ASA Connect

Does anyone know if hospitals are separating out the Coronavirus patients from the rest of the hospital; if not, then we are putting our most vulnerable people at great risk.  Can't we set up 'field' hospitals for the Coronovirus patients - doesn't that makes sense to other people?  Despite all our best efforts - hospitals are notorious places for spreading germs (see Hospital-acquired Infections!).

------------------------------
David Stokar
[Principal Statistician]
------------------------------

Hi David,

Without wading into the need/appropriateness/pros/cons of field hospitals, if such facilities were to be built then in ~35 states one of the first barriers to creating the new facilities would be "certificate of need" (CON) laws.

Here are two links from the "pedia's" to get started....

• https://www.investopedia.com/terms/c/certificate-of-need.asp
• https://en.wikipedia.org/wiki/Certificate_of_need

There are quite a few other hospital folks in these forums so perhaps they could share other requirements to create new hospital facilities and requisition the necessary equipment, like mechanical ventilators.



------------------------------
Glen Wright Colopy
DPhil Oxon
Data Scientist at Cenduit LLC, Durham, NC
------------------------------

Original Message:
Sent: 03-23-2020 09:53
From: David Stokar
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Does anyone know if hospitals are separating out the Coronavirus patients from the rest of the hospital; if not, then we are putting our most vulnerable people at great risk.  Can't we set up 'field' hospitals for the Coronovirus patients - doesn't that makes sense to other people?  Despite all our best efforts - hospitals are notorious places for spreading germs (see Hospital-acquired Infections!).

------------------------------
David Stokar
[Principal Statistician]
------------------------------

In times of emergency like this 'rules' can be relaxed, especially if it will save lives.

------------------------------
David Stokar
[Principal Statistician]
------------------------------

Original Message:
Sent: 03-23-2020 10:28
From: Glen Colopy
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Hi David,

Without wading into the need/appropriateness/pros/cons of field hospitals, if such facilities were to be built then in ~35 states one of the first barriers to creating the new facilities would be "certificate of need" (CON) laws.

Here are two links from the "pedia's" to get started....

• https://www.investopedia.com/terms/c/certificate-of-need.asp
• https://en.wikipedia.org/wiki/Certificate_of_need

There are quite a few other hospital folks in these forums so perhaps they could share other requirements to create new hospital facilities and requisition the necessary equipment, like mechanical ventilators.



------------------------------
Glen Wright Colopy
DPhil Oxon
Data Scientist at Cenduit LLC, Durham, NC

Original Message:
Sent: 03-23-2020 09:53
From: David Stokar
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Does anyone know if hospitals are separating out the Coronavirus patients from the rest of the hospital; if not, then we are putting our most vulnerable people at great risk.  Can't we set up 'field' hospitals for the Coronovirus patients - doesn't that makes sense to other people?  Despite all our best efforts - hospitals are notorious places for spreading germs (see Hospital-acquired Infections!).

------------------------------
David Stokar
[Principal Statistician]
------------------------------

If by "field hospital" you mean a tent or some other type of temporary structure that is outdoors, consider that fact that it just snowed by me. We are expecting another 1-2 inches of snow tonight. How would you keep such a space warm enough for everybody? 

If you are down south, think about the bugs and other parasites they bring. How do you keep keep the tents bug free. 


In both cases, how long would it take before the floors became so nasty that they would have to be abandoned? How many people would die because of the unsanitary conditions?  

If you are referring to a hospital that is dedicated to Covid- 19 cases, where would that hospital be? If you have a hospital in every state dedicated to Covid, what city do you put it in? What supplies do other hospitals lose to make sure this new hospital has everything it needs? How do you get the patients to this hospital?

------------------------------
Andrew Ekstrom

Statistician, Chemist, HPC Abuser;-)
------------------------------

Original Message:
Sent: 03-23-2020 09:53
From: David Stokar
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Does anyone know if hospitals are separating out the Coronavirus patients from the rest of the hospital; if not, then we are putting our most vulnerable people at great risk.  Can't we set up 'field' hospitals for the Coronovirus patients - doesn't that makes sense to other people?  Despite all our best efforts - hospitals are notorious places for spreading germs (see Hospital-acquired Infections!).

------------------------------
David Stokar
[Principal Statistician]
------------------------------

'Field' hospitals do not have to be outside or in a field (that's why I put field in quotation marks).  They could be in a building or really any structure suitable for the purpose.  I would assume they would put them as close to the existing hospitals as necessary.

------------------------------
David Stokar
[Principal Statistician]
------------------------------

Original Message:
Sent: 03-23-2020 14:09
From: Andrew Ekstrom
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

If by "field hospital" you mean a tent or some other type of temporary structure that is outdoors, consider that fact that it just snowed by me. We are expecting another 1-2 inches of snow tonight. How would you keep such a space warm enough for everybody?

If you are down south, think about the bugs and other parasites they bring. How do you keep keep the tents bug free.


In both cases, how long would it take before the floors became so nasty that they would have to be abandoned? How many people would die because of the unsanitary conditions?

