The coronavirus pandemic that has killed more than 32,000 city residents inspired life-saving innovations while also exposing health-care disparities that left some neighborhoods more at the mercy of the disease, according to Dr. Mitchell Katz, the CEO of New York City Health + Hospitals.
The nation's largest municipal health-care system, includes 11 hospitals and saw some of the highest patient death counts. Thousands of H+H workers were sidelined by the deadly virus, with 53 dying from it.
Many Balk at Vaccine
Despite that heavy toll on the workforce, only 50 percent of the H+H workforce has been vaccinated, a number Dr. Katz is committed to increasing.
"We know that many of our health-care workers have not yet wanted to be vaccinated," he said in an interview. "Our health system has worked diligently to ensure that our employees have vaccine access and education they need to decide when vaccination is right for them. As supply broadens, we know that more and more staff members will become comfortable and get vaccinated."
Engagement efforts include one-on-one conversations, leadership meetings on various floors and units of member hospitals, and its NYC VaxChamps campaign highlighting the accounts of colleagues who have been vaccinated.
H+H is committed to take any and all patients, regardless of their ability to pay or immigration status. As a consequence, its hospitals and its community-based clinics are the medical facilities of choice for the city's half-million undocumented residents.
Praises Workers' 'Grit'
When asked by phone April 9 what he had learned about the city system because of COVID, Dr. Katz said he wanted to "start with a positive, which is the amazing grit and heroism of the people working in New York City Health + Hospitals. We have often been used to working with less resources and older buildings, and that sense of ingenuity really helped us as we had to configure new wards."
H+H found ways to improve patient care while reducing the exposure of staff, which helped to slow the virus's spread.
Dr. Katz noted, "We have done a lot of work from the first wave about putting glass doors in, or glass in the walls to create a window for cameras in the patient rooms—microphones so that patients can be monitored safely without going into the room—and that is a positive development whether there's COVID or some other infectious disease."
He said one of the most-sobering discoveries was how disparities in the city's private- and public-hospital infrastructures left some communities so much more vulnerable to the virus.
Queens Short on Beds
"I think the fact that we had so many fewer hospital beds in Queens compared to Manhattan was one of the stark lessons," he said. "That's part of why it was so much more challenging to deal with the pandemic in Queens and Elmhurst Hospitals was because there were so few beds compared to the size of the population in Queens...The discrepancy in the number of beds I'd say was an issue."
The H+H CEO, who has held that job since 2017, has continued to treat patients throughout the pandemic, primarily via telemedicine. Before the virus struck, he stabilized the system's finances.
Dr. Katz, who considers himself a New Yorker, established a national reputation leading the public hospital systems in San Francisco and Los Angeles before returning home. He believes that the nation's vulnerability to the virus can be traced back to a steady disinvestment in public health that started during President Reagan's tenure for much of the 1980s.
"Yes, the pandemic shows how we have to build up our public-health infrastructure so that we are better prepared for what people need," he said.
As city, state and Federal officials attempt to regroup after the death of nearly 600,000 Americans and the infection of well over 30 million, Dr. Katz believes policy-makers should take a close look not just at those figures but high mortality rates in particular neighborhoods.
"Absolutely, and I think we have some sense already of the excess mortality that occurred both among people who had COVID and didn't come forward for testing," he said. "Some of those people were undocumented immigrants or people who were very low-income and feared coming forward to a hospital." There were other instances, he added, of "people who were having heart attacks or other serious health conditions and didn't come forward for care because they were so frightened of catching COVID from the hospital."
Dr. Katz said exposures for hospital employees during the pandemic that inspired the public response of banging pots at sundown was an "appreciation of just what heroes the health-care workers are."
"In my dealing with the first major epidemic of my career with AIDS, we were very concerned about needle sticks in our invasive work, but COVID took this to a completely different level because the risk was on a virus that's transmitted through the air by breathing," he said. "So many people saw their fellow nurses, doctors, and environmental-services people get ill."
He continued, "Everybody was at risk, but only the health-care workers were marching into the room of people with COVID while others were able to do their work by Zoom or at least able to keep a safe distance from everyone... When anesthesiologists intubate patients and put in a breathing tube, they have to get their face very close to the patient."
H+H April 7 announced an expansion of its program to help long-haul virus patients who have lingering symptoms of varying severity. It operates long-haul clinics in the Tremont section of The Bronx and Jackson Heights in Queens. In July, a third facility will be opened in Brooklyn's Bushwick section.
At a mayoral briefing on the expansion, Dr. Amanda Johnson, a practicing physician and Assistant Vice President of H+H overseeing the Take Care program, told reporter that some recovering patients "are still stricken with shortness of breath, chest discomfort, with light-headedness, with cough, anxiety, depression, confusion that they didn't have before their infection."
Dr. Katz said he supports the establishment of a COVID registry for essential workers along the lines of the 9/11 World Trade Center Health Program, which covers first-responders--as long as it protects the confidentiality of the participants.
He pointed out that due to exposure to the toxins in the vicinity of the Trade Center after the Twin Towers were destroyed by planes hijacked by terrorists, "we are still seeing cases of cancer 20 years later."
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