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A key, ever-fluctuating variable in the grim daily calculus facing a city racing against time to treat a rising tide of COVID-19 patients is the number of intensive care unit beds available.
On Thursday, in a city of 8.6 million people, that figure was 307.
Some 850 COVID-19 patients occupied ICU beds in hospitals across New York City that day — up from 525 three days earlier.
The state statistics, obtained by THE CITY, revealed stark numbers that underscored the urgent need for additional hospital capacity as more and more people get sick from coronavirus.
The details came to light as medical centers report being overwhelmed, well before the crisis is expected to hit its peak. State and city officials are scrambling to create more medical treatment space everywhere from CUNY campuses to the Javits Center as they press hospitals to increase the stock of critical care beds.
‘A Decisive Moment’
Without a marked increase in resources, the five boroughs are headed in the next eight days “to a decisive moment for the City of New York,” Mayor Bill de Blasio warned late Friday.
The state hospitalization survey obtained by THE CITY shows that of the 2,011 ICU beds in the city Thursday, just 15% remained available amid a surge of incoming patients.
Overall, 3,557 hospital beds of all types were available Thursday out of 20,330 citywide. Even as they worked to increase ICU beds, hospital officials were hampered by shortages of qualified medical staff and equipment — most prominently ventilators.
On Monday, Gov. Andrew Cuomo warned that the apex of the coronavirus outbreak is approaching faster than expected, threatening to subsume hospitals weeks before an initial May 1 projection.
De Blasio pegs the date more specifically and sooner: April 5.
The mayor said he couldn’t ensure that every life that could be saved by medical workers will be saved if ICU beds, personnel and equipment aren’t boosted in time to meet the crisis’ peaks.
“We’re getting through this week — it’s tough. We have what we need for next week, but it will definitely be a very hard week,” the mayor said during a Friday conference call with reporters.
“But after next Sunday, April 5, is when I get very, very worried about everything we’re going to need: The people power we’re going to need, the equipment, the supplies, obviously the ventilators.”
On Saturday, Cuomo noted: “April 5th is earlier than our state projections.”
Still, the governor asked hospitals to begin working in tandem so if one is at capacity, patients could be transferred to another in the area that may not be as full.
If hospitals in New York City fill up before temporary medical facilities are erected, patients could be transferred to other parts of the state, the governor told reporters during a Saturday news conference in Albany.
“Our health systems in upstate New York right now are not as occupied as the downstate ones,” Cuomo said.
Statewide, nearly a quarter of the 4,330 intensive care unit beds — 1,027 — were available on Thursday. Meanwhile, a total of 11,000 hospital beds remained open for use.
ICU Beds in Flux
The hospital bed figures provided by the Cuomo administration offer a snapshot of how close New York City was on Thursday to running out of space to treat the sick — whether they are suffering from COVID-19 or not.
More than 42% of the ICU beds in New York City were in use by coronavirus-positive patients on Thursday. Just as many Non-COVID-19 patients, around 850, occupied intensive care beds, THE CITY’s analysis found.
Aides to the governor noted these hospital stats tend to fluctuate by the day. People are discharged, patients move in and out of the ICU as their level of care changes, and some die.
While existing bed capacity in the city is reaching its limits, state and city officials are working around the clock to expand the number of hospital beds before the expected wave of COVID-19 patients inundates the health care system.
Cuomo ordered hospitals around the state earlier this week to increase their capacity by at least 50% to address the looming shortage.
As many as 140,000 hospital beds — including 40,000 ICU beds — will be required. That’s up from the roughly 53,000 hospital and 3,000 ICU beds the state previously had, according to Cuomo.
And de Blasio has said he aims to triple the number of hospital beds in the city to 60,000 by May.
Yet de Blasio has refused to publicly share how many beds or ICU beds remain available at city public and private hospitals. Instead, he has said he’ll keep updating the public about how much longer the city’s resources can last given the available beds and ventilators needed to keep the sickest patients alive.
That makes it impossible to know whether the city’s ICU bed availability has gone below 300 at any point — or whether the numbers have since been boosted and by how much.
City Hall officials refused to confirm the numbers obtained by THE CITY, saying they consider the supply of ICU beds a moving target.
The mayor said Friday that many of the city’s major hospitals would be converted to all intensive care or primarily intensive care “in coming days.”
Dr. Mitchell Katz, CEO of the city’s public hospitals system, said at the same briefing that three of the system’s 11 hospitals added ICU units on Wednesday — but officials wouldn’t name the hospitals or say how many beds were added.
’Who Lives and Who Dies’
The only details that have come out on hospital bed numbers, previous to the state report obtained by THE CITY, have come directly from volunteer hospitals or from media accounts about hospitals that are struggling.
Doctors at city-run Elmhurst Hospital told THE CITY this week that the intensive care unit, which normally serves 15 to 20 patients, recently had been expanded into a 30-bed intermediate care unit, known as a stepdown. The hospital also converted another 30-bed medical floor to cope with the influx of COVID-19 patients, they said.
Dr. Michelle Gong, chief of the department of critical care medicine at Montefiore Medical Center in The Bronx, said on a JAMA Network podcast posted Tuesday that the hospital’s 86 ICU beds — plus a number of stepdown beds — were already nearing 100% capacity. More than half were taken up by COVID-19 patients at the time, she said.
And on Saturday, a nurse at Jacobi Medical Center in The Bronx said the public hospital had about 10 ICU beds left, even after converting additional units into intensive care.
The center had about two dozen ICU beds before the crisis hit New York City, and is struggling with a shortage of qualified ICU medical staff, according to the nurse.
“I suspect by the beginning of this week we will be critically low on [ventilators],” she said. “It’s going to come to the point where we’ll have to choose who lives and who dies.”
At a news conference in Manhattan Friday, Cuomo lauded the Army Corps of Engineers, FEMA and the National Guard for completing the first 1,000-bed temporary hospital at the Javits Center, one of at least four temporary hospitals that will be used as overflow space.
The temporary hospitals are slated to treat patients who require a lower level of care — freeing up actual hospital space for COVID-19 patients. But the temporary medical centers are being equipped in case more hospital beds are needed for coronavirus patients.
On Saturday, Cuomo announced an additional three temporary hospitals — at the South Beach Psychiatric Center on Staten Island, Westchester Square in The Bronx and SUNY Downstate in Brooklyn — that would only serve COVID-19 patients.
Meanwhile, President Donald Trump authorized another four temporary hospitals so every borough has an overflow facility, the governor said Saturday.
“That would give us coverage all across the downstate area with proximate facilities to every location downstate, and frankly is the best plan that we can put together and execute in this timeline,” Cuomo said Friday.
The proposed facilities spaces would be located at the Brooklyn Cruise Terminal, Aqueduct Racetrack in Queens, CUNY’s College of Staten Island and the New York Expo Center in The Bronx.
The USNS Comfort, a 1,000-bed floating hospital with 1,200 medical personnel, is slated to arrive in New York Monday, weeks earlier than previously expected.
State officials are also looking to convert dorms at City College and Queens College into temporary hospitals, as well as repurposing the Marriott Brooklyn Bridge Hotel and the Brooklyn Center for Rehabilitation and Nursing in Midwood, Cuomo said Friday.
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