If you are referring to a hospital that is dedicated to Covid- 19 cases, where would that hospital be? If you have a hospital in every state dedicated to Covid, what city do you put it in? What supplies do other hospitals lose to make sure this new hospital has everything it needs? How do you get the patients to this hospital?

------------------------------
Andrew Ekstrom

Statistician, Chemist, HPC Abuser;-)

Original Message:
Sent: 03-23-2020 09:53
From: David Stokar
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Does anyone know if hospitals are separating out the Coronavirus patients from the rest of the hospital; if not, then we are putting our most vulnerable people at great risk.  Can't we set up 'field' hospitals for the Coronovirus patients - doesn't that makes sense to other people?  Despite all our best efforts - hospitals are notorious places for spreading germs (see Hospital-acquired Infections!).

------------------------------
David Stokar
[Principal Statistician]
------------------------------

Generally speaking, the protocol is to put covid patients on high level precautions and negative pressure rooms while they are available. Additionally some health systems are trying to consolidate covid positive patients to one hospital or clinic if they can. There is also the option of using 'Med centers' or the free standing EDs/ large clinics for less acute patients. If the patients can't be totally physically separated (another building) then they at least put them on one unit or ward. Where things get tricky is patients requiring critical care which requires specialized equipment (vents, oxygen lines, etc). Not every room has this equipment (or staffing trained to  administer this level of care)and you end up in an ICU with other ICU patients. short answer is yes, hospitals of which I am aware are trying to isolate the patients physically as much as possible, constrained my resource availability.

As far as field hospitals, I saw a picture of Yale prepping their gym for patients or some kind of triage. one of the stated reasons NYU evacuated students from the dorms was to make room for patients if the need stride. Again, limitations arise when you need specialized equipment and care (e.g. you can use oxygen tanks, but those run out quickly).

------------------------------
Michael DeWitt
------------------------------

Original Message:
Sent: 03-23-2020 09:53
From: David Stokar
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Does anyone know if hospitals are separating out the Coronavirus patients from the rest of the hospital; if not, then we are putting our most vulnerable people at great risk.  Can't we set up 'field' hospitals for the Coronovirus patients - doesn't that makes sense to other people?  Despite all our best efforts - hospitals are notorious places for spreading germs (see Hospital-acquired Infections!).

------------------------------
David Stokar
[Principal Statistician]
------------------------------

To expand: hospitals with >20 beds have always tended to separate patients into specialty groups (OB, pediatrics, surgical patients, heart attack patients...) Covid patients may be preferentially sent to some nursing units and not others within a hospital. Adult Covid patients would typically go to "medical floors" and "Medical ICUs" and sick children to "pediatric nursing units" and "pediatric ICUs."   However, with a surfeit of Covid patients and elective surgery being canceled, there will be Covid patients on "surgical" units.  Ideally, patients with respiratory infections would be isolated in negative pressure rooms, but New York City has nowhere near enough negative pressure rooms to do that now. ( I work in NYC)  When the hospital ship Comfort gets to NYC, the Comfort bosses are saying that it should NOT take Covid patients, given the recent history of ships and Covid.   Transporting Covid19 patients is not a trivial concern; moving Covid patients from one hospital to another would present another big problem to an already stressed EMS (ambulance) system.  I don't know of any hospital that preferentially seeks (or is assigned) Covid patients.   I hope that helps answer your questions. Ron Low MD MS(biostat)

------------------------------
Ronald Low
Medical Director, Appeals
MetroPlus NYCHHC
------------------------------

Original Message:
Sent: 03-24-2020 07:20
From: Michael DeWitt
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Generally speaking, the protocol is to put covid patients on high level precautions and negative pressure rooms while they are available. Additionally some health systems are trying to consolidate covid positive patients to one hospital or clinic if they can. There is also the option of using 'Med centers' or the free standing EDs/ large clinics for less acute patients. If the patients can't be totally physically separated (another building) then they at least put them on one unit or ward. Where things get tricky is patients requiring critical care which requires specialized equipment (vents, oxygen lines, etc). Not every room has this equipment (or staffing trained to  administer this level of care)and you end up in an ICU with other ICU patients. short answer is yes, hospitals of which I am aware are trying to isolate the patients physically as much as possible, constrained my resource availability.

As far as field hospitals, I saw a picture of Yale prepping their gym for patients or some kind of triage. one of the stated reasons NYU evacuated students from the dorms was to make room for patients if the need stride. Again, limitations arise when you need specialized equipment and care (e.g. you can use oxygen tanks, but those run out quickly).

------------------------------
Michael DeWitt

Original Message:
Sent: 03-23-2020 09:53
From: David Stokar
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Does anyone know if hospitals are separating out the Coronavirus patients from the rest of the hospital; if not, then we are putting our most vulnerable people at great risk.  Can't we set up 'field' hospitals for the Coronovirus patients - doesn't that makes sense to other people?  Despite all our best efforts - hospitals are notorious places for spreading germs (see Hospital-acquired Infections!).

------------------------------
David Stokar
[Principal Statistician]
------------------------------

Just to add a smidge to Ron's answer on the "specialty groups"....

