As daily Covid-19 infection rates rise in Western New York and government responds with more restrictions on daily life and business, the region's hospitals, which were the focal point of worry at the beginning of the pandemic, are not overly strained so far.
Covid-19 caseloads in the region's major hospitals are rising, but they have not stressed a system that saw hundreds of patients admitted back in the spring.
"You're talking about a whole different scenario than we're living in now," said Mark A. Sullivan, CEO of Catholic Health. "When you see this high count of Covid positives, it doesn't necessarily mean they're going to end up in the hospital."
Catholic Health packed as many as 125 Covid-19 patients into its Covid-only hospital in Cheektowaga on any given day last spring. Thursday, there were 43 virus patients in its system, 35 of them in St. Joseph's.
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But that number was an increase for Catholic Health's systemwide total of 32 on Monday.
Kaleida Health, whose daily count of Covid-19 patients peaked at 115 this spring, reported 37 virus patients in its Erie County hospitals as of Thursday morning: 19 in Millard Fillmore Suburban Hospital and 18 in Buffalo General Medical Center.
But on Oct. 28, Kaleida had only 21 Covid patients.
Erie County Medical Center had seven virus patients Monday, but Tuesday that number grew to 12, Wednesday it reached 14 and Thursday it grew to 16.
Read the full story from News Staff Reporter Sandra Tan
As of Tuesday, the state Health Department listed 126 Covid hospitalizations in the five-county Western New York region – Erie, Niagara, Chautauqua, Cattaraugus and Allegany counties. That was an increase from 92 a week earlier.
But as of Tuesday, state figures show 30% of Western New York's hospital beds were empty, as were 57% of the region's intensive care beds.
Hospital managers say they can handle the Covid-19 patient volumes they're seeing now. Based on the experience they earned this spring, they know what to do.
"We were gifted in March and April by learning a lot about Covid and how it spreads, and our ability as citizens of this community to step up and prevent the spread. It's probably more valuable than how many beds any hospital has in Western New York," Sullivan said.
Western New York saw 576 newly confirmed Covid cases Tuesday, an all-time record, and 484 more Wednesday. The seven-day average of 408 cases is the region's worst ever.
Hospitalizations are a lagging indicator, since most Covid-19 patients don't need to be hospitalized. Officials say many of the newly confirmed Covid carriers are younger than the elderly population that was hit the hardest in the early days. They don't become as sick – if they show symptoms at all – and most of them are simply sent home and told to self-isolate and ride it out.
“What we’re seeing is a younger, healthier population for the most part contracting the virus, and they’re able to handle it better," said Dr. Jamie Nadler, critical care physician and medical director for quality and patient safety at Buffalo General.
"Certainly those that need to be sent to the ICU are the same types of patients we were seeing in the spring," Nadler said. Those patients are the elderly and those with pre-existing conditions that limit their bodies' ability to resist the coronavirus.
"Because the age of positives is getting lower, that's why we're not seeing the hospitalizations," concurred Daniel J. Stapleton, Niagara County public health director.
For instance, Niagara County announced 233 new cases of the virus from Friday to Tuesday, but its total of hospitalized residents rose from three to nine.
Stapleton said many of the recent cases were among Niagara University students and other young adults.
"We're seeing a younger population right now that are not requiring hospitalization, and they're being able to manage it at home," said Charlene Ludlow, vice president of safety at ECMC. "The elderly patients that we do have are still ending up ventilated in the ICU."
Donald Boyd, chief operating officer at Kaleida, cited "the availability of drugs like remdesivir, and people applying what they’ve learned over the last several months of how to care for them and the care and treatment protocols that have been established."
Remdesivir is favored for patients in the early stage of the disease without severe symptoms, Nadler said.
“The sooner you get it the better, and that hopefully will prevent them from deteriorating into the inflammatory stage of the disease. For those who are requiring oxygen and have more severe symptoms, steroids are the drug of choice," Nadler said. "There were clinicians who were using it early in the pandemic before we had data to support it.”
Now, there is such data, and steroids are being used widely on seriously ill Covid-19 patients, Nadler said.
"They're also detecting Covid earlier," Sullivan said. "In February and March, we didn't know what people had. The disease progressed so far that they were in respiratory distress and we had to take serious measures to save that person. Now someone gets tested, we're kind of already watching them, as opposed to reacting to the deterioration of a person's health."
In March 2020, Erie County Medical Center Chief Safety Officer Charlene Ludlow, RN, explained how the hospital was preparing for the pandemic.
"We're in good shape right now for the volumes we're getting, and we're just preparing for if this surge comes greater than what we're seeing now," Ludlow said. "We're in a waiting pattern, just hoping these numbers don't go up."
Ludlow said ECMC detects two or three Covid-19 cases a day through testing in its emergency room on people who come in for other reasons, or among people preparing for outpatient surgery.
Boyd said almost all of Kaleida's new Covid-19 patients are turning up at the emergency room instead of being admitted by local physicians.
While the Buffalo area still faces smaller hospital numbers than in the spring, the story is different in the Southern Tier. Olean General Hospital, a Kaleida affiliate, typically had one or two Covid-19 patients at a time during the spring, said Dr. William F. Mills, the hospital’s chief medical officer.
Within the past 30 days, Olean General peaked at 20 Covid-19 patients, and Tuesday's number was about 10.
“It’s probably our first wave," Mills said.
But he said few of the patients require ventilation and most don’t require extended care. The exception is those who arrive from nursing homes; they often must stay at Olean General longer because they must test negative before returning to the home, Mills said.
“We can handle them,” Mills said.
All hospitals were ordered by Gov. Andrew M. Cuomo to stock up on supplies. By Oct. 1, every hospital in the state needed to have at least 90 days' worth of personal protective equipment and other supplies at all times. All the hospital officials interviewed for this story said they had done so.
"Another good call by the governor," Sullivan said. "By him mandating that months ago, many health systems like Catholic Health were able to procure the 90-day supply. When you look at where our country is now, with 100,000 Covid infections a day, your supply procurement is much more difficult now."
“Broadly speaking, we have had the ability to secure our necessary supplies," Boyd of Kaleida said. "There are certain instances where it has been proven to be more difficult.”
For instance, Boyd said, the U.S. Department of Health and Human Services directed testing supplies and reagents sent first to the hottest spots of Covid-19 outbreaks in the nation. That isn't Western New York, despite the recent increases.
“We’re confident in the supply chain we have established," Boyd said.
Several hospitals bought more beds, pumps and ventilators to comply with state mandates. So far they haven't been needed. But the hospital executives said it wouldn't take them long to restart the policies they used in the spring.
"The capability is still there," Boyd said. “This is why we’re confident. There’s a lot of lessons learned for all us.”
One of those lessons is that wearing face masks, washing hands and staying away from other people as much as possible really do stifle the spread of the coronavirus.
"Hospital admissions, hospital discharges and hospital deaths are all tied into the social responsibility we have as a community," Sullivan said. "It's more disappointing for me when I see spreads through social gatherings or through Covid fatigue and people just not taking responsibility."
“I’m personally quite concerned about this,” said Mills, the Olean doctor, who has adult children in three other states.
He told them not to come home to visit for the holidays.
