As Stony Brook Southampton Hospital begins to see a slow decline in admissions among COVID-19 patients, the hospital’s medical director took time this week to reflect on the scramble to treat “some of the sickest patients we’ve encountered in many years.”
Dr. Fredric I. Weinbaum is a veteran of New York City hospitals, and while he’s proud that Southampton’s medical facility had a better rate of successfully treating COVID-19 patients, he’s quick to point out the “good fortune” of practicing medicine here.
“We were fortunate. We were able to stay a jump ahead of this surge,” he said, crediting the local efforts at social distancing, which kept the number of cases manageable as the hospital expanded, at Governor Andrew Cuomo’s order, to keep pace.
“We are fortunate to live and work and be in Southampton, where we’ve got a population that’s afforded the luxury of social distancing, and many of whom can shelter in place at home,” Dr. Weinbaum said in an interview on Monday. “And I think that’s been a godsend to our area, and kept us from being overwhelmed.”
The hospital had to intubate a “significant number” of patients who were admitted for conditions related to COVID-19. Unlike in New York City hospitals, which recently reported a death rate of more than 80 percent for patients who were placed on ventilators, Dr. Weinbaum said the hospital had the opposite: only about 20 percent of patients placed on ventilators died, compared to the number who were discharged or are recovering in the hospital. In fact, patients who were on a ventilator an average of 11 days were twice as likely to be discharged as to die.
He stressed again that the difference was the number of patients seen locally, and the crucial importance of continued social distancing and other measures, adding, “If the system is overwhelmed, more people are going to die.”
He also credited the team at the hospital, from administrators to the medical and nursing staff, to specialists, lab technicians, and the cleaning crews working to keep the facility sterilized.
“This is a true challenge that does take a village,” he said. “We prepared for this moment for many years.”
He added, “There’s no special sauce. There’s no magic bullet here. What there is, is a lot of people working together in a collegial and collaborative way to make sure we’re delivering best patient care, with a lot of attention to detail. And that’s what it took.”
Dr. Weinbaum noted that the virus has been attacking the lungs, but it also has other “prime targets,” including vascular endothelial cells, the lining of blood vessels, which has led to an incidence of stroke in some patients. “The kidneys are also a prime target,” he said. “There’s a relative high incidence of kidney organ failure in patients who get seriously ill. We’ve had to deal with that as well.”
Likewise, patients have to be sedated to be intubated, and while they are on a ventilator, and some have needed more time to recover “their baseline mental function.”
One challenge was for the hospital to develop treatment protocols and settings to treat a singular ailment that is “a remarkably complex viral infection that attacks a host of systems within the patients who are unfortunately affected by it. Mobilizing the hospital to be able to care for such a highly contagious disease is complex and difficult.” That included establishing “negative pressure” rooms, which contain the virus.
He praised the hospital’s infrastructure and the people who maintain it: “At no time did our staff feel like they were undersupplied or unable to get the personal protective equipment that they needed to care for these very sick patients.” Good planning, he said, “enabled us to stay days ahead, weeks ahead, even, of what our needs were.”
He even credited the hospital’s security staff, noting, “None of our PPE was ‘walking out’” — using a phrase President Trump had used in suggesting why some PPE shortages were occurring at some hospitals.
“This has been an extraordinary challenge, but we’ve always been able to envision the future, in chunks, several days to several weeks at a time, and prepare for it, so that our team and our teammates always felt they were well prepared and able to deal with whatever came our way.”
Dr. Weinbaum said the hospital had been selectively using the anti-malarial drug hydroxychloroquine for a time, until a Veterans Administration observational study concluded with a report that the drug was not effective against COVID-19 and, in fact, could be dangerous in some patients. The hospital immediately stopped its use, he said, adding, “We saw neither benefit nor harm from it.”
One thing the medical staff has observed, he said, is the frequency of a “cytokine storm,” when the body begins to attack its own tissue and cells rather than fighting off the virus. It’s similar to what occurs in autoimmune disorders, which suggests that the virus is a more complicated threat than a typical coronavirus.
“We’ve learned a lot through this,” he said. “Our results have been excellent, as have the results through the whole Stony Brook system.”
Dr. Weinbaum has unbridled praise for his staff and said he’s confident they “are going to be fine. They’ve had fears along the way, and they’ve faced up to their fears and done everything necessary.”
But he said he worries about the economic impact on staff, and on the doctors whose local practices are small businesses affected by the same economic pressures as other local businesses. “The longer this goes on, the heavier the burden will be,” he said.
He also acknowledged the various ways the community has offered thanks, with gestures like food donations and other means. “We hear, loud and clear, the appreciation from the community,” he said. “The front-line staff really sensed the love that the community has.”
He added, “I think the community has to understand the gratitude of the hospital for their support — and our gratitude for the sacrifices they’re making. That’s made a world of difference in our ability to care for these very sick patients.”
This story was first published by The Southampton Press.