The division of critically ill patients into specialty groups is a practice of hospitals in the UK & US.**
So if you walk into a hospital you can see signs for different like the "Neuro ICU", "Neonate ICU", "Medical ICU", "Cardiac ICU".

Broadly speaking, this is not done in European hospital systems (with the exception for Neonate ICUs***)...the separate wards for the neuro/cardio/medical/trauma is frequently not done. Hospitals might specialize within a larger hopsital system...but if you walked into a hospital in Amsterdam you probably won't see sign saying, "Neuro ICU, this way! / "Cardiac ICU, that way!"

A further issue is that (again, broadly speaking), patient are stratified differently in Eu hospitals. Patients on critical care wards in the EU are typically more acutely ill than US patients in ICU. The European patients might be highly varied in the cause of their critical status (bc the neuro/cardiac/trauma patients are all co-located) but are more homogeneous in terms of their highly critical status.

So the TL;DR is, if you are interested in deciphering differing hospital statistics for the various affected countries there's an added challenge due to definitions.


**Not stating this as an exhaustive list: Mexican, Canadian, and Common Wealth countries might organize similarly...if anyone else can comment, please do.
***I've never seen or heard of a hospital that combines/co-locates neonate & adult ICUs..if anyone else can comment, please do.

------------------------------
Glen Wright Colopy
DPhil Oxon
Data Scientist at Cenduit LLC, Durham, NC
------------------------------

Original Message:
Sent: 03-24-2020 08:49
From: Ronald Low
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

To expand: hospitals with >20 beds have always tended to separate patients into specialty groups (OB, pediatrics, surgical patients, heart attack patients...) Covid patients may be preferentially sent to some nursing units and not others within a hospital. Adult Covid patients would typically go to "medical floors" and "Medical ICUs" and sick children to "pediatric nursing units" and "pediatric ICUs."   However, with a surfeit of Covid patients and elective surgery being canceled, there will be Covid patients on "surgical" units.  Ideally, patients with respiratory infections would be isolated in negative pressure rooms, but New York City has nowhere near enough negative pressure rooms to do that now. ( I work in NYC)  When the hospital ship Comfort gets to NYC, the Comfort bosses are saying that it should NOT take Covid patients, given the recent history of ships and Covid.   Transporting Covid19 patients is not a trivial concern; moving Covid patients from one hospital to another would present another big problem to an already stressed EMS (ambulance) system.  I don't know of any hospital that preferentially seeks (or is assigned) Covid patients.   I hope that helps answer your questions. Ron Low MD MS(biostat)

------------------------------
Ronald Low
Medical Director, Appeals
MetroPlus NYCHHC

Original Message:
Sent: 03-24-2020 07:20
From: Michael DeWitt
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Generally speaking, the protocol is to put covid patients on high level precautions and negative pressure rooms while they are available. Additionally some health systems are trying to consolidate covid positive patients to one hospital or clinic if they can. There is also the option of using 'Med centers' or the free standing EDs/ large clinics for less acute patients. If the patients can't be totally physically separated (another building) then they at least put them on one unit or ward. Where things get tricky is patients requiring critical care which requires specialized equipment (vents, oxygen lines, etc). Not every room has this equipment (or staffing trained to  administer this level of care)and you end up in an ICU with other ICU patients. short answer is yes, hospitals of which I am aware are trying to isolate the patients physically as much as possible, constrained my resource availability.

As far as field hospitals, I saw a picture of Yale prepping their gym for patients or some kind of triage. one of the stated reasons NYU evacuated students from the dorms was to make room for patients if the need stride. Again, limitations arise when you need specialized equipment and care (e.g. you can use oxygen tanks, but those run out quickly).

------------------------------
Michael DeWitt

Original Message:
Sent: 03-23-2020 09:53
From: David Stokar
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Does anyone know if hospitals are separating out the Coronavirus patients from the rest of the hospital; if not, then we are putting our most vulnerable people at great risk.  Can't we set up 'field' hospitals for the Coronovirus patients - doesn't that makes sense to other people?  Despite all our best efforts - hospitals are notorious places for spreading germs (see Hospital-acquired Infections!).

------------------------------
David Stokar
[Principal Statistician]
------------------------------

Short answer: No, they are not, because they cannot identify them. See https://www.nytimes.com/video/nyregion/100000007052136/coronavirus-elmhurst-hospital-queens.html?campaign_id=9&emc=edit_NN_p_20200326&instance_id=17074&nl=morning-briefing&regi_id=112672077&section=topNews&segment_id=22910&te=1&user_id=1c3c02b3e9f02ee423f313546fcc7edc&fbclid=IwAR0IAZ_ZuAMZxLgAV5dxSMQUxUk-bzWXHHONLBfnbXJ4yo5zyQ_L6L_otWc.


