Covid-19: Impact will last for years, says US hospital group chief

His hospitals treated more Covid-19 patients than any other system in the US, but at the height of the pandemic you could hear a pin drop in them.

Limerick-born Michael Dowling recalls walking the floors of one hospital, in New York, last April, past rows of patients on ventilators. With visiting banned, all there was to break the “eerie quiet” was the shuffling of medical staff from bed to bed.

“It was a tough time. Virtually all of our 3,500 patients were Covid. We had to open 200 new beds a day. Those who went on a ventilator had a 70 per cent chance of dying. We had 90 deaths a day in our system alone,” says Dowling, chief executive of Northwell Health, which has 23 hospitals, 800 outpatient facilities and 72,000 employees.

New York had a torrid pandemic in the spring, with more than 27,000 deaths. But after a rocky start, the state has won plaudits for suppressing the virus effectively and – unlike many places in Europe – keeping it suppressed.

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State governor Andrew Cuomo, flanked by handpicked advisers such as Dowling, has obdurately prioritised health over economic considerations during the crisis, backed up by strict quarantining, and massive testing and contact tracing operations.

Consequently, case numbers have remained low – at least until recent days when infections spiked in some orthodox Jewish neighbourhoods.

"We're doing quite well right now but remaining cautious. We're always planning as if it might bounce back again," he tells The Irish Times, in advance of speaking at an online conference organised by Home and Community Care Ireland.

This week was a big one for many restaurants in the Big Apple, who are allowed open for the first time in months, though under severe restrictions.

Dowling acknowledges the economy is “hurting” and many business in the city remain “semi-closed” thanks to Cuomo’s cautious approach to easing restrictions. “The hotels are empty and only 20 to 30 per cent of offices are open, with the rest of staff working remotely”.

“The impact of this will last for years and years. But we’d rather open carefully and slow. A lot of other places have opened up too quickly, and then the virus bounces back at you and you have to close again. We don’t want that to happen.”

Although New York has managed to keep its cases down, Dowling says he would not rule out a second wave. “We have to avoid the tendency to reopen quickly just because things look good.”

The success of the strategy is most evident in the health system. Dowling’s hospitals slashed their case numbers by being the first to require mask wearing, he says. Today, they have just 85 Covid-19 patients, including a handful in intensive care. “It’s been like that for the last month.”

With his laboratories able to perform up to 50,000 rapid antibody tests a day, he says there are “hardly any infections” in his hospitals. “The safest place to be these days is in a hospital, because everyone is wearing a mask and protective gear.”

It helps that much of the care delivered by his organisation is provided in specialist centres – urgent care, cardiology, cancer treatment, even surgery. “Ireland needs to shift the provision of care out of hospitals and into these centres in the community.”

There is close to herd immunity in some areas of New York, he maintains, though not overall. In some populations, up to 50 per cent of people have antibodies.

Vaccine in the new year?

He isn’t counting on any miracles, though. “I think we’ll be wearing masks and maintaining social distancing well into next year. I don’t see a vaccine until the new year, and the big question then is who gets it.

“Managing the distribution of a vaccine is going to be unbelievably crucial. It will take most of next year to get all New Yorkers vaccinated.”

It would be foolish to rush the introduction of a vaccine, he says. “If there’s a sense it is being developed for political reasons – and we have a president who is pretending to be a scientist every day – people will be hesitant to take it. I hope we do it right. And if it’s not available in the spring, then so be it.”

He is no fan of US president Donald Trump, whose leadership on the pandemic he describes as an "abomination".

“It’s absolutely disgusting and deplorable that you have a president of the US who pretends the virus doesn’t exist, who holds rallies where masks are not worn and who refuses to wear one himself. It’s a contempt for reality, not leadership.”

His advice to Ireland? “You seem to be doing a lot of the right things. You need continuing education on masks so people use the right kind. There are a lot of knock-offs out there and visors are no use. And be careful with students.”