well-stocked with masks, personal-protective equipment, new ventilators, and more resources to expand the capacity of intensive-care units by creating negative pressure rooms that contain virus particles shed by sick patients. “For our department, we even have backup schedules if another ICU opens and we have to get redeployed. Our department has a back up plan,” one critical-care doctor at Mount Sinai said. “We are more prepared than we will need to be. My hope is that this is a more infectious but less severe variant and so many people have been vaccinated. I think we’re gonna see a lot of an uptick in cases, but not as many patients intubated.”

The immediate concern though is waves of staff out sick. Among the hardest hit have been the young resident physicians who are key to a hospital’s emergency department, often working day-long shifts. Scores of ER residents at NYU Langone, NewYork-Presbyterian Queens, and throughout the Mount Sinai hospital system are at home with mild or asymptomatic COVID, though the size of the outbreaks varies at each hospital. “A lot of our residents are out right now,” one NYU resident said, adding that enough of the remaining 70 residents are healthy enough for there not to be a shortage. A spokesperson for NewYork-Presbyterian didn’t respond to a question about how many residents were sick, except to say that the hospital is “operating normally.”

The city’s largest private hospital network, Mount Sinai, is missing more than a quarter of its 100 resident physicians working in emergency rooms. The first of them began showing symptoms last Friday, with many of them believed to be sick from work-related exposure and a private holiday party that took place days earlier, according to three people at Mount Sinai. The party came at a delicate time, right before a new COVID surge threatened to flow into ERs, but just days after the hospital sent a note discouraging holiday parties, or even staff meeting in conference rooms, in order to stem the spread of the virus. “We deserve to have holiday parties just like normal people,” said a Mount Sinai nurse. “It’s unfair that we’re held to a higher standard.”

The nursing ranks that make up an emergency room’s frontline have also been thinned by Omicron. “Nurses have been calling out sick because they are testing positive for COVID. It’s hospital wide,” said Peggy Desiderio, co-president of the labor bargaining committee of the New York State Nurses Association for Mount Sinai Morningside. At least five nurses have tested positive in the Morningside hospital’s emergency department this week and 17 nurses have transferred out or resigned since the start of this month, she said. To make up for the losses, the affected hospitals mandated that nurses work 24-hour shifts with only a four hour break to sleep.

A medical worker watches from the window at NYU Langone hospital in Manhattan last year. Photo: Noam Galai/Getty Images

Nurses are in short supply throughout the country, and the deficit has been pronounced in the city. Private hospitals are down more than 700 nurses. NewYork-Presbyterian shed 370 registered nurses between February 2020 and today. Montefiore Medical Center in the Bronx dropped 170 nurses and Mount Sinai lost 167 nurses during the same period, according to the New York State Nurses Association. The Mount Sinai and Montefiore systems each have about 600 nursing vacancies, according to NYSNA, and NewYork-Presbyterian has 300 openings for nurses. Three weeks ago, Sinai nurses walked out in protest. By contrast, public hospitals had 8,341 nurses in December, roughly the same as just before the pandemic, after the city made hiring them a priority.

“The biggest challenge throughout this fall and winter, including the current surge, is the nursing shortage, which in the ER translates to both fewer nurses working and more admitted patients boarding in the ED because there aren’t enough nurses upstairs to take care of patients,” a resident at NYU said, noting that those nurses don’t have fixed nurse to patient ratios, while other departments have a two-to-one or four-to-one limit. The resident said she recognized a quarter to half the nursing staff at the hospitals from about a year ago.

As Omicron tears across the country with ferocious speed, the Centers for Disease Control on Thursday evening issued emergency guidance relaxing quarantine time for asymptomatic COVID medical workers to seven days from ten, “and that isolation time can be cut further if there are staffing shortages.” Prior to that announcement, however, the city’s hospitals had already changed their own protocols. NYU Langone requires workers to return to work 72 hours after a fever naturally breaks, or five days after a positive test, whichever is longer, according to the hospital — one of the shortest isolation periods in the city. Northwell Health, the state’s largest hospital system, told its employees earlier Thursday it would allow vaccinated staff members to return to work eight days after a positive test as long as their symptoms are resolving and they have not had a fever for the past 24 hours. NewYork-Presbyterian allows fully vaccinated employees to return to work after seven days, according to a spokesperson. Mount Sinai also recently shortened its quarantine period, according to a spokesperson. Staff there must report any high risk exposure — defined as closer than six feet for more than 15 minutes without a mask — and can keep working until testing positive or the onset of symptoms, according to an internal email sent on December 20.

But several hospital workers noted that there are still gaps between what’s considered official policy and the reality on the hospital floor, where people are expected to work through emergencies every day. “Culturally — and this predates COVID — residents are strongly encouraged to work despite being sick, despite being in pain. Residents are encouraged to work under all circumstances,” one at Mount Sinai Morningside said. “That does trickle into the COVID era.” Dr. Anthony Fauci suggested hospitals “put an N95 mask on [health care workers] and make sure they have the proper PPE” so they can return to work sooner than a week. That would mean they would have to wear masks all the time during their shift and the hospital would need to create separate rooms for infected workers whenever they remove their protective equipment for a break to take medicine or eat. “What are they going to do when they have lunch?” Kane said. “They don’t have a place to eat lunch now. You see nurses eating spaghetti in the corner out of Tupperware.”

Some health care leaders worry that staff who test positive but aren’t showing symptoms could still spread COVID if brought back too soon.“I get it, there’s a shortage and you need people to take care of folks but this also creates potential for making more people sick,” Pat Kane, executive director of the New York State Nurses Association, told Intelligencer. “The public expressed very clearly that they want their health care workers to be vaccinated. Do you think they want their health care workers to come back and take care of them earlier when they know they have an infection?” When a dropbox for COVID self-testing went missing at Mount Sinai West near Lincoln Center, it wasn’t replaced, according to the resident, which they took as evidence of the hospital’s ambivalence towards its own staff’s testing. “The hospital almost seems to discourage residents from testing, because they don’t want residents to come back positive.” A Mount Sinai spokesperson said that the hospital system wasn’t aware of the issue.

This weekend, the first wave of workers who got sick last Friday will begin returning to their posts under the new seven-day quarantine guidance. When they do, they’ll find changed workplaces, anxious over losing more staff and anticipating patients infected by the same virus they were.

— Additional reporting by Caroline Spivack.

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The Silent Wave