------------------------------
Sheila Braun
------------------------------

Original Message:
Sent: 03-24-2020 08:49
From: Ronald Low
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

To expand: hospitals with >20 beds have always tended to separate patients into specialty groups (OB, pediatrics, surgical patients, heart attack patients...) Covid patients may be preferentially sent to some nursing units and not others within a hospital. Adult Covid patients would typically go to "medical floors" and "Medical ICUs" and sick children to "pediatric nursing units" and "pediatric ICUs."   However, with a surfeit of Covid patients and elective surgery being canceled, there will be Covid patients on "surgical" units.  Ideally, patients with respiratory infections would be isolated in negative pressure rooms, but New York City has nowhere near enough negative pressure rooms to do that now. ( I work in NYC)  When the hospital ship Comfort gets to NYC, the Comfort bosses are saying that it should NOT take Covid patients, given the recent history of ships and Covid.   Transporting Covid19 patients is not a trivial concern; moving Covid patients from one hospital to another would present another big problem to an already stressed EMS (ambulance) system.  I don't know of any hospital that preferentially seeks (or is assigned) Covid patients.   I hope that helps answer your questions. Ron Low MD MS(biostat)

------------------------------
Ronald Low
Medical Director, Appeals
MetroPlus NYCHHC

Original Message:
Sent: 03-24-2020 07:20
From: Michael DeWitt
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Generally speaking, the protocol is to put covid patients on high level precautions and negative pressure rooms while they are available. Additionally some health systems are trying to consolidate covid positive patients to one hospital or clinic if they can. There is also the option of using 'Med centers' or the free standing EDs/ large clinics for less acute patients. If the patients can't be totally physically separated (another building) then they at least put them on one unit or ward. Where things get tricky is patients requiring critical care which requires specialized equipment (vents, oxygen lines, etc). Not every room has this equipment (or staffing trained to  administer this level of care)and you end up in an ICU with other ICU patients. short answer is yes, hospitals of which I am aware are trying to isolate the patients physically as much as possible, constrained my resource availability.

As far as field hospitals, I saw a picture of Yale prepping their gym for patients or some kind of triage. one of the stated reasons NYU evacuated students from the dorms was to make room for patients if the need stride. Again, limitations arise when you need specialized equipment and care (e.g. you can use oxygen tanks, but those run out quickly).

------------------------------
Michael DeWitt

Original Message:
Sent: 03-23-2020 09:53
From: David Stokar
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Does anyone know if hospitals are separating out the Coronavirus patients from the rest of the hospital; if not, then we are putting our most vulnerable people at great risk.  Can't we set up 'field' hospitals for the Coronovirus patients - doesn't that makes sense to other people?  Despite all our best efforts - hospitals are notorious places for spreading germs (see Hospital-acquired Infections!).

------------------------------
David Stokar
[Principal Statistician]
------------------------------

I can't watch the video you linked to.

Why can't they identify people with respiratory illnesses?

------------------------------
David Stokar
[Principal Statistician]
------------------------------

Original Message:
Sent: 03-26-2020 09:50
From: Sheila Braun
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Short answer: No, they are not, because they cannot identify them. See https://www.nytimes.com/video/nyregion/100000007052136/coronavirus-elmhurst-hospital-queens.html?campaign_id=9&emc=edit_NN_p_20200326&instance_id=17074&nl=morning-briefing&regi_id=112672077&section=topNews&segment_id=22910&te=1&user_id=1c3c02b3e9f02ee423f313546fcc7edc&fbclid=IwAR0IAZ_ZuAMZxLgAV5dxSMQUxUk-bzWXHHONLBfnbXJ4yo5zyQ_L6L_otWc.


------------------------------
Sheila Braun

Original Message:
Sent: 03-24-2020 08:49
From: Ronald Low
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

To expand: hospitals with >20 beds have always tended to separate patients into specialty groups (OB, pediatrics, surgical patients, heart attack patients...) Covid patients may be preferentially sent to some nursing units and not others within a hospital. Adult Covid patients would typically go to "medical floors" and "Medical ICUs" and sick children to "pediatric nursing units" and "pediatric ICUs."   However, with a surfeit of Covid patients and elective surgery being canceled, there will be Covid patients on "surgical" units.  Ideally, patients with respiratory infections would be isolated in negative pressure rooms, but New York City has nowhere near enough negative pressure rooms to do that now. ( I work in NYC)  When the hospital ship Comfort gets to NYC, the Comfort bosses are saying that it should NOT take Covid patients, given the recent history of ships and Covid.   Transporting Covid19 patients is not a trivial concern; moving Covid patients from one hospital to another would present another big problem to an already stressed EMS (ambulance) system.  I don't know of any hospital that preferentially seeks (or is assigned) Covid patients.   I hope that helps answer your questions. Ron Low MD MS(biostat)

------------------------------
Ronald Low
Medical Director, Appeals
MetroPlus NYCHHC

Original Message:
Sent: 03-24-2020 07:20
From: Michael DeWitt
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Generally speaking, the protocol is to put covid patients on high level precautions and negative pressure rooms while they are available. Additionally some health systems are trying to consolidate covid positive patients to one hospital or clinic if they can. There is also the option of using 'Med centers' or the free standing EDs/ large clinics for less acute patients. If the patients can't be totally physically separated (another building) then they at least put them on one unit or ward. Where things get tricky is patients requiring critical care which requires specialized equipment (vents, oxygen lines, etc). Not every room has this equipment (or staffing trained to  administer this level of care)and you end up in an ICU with other ICU patients. short answer is yes, hospitals of which I am aware are trying to isolate the patients physically as much as possible, constrained my resource availability.

