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发帖数: 3656 | 1 a peek into the New York city infectious disease response plan.
https://brooklyneagle.com/articles/2020/02/17/coronavirus-is-new-york-city-
prepared-to-deal-with-thousands-of-cases/
Coronavirus: Is New York City prepared to deal with thousands of cases?
Surge capacity, coordination are key
February 17, 2020 Mary Frost
It’s only a matter of time before the novel coronavirus (COVID-19) breaks
out in New York City, according to officials and the city Health Department.
Is the city’s health care system ready?
That depends in part on hospitals’ “surge capacity” — the ability to
handle 20-25 percent more patients than usual.
National policy calls for hospitals to accommodate surges of 500 new
patients per million population in a disaster. That would amount to 4,300
additional patients across New York City. Based on population, Brooklyn
would need to handle about 1,250 additional patients during a surge, and
there could be two or three surges during an outbreak.
It also depends on the city’s ability to coordinate the responses of
hospitals, agencies and the state and federal government. During biological
outbreaks, the New York City Department of Health is considered the “
primary agency” under the Citywide Incident Management System, and takes on
coordination responsibility.
Increasing surge capacity means hospitals have to empty rooms currently
being used for less seriously ill patients (in a process called Rapid
Patient Discharge) and utilize unused spaces. During Superstorm Sandy, for
example, some receiving hospitals turned lobbies into inpatient wards.
Hospitals must also create rooms fitted out especially for children. (A 2010
study found that few hospitals with pediatric intensive care units had
detailed surge capacity plans.)
Hospitals have to muster extra staff, stockpile protective gear, equipment
and medicines, and arrange myriad details — like contracting with linen
companies for extra sheets and towels. The city must coordinate with state
and federal authorities, and may need to acquire medicine from the Strategic
National Stockpile.
In the New York area, Joint Base McGuire-Dix-Lakehurst in New Jersey and
Fort Hamilton in Brooklyn have been designated as potential emergency camps
to quarantine people with possible exposure.
Likely to stress the system
So far, all suspected cases of coronavirus in New York City have been ruled
negative. But as Mayor Bill de Blasio said at a press conference in January,
it’s not a question of if, it’s a question of when.
Panelists testifying before the Senate’s Homeland Security subcommittee on
Friday spoke urgently about the country’s surge capacity.
“We have to look and see what’s happening in these other countries and
assume the same thing is going to happen here,” Dr. Asha George, executive
director of the Bipartisan Commission on Biodefense, said. “I think we have
to plan for the possibility that we have thousands of cases. Or hundreds of
thousands.”
Dr. Luciana Boreo, vice president at In-Q-Tel and former director for
medical and biodefense preparedness at the National Security Council, told
the panel, “It’s pretty clear that [coronavirus is] likely to severely
stress our health care systems because of the lack of surge capacity we have
today to treat a large influx of patients with acute and serious
respiratory diseases.”
Dr. Scott Gottlieb, former Commissioner of the Food and Drug Administration,
told the Senate panel that the odds are high that cases are already going
undetected in the U.S.
“Some of the modeling out of the U.K. suggests we’re capturing about 25
percent of the cases at best,” he said. “At least some of these cases are
probably propagating virus at a local level.”
‘Staffing, supplies, space and system’
NYC Health + Hospitals, the city’s public health care system, says surge
capacity preparations include the four S’s: staffing, supplies, space and
system.
“NYC Health + Hospitals regularly prepares and drills for all hazards,
including special pathogens such as the coronavirus,” the agency’s
spokesperson Christopher Miller told the Brooklyn Eagle.
“Any time there is a potential for a surge, we revisit our existing plans
to ensure that we can triage and accommodate patients should we receive a
high volume of potential or confirmed cases,” he said.
New York City’s private hospitals and clinics have also been preparing.
Dr. Reed Caldwell, chief of service at NYU Langone Cobble Hill Emergency
Department, told the Eagle that NYU has carried out an “enterprise-wide
table top drill and [has] been doing daily site-specific preparations.”
“Interdisciplinary teams have developed plans to expand capacity within
each of our facilities” and are working with senior leadership and NYU’s
emergency management team to assess the need for staffing, Caldwell said.
NYU Langone “works closely with city, state and federal agencies to plan
for this and all kinds of emergencies,” he added.
Some of New York City’s hospitals have been participating in joint drills,
such as the recent SurgeEx 2020. This state-level drill included 55
hospitals, 17 nursing homes and multiple state agencies. During the drill,
seven hospitals were designated as “evacuating” facilities (including
Bellevue in Manhattan) and nine were selected as “receiving” facilities (
including SUNY Downstate Medical Center in Brooklyn).
Worst case: tens of thousands of bodies
In a pandemic, the office of the city’s Chief Medical Examiner has
estimated it might have to handle two to three surges, with each surge
lasting roughly eight weeks.
In its detailed pandemic plan for a severe influenza outbreak drawn up by
the Medical Examiner’s Office, death rates were estimated to range from 1.1
percent to 3.5 percent, leading to a potential for 27,000 to 86,000 victims
over an eight-week period. The actual death rate of coronavirus is not yet
known, and may be higher or lower than severe influenza.
The agency will “recover, process and hold decedents from residential and
healthcare facility locations until private sector entities are able to
manage final disposition,” the plan says. If the decedents’ family members
are also sick, the agency may have to store the bodies in refrigerated
trucks until someone can deal with them. Since supplies such as body bags
are stocked using a just-in-time inventory system, the agency will likely
run short.
Supply chain could become a problem
NYC Health + Hospitals says it is in regular contact with suppliers to
ensure that their medical equipment and medicine supply chain remains
uninterrupted.
NYU Langone also says it’s ready, as far as masks, gowns, equipment and
medications are concerned. “We have evaluated our stock and are well
prepared,” Caldwell told the Eagle.
But in the long run, obtaining supplies and medicine could be a problem.
The FDA has estimated that about 80 percent of active drug ingredients are
manufactured overseas, many in China.
Dr. Gottlieb told the Senate panel on Friday that China is the sole source
of many medications and medical supplies essential to Americans. Wuhan,
where the virus broke out, is a global center of production for
pharmaceutical ingredients.
“We’ve identified a critical choke point for critical pharmaceuticals,”
Gottlieb said. “It calls into question disruptions in the supply chain.”
Dr. Julie Gerberding, chief patient officer at Merck, co-chair of the
Commission on Global Health Security and former CDC director, told senators
on Friday that the U.S. has a strategic national stockpile, “an enormous
reservoir of medical equipment, supplies, medicines, vaccines, etc.
strategically situated around our country.
“That is our first line of defense,” Gerberding said. “The stockpile is
not limitless, and the supply chains for replenishing it will be very
marginal at best, so I don’t think it’s a solution, but it will definitely
help us buy some time.” |
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