The Office of Governor Ned Lamont expects testing for COVID-19 in Connecticut to reach a minimum threshold of 30,000 tests administered daily statewide before lifting any restrictions on businesses, hospitals or social gatherings intended to slow the spread of the virus. A longer-term goal for Connecticut of 50,000 daily tests has been set by neighboring New York State.
To date, seven weeks into the coronavirus pandemic, Yale New Haven Health has performed a total of just 30,000 tests.
“The key to coming out of our stay at home orders depends on having reliable, accessible testing available to all of us. Through the state task force we are looking at creating a number of areas that we can perform more tests, more easily,” said Marna Borgstrom, president and CEO of Yale-New Haven Hospital and member of the Governor’s Reopen Connecticut Advisory Committee. “We at Yale are pursuing several avenues and hope to be able to ramp up testing in our region to do 10,000 tests per day.”
Once testing meets a minimum threshold, elective surgeries, procedures and non-essential medical visits can resume, combined with a slow reopening of businesses and offices.
Access to needed reagents, swabs and equipment required to perform tests remains in high demand and short supply across the county, but officials expressed hope that a phased-in-reopening effort could get underway by the beginning of June, but they offered no guarantees if testing does not meet requirements set by the state.
On April 21, the number of cases in the western and central portions of Connecticut peaked and hospitalizations began a steady decline, alleviating some pressure on the state. Today, 1,600 individuals with coronavirus are hospitalized.
In eastern Connecticut, however, the peak is likely still weeks away.
“We broke the 30 mark this morning with 31 COVID positive patients at L&M. At Westerly there are five cases,” said Patrick Green, president of Lawrence & Memorial Hospital in New London.
As COVID-19 cases continue to crop up across the state, hospitals are working to ensure that they can adequately care not only for those patients, but all patients who have emergency medical needs or necessary surgeries and procedures.
“In addition to COVID, we are starting to see a slight uptick in our non-COVID volume and we have the ability to cohort those patients on certain units to keep them safe,” Green said. “That is something that is front and center as we have to be able to care for all patients.”
After a more than two-thirds decline in emergency room visits at the start of the COVID-19 pandemic, hospitals – including those in Yale-New Haven Health — are starting to see the trend reverse.
“At first we saw a significant change in population with as low as just 50 to 60 patients coming into the emergency department,” said Dr. Richard Goulding, a physician at William Backus Hospital in Norwich.
Typically, the hospital sees about 150 emergency room patients each day.
“The low acuity stuff just disappeared while higher acuity increased… There is no question that one of the biggest fears was that people were waiting too long at home,” he said.
According to Goulding, patients were often arriving hours or days later than they normally would have with strokes and heart attacks. Unfortunately, that delay can result in far worse health outcomes.
Goulding said that in the last week that trend has turned a corner and Backus is now seeing slightly fewer than 100 emergency department patients daily.
“We are starting to see some returns to normalcy as people are starting to get cabin fever,” Goulding said. “I expect the trend to continue as we get into warmer weather, but I don’t know if we will reach the same volume again. There might be a new defined normal.”
A Coronavirus backlog
Hospital systems postponed as many surgeries as possible in the wake of the coronavirus, creating a backlog of patients in need of care.
“There isn’t going to be a going back to business as usual, it’s going to be a return to a new normal and that will include taking care of patients with the virus as well as our typical volume,” Borgstrom said. “The Centers for Medicare and Medicaid are saying we are now living with COVID and that we need to continue to cohort COVID populations and staff who care for them.”
Dr. Tom Balcezak, chief medical officer at Yale-New Haven Health, and Borgstrom both warned that there is no guarantee of a vaccine any time soon, or at all, to prevent the spread of COVID-19.
Antibody tests, however, have shown promise. According to Balcezek, recent lab tests at Yale Medicine have shown that antibodies do aid in resistance. Whether antibodies prevent a second occurrence of the virus in humans, however, is not yet clear.
“Although we’ve reached peak, I don’t think we are at a point where we can celebrate,” Borgstrom said. “Our staff are still fighting a battle.”
Balcezak said that it’s already clear that a reliable cure for this virus will not be easy to find.
“Our ability to find reliable treatments that are effective against the virus is going to take a lot more time, if there was a known therapy that was spectacularly successful it would have shown by now,” Balcezak said.
A shift in patient care
This week, Hartford Healthcare announced that it will be including urgent-elective care to the urgent care being provided now.
“Surgeons have been trying to move to an elective mentality, work to see if the gallbladder can be cooled down for an extra week or a procedure can be delayed,” Goulding said. “As we start to go back there will be a backlog for quite some time. OR time in hospitals is precious to being with, creating OR time is incredibly difficult.”
Delays in medical care could stretch well beyond the next few months, leaving telehealth the norm for routine visits.
“There is no normal operations anymore, I think this will forever change us,” Balcezak said. “Some of the silver linings here are some of the things that have worked so well, and telehealth is one of them.”
Since the start of the COVID-19 shutdowns, Yale New Haven Health has performed more than 50,000 telehealth visits.
Fewer patients, less space
Although the total number of patients at Backus has decreased during the COVID-19 pandemic, because of the rearrangement of hospital rooms and floors there is now often not enough space for non-COVID patients.
“We have floors that have been converted into ICU bed capability, but that means a drop in the number of beds,” Goulding said. “Currently, we are holding ten patients in the emergency department because of cohort issues upstairs.”
Although much of the state has already passed an initial peak of cases, Balcezak said that the increased ICU beds and space will remain for months to come.
“One thing we’ve learned during this time is that the length of this illness is extremely long,” he said. “Patients are there for two weeks or more on ventilators and recovery is very, very slow. ICUS are going to stay open and it’s going to put a lot of pressure on our staff.”