As far as field hospitals, I saw a picture of Yale prepping their gym for patients or some kind of triage. one of the stated reasons NYU evacuated students from the dorms was to make room for patients if the need stride. Again, limitations arise when you need specialized equipment and care (e.g. you can use oxygen tanks, but those run out quickly).

------------------------------
Michael DeWitt

Original Message:
Sent: 03-23-2020 09:53
From: David Stokar
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Does anyone know if hospitals are separating out the Coronavirus patients from the rest of the hospital; if not, then we are putting our most vulnerable people at great risk.  Can't we set up 'field' hospitals for the Coronovirus patients - doesn't that makes sense to other people?  Despite all our best efforts - hospitals are notorious places for spreading germs (see Hospital-acquired Infections!).

------------------------------
David Stokar
[Principal Statistician]
------------------------------

And example the doctor in the video gives is that people come in for things like car crashes, and then their scans indicate that they have COVID-19. It is such a sneaky virus, affecting people without any symptoms, then suddenly exploding in the lungs of the unlucky ones, resulting in something akin to drowning. 

So unless you test everybody, really everybody, you can't know who has it. You can't isolate those with the disease unless you know who they are.

------------------------------
Sheila Braun
------------------------------

Original Message:
Sent: 03-26-2020 09:57
From: David Stokar
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

I can't watch the video you linked to.

Why can't they identify people with respiratory illnesses?

------------------------------
David Stokar
[Principal Statistician]

Original Message:
Sent: 03-26-2020 09:50
From: Sheila Braun
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Short answer: No, they are not, because they cannot identify them. See https://www.nytimes.com/video/nyregion/100000007052136/coronavirus-elmhurst-hospital-queens.html?campaign_id=9&emc=edit_NN_p_20200326&instance_id=17074&nl=morning-briefing&regi_id=112672077&section=topNews&segment_id=22910&te=1&user_id=1c3c02b3e9f02ee423f313546fcc7edc&fbclid=IwAR0IAZ_ZuAMZxLgAV5dxSMQUxUk-bzWXHHONLBfnbXJ4yo5zyQ_L6L_otWc.


------------------------------
Sheila Braun

Original Message:
Sent: 03-24-2020 08:49
From: Ronald Low
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

To expand: hospitals with >20 beds have always tended to separate patients into specialty groups (OB, pediatrics, surgical patients, heart attack patients...) Covid patients may be preferentially sent to some nursing units and not others within a hospital. Adult Covid patients would typically go to "medical floors" and "Medical ICUs" and sick children to "pediatric nursing units" and "pediatric ICUs."   However, with a surfeit of Covid patients and elective surgery being canceled, there will be Covid patients on "surgical" units.  Ideally, patients with respiratory infections would be isolated in negative pressure rooms, but New York City has nowhere near enough negative pressure rooms to do that now. ( I work in NYC)  When the hospital ship Comfort gets to NYC, the Comfort bosses are saying that it should NOT take Covid patients, given the recent history of ships and Covid.   Transporting Covid19 patients is not a trivial concern; moving Covid patients from one hospital to another would present another big problem to an already stressed EMS (ambulance) system.  I don't know of any hospital that preferentially seeks (or is assigned) Covid patients.   I hope that helps answer your questions. Ron Low MD MS(biostat)

------------------------------
Ronald Low
Medical Director, Appeals
MetroPlus NYCHHC

Original Message:
Sent: 03-24-2020 07:20
From: Michael DeWitt
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Generally speaking, the protocol is to put covid patients on high level precautions and negative pressure rooms while they are available. Additionally some health systems are trying to consolidate covid positive patients to one hospital or clinic if they can. There is also the option of using 'Med centers' or the free standing EDs/ large clinics for less acute patients. If the patients can't be totally physically separated (another building) then they at least put them on one unit or ward. Where things get tricky is patients requiring critical care which requires specialized equipment (vents, oxygen lines, etc). Not every room has this equipment (or staffing trained to  administer this level of care)and you end up in an ICU with other ICU patients. short answer is yes, hospitals of which I am aware are trying to isolate the patients physically as much as possible, constrained my resource availability.

As far as field hospitals, I saw a picture of Yale prepping their gym for patients or some kind of triage. one of the stated reasons NYU evacuated students from the dorms was to make room for patients if the need stride. Again, limitations arise when you need specialized equipment and care (e.g. you can use oxygen tanks, but those run out quickly).

------------------------------
Michael DeWitt

Original Message:
Sent: 03-23-2020 09:53
From: David Stokar
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Does anyone know if hospitals are separating out the Coronavirus patients from the rest of the hospital; if not, then we are putting our most vulnerable people at great risk.  Can't we set up 'field' hospitals for the Coronovirus patients - doesn't that makes sense to other people?  Despite all our best efforts - hospitals are notorious places for spreading germs (see Hospital-acquired Infections!).

