Interview, Fireside Chat
From “The Way Forward" Conference: Dr. Stephen J. Corwin, President and CEO, New York-Presbyterian
- New York Presbyterian Hospital, led by President and CEO Dr. Steve Corwin, faced an unprecedented surge during the initial outbreak, described by Dr. Corwin as the most severe level of illness and contagiousness in his 40-year medical career.
- The healthcare system initially lagged in recognizing widespread community spread due to a lack of appropriate testing, leaving the city and hospital system in danger of being overwhelmed.
- At the peak of the crisis, New York Presbyterian's hospital occupancy exceeded 80%, treating 2,700 COVID-19 patients, with 800+ patients requiring ventilators in the ICU.
- Daily mask usage surged from a pre-COVID baseline of 4,000 to 100,000 per day, representing a 25-fold increase against prior pandemic doubling projections.
- Supply chain fragility was a critical constraint, specifically regarding N95 and KN95 masks reliant on Chinese manufacturing; Dr. Corwin noted that many imported masks were of inadequate quality, requiring hospital staff to test every batch.
- The psychological toll on healthcare workers was severe, with over 3,600 of the hospital's 47,000 employees contracting the virus at one point, resulting in the suicide of a prominent ER physician leader due to the overwhelming burden.
- Current clinical treatment remains primarily supportive care; while remdesivir offers some benefit, its mortality impact on critically ill patients is unproven, and Dr. Corwin remains pessimistic regarding a vaccine before year-end.
- Dr. Corwin anticipates a potential second wave in New York City as well as in emerging epicenters like Houston and Phoenix, citing rising ICU demand in those regions.
- In preparation for a second wave, the hospital plans to permanently increase ICU capacity from 450 beds to 650, with the ability to expand to 900 by converting operating rooms and anesthesia units if necessary.
- To ensure supply resilience, the hospital aims to maintain a 60-day stockpile of Personal Protective Equipment (PPE) at peak usage levels and has accelerated contracts to secure supplies starting in November.
- The hospital has developed a novel, layered staffing model for ICUs to manage large-scale surges, a strategy refined from the inability to staff 900 beds with standard ratios.
- New York Presbyterian expects losses exceeding $1 billion for the year despite receiving CARES Act funding, a financial hit described as substantial for their $9 billion revenue organization.
- Dr. Corwin warns that the current healthcare business model, which relies on balancing commercial insurance profits against Medicare/Medicaid losses, is "brittle" and faces existential threats from the cessation of elective surgeries.
- The in-hospital mortality rate for COVID-19 patients is approximately 20%, rising to nearly 50% for patients requiring ventilator support.
- Regarding future vaccines, Dr. Corwin highlights significant ethical concerns regarding Emergency Use Authorization (EUA) for frontline workers due to uncertainties in safety and efficacy, noting that even the fastest historical vaccine approval (mumps) took four years.
- He projects that an effective, approved vaccine is unlikely to be available until early 2021, making therapeutic advances the more immediate hope for the sector.
- The hospital has established peer-support platforms, such as "Bongo," pairing doctors to mitigate the profound psychological effects on frontline staff.
- The hospital plans to maintain increased warehousing capacity and has learned to convert anesthesia machines into ventilators to manage surge capacity for future waves.