The Covid-19 Response in New York City

Crisis Management in the Epicenter of the Epicenter

1st Edition - April 21, 2024
Editors: Syra S. Madad, Laura G. Iavicoli, Eric K. Wei
Language: English
Paperback ISBN:
9 7 8 - 0 - 4 4 3 - 1 8 7 5 5 - 1
eBook ISBN:
9 7 8 - 0 - 4 4 3 - 1 8 7 5 6 - 8

The COVID-19 Response in New York City: Crisis Management in the Largest Public Health System provides an historical accounting of the response to the COVID-19 pandemic through t… Read more

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The COVID-19 Response in New York City: Crisis Management in the Largest Public Health System provides an historical accounting of the response to the COVID-19 pandemic through the eyes of the largest public health system in the United States. The book offers a roadmap to guide healthcare systems and their providers in the event of future pandemics. Readers will learn about surge staffing and level loading, as well as tips from the ED and ICUs on how to respond to an unprecedented influx of inpatients.

Written by healthcare providers who were at the epicenter of the pandemic in New York City, this book provides a sound accounting of the response to the pandemic in one of the world's largest cities.

Cover image
Title page
Table of Contents
Copyright
Contributors
Preface
Acknowledgments
Section I. In the beginning
Chapter 1. Standing up the emergency response in the epicenter of the epicenter
Vignette
Preface
Problem areas and the unwavering effort to solve them
Community support
Vignette continued
Conclusion
Chapter 2. The history of NYC Health+Hospitals
NYC Health + Hospitals/Bellevue
NYC Health + Hospitals/South Brooklyn Health
NYC Health + Hospitals/Elmhurst
NYC Health + Hospitals/Harlem
NYC Health + Hospitals/Jacobi
NYC Health + Hospitals/Kings County
NYC Health + Hospitals/Lincoln
NYC Health + Hospitals/Metropolitan
NYC Health + Hospitals/North Central Bronx
NYC Health + Hospitals/Queens
NYC Health + Hospitals/Woodhull
NYC Health + Hospitals/Gotham Health
Section II. The pivotal moment
Chapter 3. Emergency Departments spring into action
Vignette
Preface
Background
Initial and then expanded goals of the ED Action Team
Chapter 4. The crisis shifted to the intensive care units
Vignette
Preface
Timeline of critical care council activities
Problem areas and solutions implemented
Communication
Supplies
Personal protective equipment
Space
Staffing
Clinical guidelines and protocols
Section III. A system surge plan put into place
Chapter 5. Bringing key players together, standing up incident command, and communicating with everyone
Vignette
Conclusion
Chapter 6. The iterations of patient movement throughout the surge: Load-balancing demand through interfacility transfers
Vignette
Introduction
Challenges and solutions
Conclusion
Vignette
Chapter 7. Supply chain and PPE, the wave 1 dilemma
A supply chain at the breaking point and reshaping materials management
Conservation and crisis care strategies
The changing landscape of infection prevention and control
Chapter 8. Staffing for pandemic surges in the NYC safety-net health system
Vignette
Wave 1 the ancestor strain
Nursing
Credentialed providers: Doctors, advanced practice providers, certified nurse anesthetists
Wave 2 and beyond
Chapter 9. Fatality management during the worst crisis of our lifetime
Vignette 1
COVID's unexpected impact
Initial wave challenges
Vignette 2
Omicron variant wave—December 2021 through January 2022
Moving forward: A journey of continual improvement
Conclusion
Chapter 10. Fine tuning the surge (and flex) plan
Prologue
Sustaining the surge
Bed surge plan
PPE surge plan
Mass casualty plan
Staffing plan
Staff support and care
Support service
Community support
Capital plan
Coordination
Level-loading
Transportation challenges
Epilogue
Section IV. The technical side of the response
Chapter 11. Situational awareness, going from flying blind to eyes on it all: DnA (Data and Analytics)
Vignette
Building a data and analytics program during a pandemic
Sudden need
System enhancement
Defined and managed
Optimized
Proactive and predictive
Conclusion
Chapter 12. IT-coordinating the technology infrastructure of the system
Vignette—Defining the patient with COVID-19
The challenge of defining the patient with COVID-19
The solution – A COVID-19 patient registry
External data challenge
Enterprise Information Technology Services (EITS): An overview of COVID-19 response
Vignette: Informatics during a disaster
Clinical vignette conclusion
Chapter conclusion
Chapter 13. Donations were a full-time job
Vignette/musing
Introduction
Challenges/solutions
Conclusion
Section V. Nuances of a massive health system
Chapter 14. The correctional health response to COVID-19
Vignette
NYC health+hospitals/correctional health services
The patients
Responding to COVID-19
Containment: Housing
Containment: Screening/testing
Containment: Vaccination
Decarceration
Healthcare access
Conclusion
Chapter 15. Alternate care sites including hoteling, a new path in a massive surge response
Vignette
Roosevelt Island Medical Center experience
Standing up isolation and quarantine hotels
Employee lodging: Creating a safe space for healthcare workers
Chapter 16. Behavioral health and COVID-19
Vignette (COVID: Not just on inpatient medicine)
Telebehavioral support implementation: Technological advances in real time paired with regulatory support
Vignette (Early days and the struggle for safety)
Adapting treatment for the new normal: COVID care in the midst of behavioral healthcare
Vignette: Workforce isolation and mutual support
Supporting staff through the pandemic
Vignette: In this together and working together
Intradepartment and interagency collaboration for systemic change in service delivery
Vignette (Adapting together to keep on going)
Chapter 17. External affairs: Managing communications with regulators and stakeholders
Vignette
Background
Section VI. A light at the end of the tunnel
Chapter 18. Testing and tracing in the “world's capital”
Vignette
Introduction
Trace
Take Care to AfterCare
Test and vax
Conclusion
Chapter 19. Vaccines and outpatient therapeutics: The race against the variants and the road to normalcy
Vignette
The initial NYC Health+Hospitals response to COVID-19 vaccination planning
COVID-19 vaccination program
COVID-19 vaccines
Vaccine administration (Fig. 19.2)
Vaccine equity and hesitancy
Vaccinations 2.0—beyond the vaccine hub
Outpatient therapeutics
Vignette
Conclusion
Chapter 20. Wellness and Helping Healers Heal during the biggest crisis of our lifetime
Vignette
Preface
Define wellness for your institution: What it is and what it is not
Wellness programming: Just do it, but do it responsibly
Growth mindset: Ensure sustainability and strategically informed enhancement
Hurdles are Abound: Anticipate and counteract real and perceived barriers
Vignette
Section VII. Conclusion
Chapter 21. The future of public healthcare delivery systems in the United States in the post-COVID era
Mobilization of resources
COVID testing
COVID vaccine provision
Prevention
Looking toward the future
Index