------------------------------
David Stokar
[Principal Statistician]
------------------------------

But, you can still try your best and screen out the obvious and suspected ones - which are the preponderance I would think.

That was my question - not cases of car crashes.

------------------------------
David Stokar
[Principal Statistician]
------------------------------

Original Message:
Sent: 03-26-2020 10:02
From: Sheila Braun
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

And example the doctor in the video gives is that people come in for things like car crashes, and then their scans indicate that they have COVID-19. It is such a sneaky virus, affecting people without any symptoms, then suddenly exploding in the lungs of the unlucky ones, resulting in something akin to drowning. 

So unless you test everybody, really everybody, you can't know who has it. You can't isolate those with the disease unless you know who they are.

------------------------------
Sheila Braun

Original Message:
Sent: 03-26-2020 09:57
From: David Stokar
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

I can't watch the video you linked to.

Why can't they identify people with respiratory illnesses?

------------------------------
David Stokar
[Principal Statistician]

Original Message:
Sent: 03-26-2020 09:50
From: Sheila Braun
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Short answer: No, they are not, because they cannot identify them. See https://www.nytimes.com/video/nyregion/100000007052136/coronavirus-elmhurst-hospital-queens.html?campaign_id=9&emc=edit_NN_p_20200326&instance_id=17074&nl=morning-briefing&regi_id=112672077&section=topNews&segment_id=22910&te=1&user_id=1c3c02b3e9f02ee423f313546fcc7edc&fbclid=IwAR0IAZ_ZuAMZxLgAV5dxSMQUxUk-bzWXHHONLBfnbXJ4yo5zyQ_L6L_otWc.


------------------------------
Sheila Braun

Original Message:
Sent: 03-24-2020 08:49
From: Ronald Low
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

To expand: hospitals with >20 beds have always tended to separate patients into specialty groups (OB, pediatrics, surgical patients, heart attack patients...) Covid patients may be preferentially sent to some nursing units and not others within a hospital. Adult Covid patients would typically go to "medical floors" and "Medical ICUs" and sick children to "pediatric nursing units" and "pediatric ICUs."   However, with a surfeit of Covid patients and elective surgery being canceled, there will be Covid patients on "surgical" units.  Ideally, patients with respiratory infections would be isolated in negative pressure rooms, but New York City has nowhere near enough negative pressure rooms to do that now. ( I work in NYC)  When the hospital ship Comfort gets to NYC, the Comfort bosses are saying that it should NOT take Covid patients, given the recent history of ships and Covid.   Transporting Covid19 patients is not a trivial concern; moving Covid patients from one hospital to another would present another big problem to an already stressed EMS (ambulance) system.  I don't know of any hospital that preferentially seeks (or is assigned) Covid patients.   I hope that helps answer your questions. Ron Low MD MS(biostat)

------------------------------
Ronald Low
Medical Director, Appeals
MetroPlus NYCHHC

Original Message:
Sent: 03-24-2020 07:20
From: Michael DeWitt
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Generally speaking, the protocol is to put covid patients on high level precautions and negative pressure rooms while they are available. Additionally some health systems are trying to consolidate covid positive patients to one hospital or clinic if they can. There is also the option of using 'Med centers' or the free standing EDs/ large clinics for less acute patients. If the patients can't be totally physically separated (another building) then they at least put them on one unit or ward. Where things get tricky is patients requiring critical care which requires specialized equipment (vents, oxygen lines, etc). Not every room has this equipment (or staffing trained to  administer this level of care)and you end up in an ICU with other ICU patients. short answer is yes, hospitals of which I am aware are trying to isolate the patients physically as much as possible, constrained my resource availability.

As far as field hospitals, I saw a picture of Yale prepping their gym for patients or some kind of triage. one of the stated reasons NYU evacuated students from the dorms was to make room for patients if the need stride. Again, limitations arise when you need specialized equipment and care (e.g. you can use oxygen tanks, but those run out quickly).

------------------------------
Michael DeWitt

Original Message:
Sent: 03-23-2020 09:53
From: David Stokar
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Does anyone know if hospitals are separating out the Coronavirus patients from the rest of the hospital; if not, then we are putting our most vulnerable people at great risk.  Can't we set up 'field' hospitals for the Coronovirus patients - doesn't that makes sense to other people?  Despite all our best efforts - hospitals are notorious places for spreading germs (see Hospital-acquired Infections!).

------------------------------
David Stokar
[Principal Statistician]
------------------------------

Good point. I suppose if your question is, "Are they trying?" then the answer is most definitely yes, at least where I have any knowledge of process. If the question is, "Are they succeeding?" then the answer is no, because they can't test everybody, and that is what it would take.

------------------------------
Sheila Braun
------------------------------

Original Message:
Sent: 03-26-2020 10:09
From: David Stokar
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

But, you can still try your best and screen out the obvious and suspected ones - which are the preponderance I would think.

That was my question - not cases of car crashes.

------------------------------
David Stokar
[Principal Statistician]

Original Message:
Sent: 03-26-2020 10:02
From: Sheila Braun
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

And example the doctor in the video gives is that people come in for things like car crashes, and then their scans indicate that they have COVID-19. It is such a sneaky virus, affecting people without any symptoms, then suddenly exploding in the lungs of the unlucky ones, resulting in something akin to drowning. 

