Guiding the Big Apple Through a Pandemic

by KIMBERLY OLSON

On March 14, 2020, Richmond University Medical Center received its first COVID-19 patient. By April 8, the Staten Island hospital had 210 such patients, with its 26 critical care beds ballooning to 71, and general medicine surging from 125 to 250 beds.

“This was a unique stressor on every part of the organization,” says Daniel Messina, PhD, (right), the hospital’s president and CEO. “It’s usually a single type of event that hits you, and you do what you need to do, and you bounce back. This was a pandemic where there was just no end in sight.” The hospital froze elective care and organized into COVID and non-COVID units, as its dedicated staff rose to the unprecedented challenge.

On May 8, as New York City became a COVID hotspot, Mayor Bill de Blasio appointed Messina to his newly formed Public Health and Healthcare Sector Advisory Council. “That put me shoulderto-shoulder with my colleagues, advising the city on getting back to whatever that new normal is going to be,” Messina says.

The council worked with Department of Health staff, elected officials, public health experts, and hospital and post-acute personnel — all collaborating to make datadriven recommendations for the city’s next steps, drawing on best practices across the United States and from other countries. Messina, who works on both a city and state level with fellow CEOs from across the state, participated in regular calls with Governor Andrew Cuomo, worked with his colleagues to help create a more direct, comprehensive oversight system so hospitals could quickly communicate their needs for additional resources, such as staffing and personal protective equipment (PPE). They also provided input for enhancing coordination among city hospitals and healthcare facilities, to improve the public’s connection to post-acute care providers. The council offered guidance in creating protocols for each phase of reopening

to limit the spread of COVID-19 as public activities increased.

“Obviously, people are pretty burned out from this whole experience,” Messina says. “But it was important to make sure we didn’t jump the gun and reopen too soon. In some businesses still, there are fairly tight restrictions.”

New York City went from 8,021 newly reported daily cases on April 15 to just 386 by August 15. “New York got hit worse than any place in the world, and they did it correctly,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health.

Working on the task force also helped Messina guide his own hospital which, for example, has created a Post COVID-19 Care Center. The new center welcomes patients who have been treated for COVID-19 and are experiencing both short- and long-term side effects such as pulmonary disease, anxiety, depression and chronic fatigue, or perhaps need to change their medications.“Similar to the aftermath of 9/11, where people around the World Trade Center were unfortunately exposed to all types of chemicals and stresses to their body that bore out years later in clinical conditions that are still being diagnosed, we see people who have had COVID who are dealing with heart issues and pulmonary issues and clotting disorders — things that we need to monitor and track closely,” Messina says. The center, which includes a pediatric program, is staffed by a multidisciplinary team of healthcare experts in cardiology, infectious disease, psychiatry, behavioral health and physiatry, to name a few.

Richmond University Medical Center has also made some design adjustments to its newly built emergency department and geared up for a second surge, which just arrived on Staten Island.

Messina says that the experience that his staff gained during the pandemic — including a deeper understanding of the complexities of medical treatment for COVID — will serve them well moving forward. “One of the biggest challenges in this pandemic was the effect on the respiratory system and the fact that patients develop progressively worsening pneumonias to the point where they needed to be put on a ventilator,” says Messina, who was once a respiratory therapist. “Unfortunately, the statistics for COVID patients were greater than 50 percent mortality once they went on a ventilator. We were aggressive in our measures to avoid patients going on ventilators by using a CPAP, high-flow oxygen and proning patients, which is basically turning them over to create better ventilation. So I think we learned quite a bit, and we’re prepared.” ■