Statement by New York Hospital System CEOs
NEW YORK, Feb. 24, 2021
NEW YORK, Feb. 24, 2021 /PRNewswire/ -- As Chief Executive Officers of New York's major health care systems, we would like to provide facts to clear up confusion in the public and the media regarding decisions to discharge patients to nursing homes during New York's spring coronavirus surge.
Collectively, our hospitals treated more COVID-19 patients than any group of hospitals in the nation. Since the pandemic began, hospitals in New York State have safely cared for and discharged 135,000 COVID-19 inpatients. Every patient we treat is precious. We are particularly saddened by every patient that has passed away. This disease has taken a significant emotional toll on patients' families and on our hardworking and dedicated staff.
Starting in late February and early March of 2020, New York hospitals mounted the largest mobilization of health care resources in our nation's history. We rose to the challenge—but early in the pandemic it was not clear how many patients we would need to admit to our hospitals and not at all clear that we would not become overwhelmed and unable to safely care for our patients. With the Italian experience informing our planning and preparedness efforts, where hospitals were completely overwhelmed, we did everything possible to increase capacity. We cancelled thousands of non-urgent surgeries, procedures, and treatments. We significantly increased our bed capacity within days and were required to develop plans to increase capacity even more.
Part of this effort was to discharge patients to non-hospital care settings where they could be safely cared for, including nursing homes. It is an everyday practice for hospitals to discharge stable, medically recovered patients to nursing homes so long as the nursing home can safely care for the patient. This is true even of infectious patients who are medically stable, if proper precautions are taken.
Federal and NYS guidance make this clear. The U.S. Centers for Medicare and Medicaid Services emphasized this on March 13, 2020—two weeks before the New York State Department of Health issued its March 25th directive—when it stated that nursing homes "can accept a resident diagnosed with COVID-19 and still under Transmission-Based Precautions for COVID-19 [from a hospital] as long as the facility can follow CDC guidance for Transmission-Based Precautions." The guidance emphasized: "Nursing homes should admit any individuals that they would normally admit to their facility, including individuals from hospitals where a case of COVID-19 was/is present."1 The March 25th NYS directive closely adheres to this Federal guidance, stating that a resident cannot be denied admission to a nursing home based "solely" on a confirmed or suspected COVID-19 diagnosis, and made clear that precautions must be maintained.2 Nothing in either the Federal or State guidance and directives required nursing homes to accept patients that they could not safely care for. Indeed, the longstanding New York State regulatory requirement that a nursing home "shall accept and retain only those nursing home residents for whom it can provide adequate care" remained in effect.3 In addition, Federal regulations continued to require that nursing homes protect all residents and staff from communicable diseases.4
Experts from across the globe and our own CDC have concluded that COVID-19 patients are only contagious relatively early in their illness. The latest report from the CDC states that most adults with moderate COVID-19 disease "remain infectious no longer than 10 days after symptom onset."5 The CDC also states that, while there have been reports of potentially infectious virus in some adults with severe disease between 10 and 20 days after symptom onset, it was estimated that 88% and 95% of their specimens were no longer infectious after 10 and 15 days, respectively, following symptom onset.
Many studies have also found that the maximum infectious period is within the first week of illness, with some studies finding maximum infectiousness occurring from 2-3 days before the onset of symptoms and 2-3 days after.6 In many cases, then, including residents in nursing homes, the time period of maximum infectiousness is prior to admission to a hospital, both during an asymptomatic period and 2-3 days after symptoms occur.7
In spring 2020, the average length of hospital stay for COVID-19 hospitalized patients discharged to nursing homes from our hospitals was nearly 10 days. This suggests that a great many recovering COVID-19 patients who were discharged from hospitals to nursing homes in New York were no longer transmitting the virus. Most, if not all, would have been admitted to the hospital once they were highly symptomatic, which would have been several days after first contracting the virus. They then would have spent many days in the hospital.
Given that COVID-19 nursing home residents that were admitted to our hospitals had already, by definition, contracted COVID-19 in their nursing homes, discharging them back to their nursing homes—so long as their nursing homes could properly care for them under Federal and State guidelines and with proper precautions--was a prudent and safe option, both for them and the other residents in their nursing homes.
Steven J. Corwin, MD
President and CEO
Kenneth L. Davis, MD
President and CEO
Mount Sinai Health System
President and CEO
Robert I. Grossman, MD
Chief Executive Officer
NYU Langone Health
Philip O. Ozuah, MD, PhD
President and CEO
3 Title 10 New York Codes, Rules, and Regulations, Section 415.26(i)(l)(ii)
4 42 U.S. Code of Federal Regulations, Section 483.80
6 See for example Luca Ferretti, et al., The Timing of COVID-19 Transmission, the Lancet, https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3716879
7 David Grabowski, PhD, Professor of Health Care Policy, Harvard Medical School, https://www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/Analysis-COVID-Outbreaks-in-Nursing-Homes.pdf
SOURCE New York Hospital System CEOs