So unless you test everybody, really everybody, you can't know who has it. You can't isolate those with the disease unless you know who they are.

------------------------------
Sheila Braun

Original Message:
Sent: 03-26-2020 09:57
From: David Stokar
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

I can't watch the video you linked to.

Why can't they identify people with respiratory illnesses?

------------------------------
David Stokar
[Principal Statistician]

Original Message:
Sent: 03-26-2020 09:50
From: Sheila Braun
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Short answer: No, they are not, because they cannot identify them. See https://www.nytimes.com/video/nyregion/100000007052136/coronavirus-elmhurst-hospital-queens.html?campaign_id=9&emc=edit_NN_p_20200326&instance_id=17074&nl=morning-briefing&regi_id=112672077&section=topNews&segment_id=22910&te=1&user_id=1c3c02b3e9f02ee423f313546fcc7edc&fbclid=IwAR0IAZ_ZuAMZxLgAV5dxSMQUxUk-bzWXHHONLBfnbXJ4yo5zyQ_L6L_otWc.


------------------------------
Sheila Braun

Original Message:
Sent: 03-24-2020 08:49
From: Ronald Low
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

To expand: hospitals with >20 beds have always tended to separate patients into specialty groups (OB, pediatrics, surgical patients, heart attack patients...) Covid patients may be preferentially sent to some nursing units and not others within a hospital. Adult Covid patients would typically go to "medical floors" and "Medical ICUs" and sick children to "pediatric nursing units" and "pediatric ICUs."   However, with a surfeit of Covid patients and elective surgery being canceled, there will be Covid patients on "surgical" units.  Ideally, patients with respiratory infections would be isolated in negative pressure rooms, but New York City has nowhere near enough negative pressure rooms to do that now. ( I work in NYC)  When the hospital ship Comfort gets to NYC, the Comfort bosses are saying that it should NOT take Covid patients, given the recent history of ships and Covid.   Transporting Covid19 patients is not a trivial concern; moving Covid patients from one hospital to another would present another big problem to an already stressed EMS (ambulance) system.  I don't know of any hospital that preferentially seeks (or is assigned) Covid patients.   I hope that helps answer your questions. Ron Low MD MS(biostat)

------------------------------
Ronald Low
Medical Director, Appeals
MetroPlus NYCHHC

Original Message:
Sent: 03-24-2020 07:20
From: Michael DeWitt
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Generally speaking, the protocol is to put covid patients on high level precautions and negative pressure rooms while they are available. Additionally some health systems are trying to consolidate covid positive patients to one hospital or clinic if they can. There is also the option of using 'Med centers' or the free standing EDs/ large clinics for less acute patients. If the patients can't be totally physically separated (another building) then they at least put them on one unit or ward. Where things get tricky is patients requiring critical care which requires specialized equipment (vents, oxygen lines, etc). Not every room has this equipment (or staffing trained to  administer this level of care)and you end up in an ICU with other ICU patients. short answer is yes, hospitals of which I am aware are trying to isolate the patients physically as much as possible, constrained my resource availability.

As far as field hospitals, I saw a picture of Yale prepping their gym for patients or some kind of triage. one of the stated reasons NYU evacuated students from the dorms was to make room for patients if the need stride. Again, limitations arise when you need specialized equipment and care (e.g. you can use oxygen tanks, but those run out quickly).

------------------------------
Michael DeWitt

Original Message:
Sent: 03-23-2020 09:53
From: David Stokar
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Does anyone know if hospitals are separating out the Coronavirus patients from the rest of the hospital; if not, then we are putting our most vulnerable people at great risk.  Can't we set up 'field' hospitals for the Coronovirus patients - doesn't that makes sense to other people?  Despite all our best efforts - hospitals are notorious places for spreading germs (see Hospital-acquired Infections!).

------------------------------
David Stokar
[Principal Statistician]
------------------------------

I just replied to this and then realized I forgot to address the phrase "which are the preponderance". 

Unfortunately, we have absolutely no idea how many people are infected without symptoms. Separating people with symptoms from the rest of the population has been utterly failing to safeguard us. Guessing that the preponderance of people who are sick have symptoms has not led to effective strategies, so far, at containing the virus.

------------------------------
Sheila Braun
------------------------------

Original Message:
Sent: 03-26-2020 10:09
From: David Stokar
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

But, you can still try your best and screen out the obvious and suspected ones - which are the preponderance I would think.

That was my question - not cases of car crashes.

------------------------------
David Stokar
[Principal Statistician]

Original Message:
Sent: 03-26-2020 10:02
From: Sheila Braun
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

And example the doctor in the video gives is that people come in for things like car crashes, and then their scans indicate that they have COVID-19. It is such a sneaky virus, affecting people without any symptoms, then suddenly exploding in the lungs of the unlucky ones, resulting in something akin to drowning. 

So unless you test everybody, really everybody, you can't know who has it. You can't isolate those with the disease unless you know who they are.