Syra S. Madad

Dr. Syra Madad, DHSc, MSc, MCP, CHEP, is an internationally renowned public health leader, biosecurity advisor, and epidemiologist in special pathogens. She serves as the Senior Director, System-wide Special Pathogens Program at New York City Health + Hospitals, and Co-Principal Investigator of NYC Health + Hospitals Institute of Diseases and Disaster Management. Dr. Madad is Core Faculty in the National Emerging Special Pathogens Training and Education Center, and affiliate faculty at the Center for Emerging Infectious Diseases Policy and Research at Boston University. In addition, she is a fellow at the Harvard Kennedy School Belfer Center for Science and International Affairs and Healthcare Simulation Fellow at The Institute for Medical Simulation and Advanced Learning. She has over 100 publications including opinion pieces in major news outlets and is featured in 1 Emmy-nominated and 3 additional public health documentaries. Dr. Madad’s work focuses on all 5 phases of emergency management: prevention, preparedness, mitigation, response and recovery from infectious disease threats with an emphasis on healthcare and public health biopreparedness.

Affiliations and expertise

Senior Director, System-wide Special Pathogens Program, NYC Health + Hospitals, NY, USA

Laura G. Iavicoli

Dr. Laura Iavicoli, MD, MBA, FACEP, CHEP, is a Board-Certified Emergency Medicine Physician, Chief Medical Officer for New York City Health + Hospitals/ Elmhurst. As the Senior Assistant Vice President for Emergency Management for New York City Health and Hospital System, she helped lead the health system through the COVID-19 Pandemic response. Dr. Iavicoli interfaced at the local, regional, national, and international level to assist with crafting and implementing Covid-19 response protocols during the Covid-19 pandemic response. She has served on numerous national, regional, and local committees devoted to emergency management. She presents and trains both nationally and regionally on topics pertaining to disaster preparedness. She served as a Disaster relief team member for >10 years for NYC and Federal Emergency Management Agency (FEMA) and is well published in the field. Dr. Iavicoli has worked clinically and as Emergency Management clinical leadership at Elmhurst Hospital, a teaching affiliate of Mount Sinai Medical Center for 20 years, and trains and teaches Emergency Medicine Residents and Medical Students in Emergency Medicine. She is a Fellow of the American College of Emergency Physicians specializing in Emergency Management and is a Professor at the Icahn School of Medicine at Mount Sinai.

Affiliations and expertise

Chief Medical Officer New York City Health + Hospitals/ Elmhurst; Professor, Emergency Medicine, Mount Sinai School of Medicine, New York, NY, USA

Eric K. Wei

Dr. Eric Wei, MD, MBA serves as Senior Vice President and Chief Quality Officer for NYC Health + Hospitals, the largest municipal safety-net health system in the United States, serving over 1.3 million New Yorkers every year. He is a Professor of Emergency Medicine through the Icahn School of Medicine at Mt. Sinai and Adjunct Professor for the NYU School of Global Public Health. He is the fellowship director for the NYC Health + Hospitals Clinical Leadership Fellowship. He is a practicing Emergency Medicine physician rotating through all 11 Emergency Departments in the system. Dr. Wei oversees the Office of Quality & Safety, which includes Emergency Management for the system. Dr. Wei previously served as Interim Chief Executive Officer of NYC Health + Hospitals/Elmhurst in 2020 and NYC Health + Hospitals/Harlem in 2021.

Affiliations and expertise

Senior Vice President and Chief Quality Officer, NYC Health + Hospitals, New York, NY, USA Professor, Emergency Medicine, Icahn School of Medicine at Mt. Sinai, New York, NY, USA Adjunct Professor, NYU School of Global Public Health, New York, NY, USA

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The Covid-19 Response in New York City

Crisis Management in the Epicenter of the Epicenter

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Syra S. Madad

Laura G. Iavicoli

Eric K. Wei

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