------------------------------
Sheila Braun

Original Message:
Sent: 03-26-2020 09:57
From: David Stokar
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

I can't watch the video you linked to.

Why can't they identify people with respiratory illnesses?

------------------------------
David Stokar
[Principal Statistician]

Original Message:
Sent: 03-26-2020 09:50
From: Sheila Braun
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Short answer: No, they are not, because they cannot identify them. See https://www.nytimes.com/video/nyregion/100000007052136/coronavirus-elmhurst-hospital-queens.html?campaign_id=9&emc=edit_NN_p_20200326&instance_id=17074&nl=morning-briefing&regi_id=112672077&section=topNews&segment_id=22910&te=1&user_id=1c3c02b3e9f02ee423f313546fcc7edc&fbclid=IwAR0IAZ_ZuAMZxLgAV5dxSMQUxUk-bzWXHHONLBfnbXJ4yo5zyQ_L6L_otWc.


------------------------------
Sheila Braun

Original Message:
Sent: 03-24-2020 08:49
From: Ronald Low
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

To expand: hospitals with >20 beds have always tended to separate patients into specialty groups (OB, pediatrics, surgical patients, heart attack patients...) Covid patients may be preferentially sent to some nursing units and not others within a hospital. Adult Covid patients would typically go to "medical floors" and "Medical ICUs" and sick children to "pediatric nursing units" and "pediatric ICUs."   However, with a surfeit of Covid patients and elective surgery being canceled, there will be Covid patients on "surgical" units.  Ideally, patients with respiratory infections would be isolated in negative pressure rooms, but New York City has nowhere near enough negative pressure rooms to do that now. ( I work in NYC)  When the hospital ship Comfort gets to NYC, the Comfort bosses are saying that it should NOT take Covid patients, given the recent history of ships and Covid.   Transporting Covid19 patients is not a trivial concern; moving Covid patients from one hospital to another would present another big problem to an already stressed EMS (ambulance) system.  I don't know of any hospital that preferentially seeks (or is assigned) Covid patients.   I hope that helps answer your questions. Ron Low MD MS(biostat)

------------------------------
Ronald Low
Medical Director, Appeals
MetroPlus NYCHHC

Original Message:
Sent: 03-24-2020 07:20
From: Michael DeWitt
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Generally speaking, the protocol is to put covid patients on high level precautions and negative pressure rooms while they are available. Additionally some health systems are trying to consolidate covid positive patients to one hospital or clinic if they can. There is also the option of using 'Med centers' or the free standing EDs/ large clinics for less acute patients. If the patients can't be totally physically separated (another building) then they at least put them on one unit or ward. Where things get tricky is patients requiring critical care which requires specialized equipment (vents, oxygen lines, etc). Not every room has this equipment (or staffing trained to  administer this level of care)and you end up in an ICU with other ICU patients. short answer is yes, hospitals of which I am aware are trying to isolate the patients physically as much as possible, constrained my resource availability.

As far as field hospitals, I saw a picture of Yale prepping their gym for patients or some kind of triage. one of the stated reasons NYU evacuated students from the dorms was to make room for patients if the need stride. Again, limitations arise when you need specialized equipment and care (e.g. you can use oxygen tanks, but those run out quickly).

------------------------------
Michael DeWitt

Original Message:
Sent: 03-23-2020 09:53
From: David Stokar
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Does anyone know if hospitals are separating out the Coronavirus patients from the rest of the hospital; if not, then we are putting our most vulnerable people at great risk.  Can't we set up 'field' hospitals for the Coronovirus patients - doesn't that makes sense to other people?  Despite all our best efforts - hospitals are notorious places for spreading germs (see Hospital-acquired Infections!).

------------------------------
David Stokar
[Principal Statistician]
------------------------------

David, you're absolutely right. California is setting up field hospitals for exactly this purpose. Hopefully other states are doing the same. From Sen. Feinstein's press release:

     "The U.S. Navy hospital ship Mercy is deploying to the Port of Los Angeles with a team of medical professionals, medical equipment and supplies. The hospital ship will provide up to 1,000 additional hospital beds to treat non-coronavirus patients, freeing up critical hospital space that is more suitable for treating infectious disease.

            "In addition, FEMA is deploying eight Army field hospitals to California that will add 2,000 hospital beds to the state's capacity, also intended for non-coronavirus patients. The locations for these field hospitals will be determined later this week."

https://www.feinstein.senate.gov/public/index.cfm/press-releases?id=26751B93-FEC3-4AFD-8714-23B6B63CBE44

------------------------------
Kelly Radimer
------------------------------

Original Message:
Sent: 03-23-2020 09:53
From: David Stokar
Subject: Are hospitals separating out the Coronavirus patients from the rest of the hospital?

Does anyone know if hospitals are separating out the Coronavirus patients from the rest of the hospital; if not, then we are putting our most vulnerable people at great risk.  Can't we set up 'field' hospitals for the Coronovirus patients - doesn't that makes sense to other people?  Despite all our best efforts - hospitals are notorious places for spreading germs (see Hospital-acquired Infections!).

------------------------------
David Stokar
[Principal Statistician]
------------------------------