The nation is facing yet another surge of COVID-19 cases, and public health experts fear that the holiday season will compound the problem as family and friends gather and COVID fatigue sets in. The spike is putting a huge amount of stress on an already taxed workforce. Managing Editor Matthew Weinstock recently spoke with Dr. Steven Corwin, president and CEO of New York-Presbyterian, about ways leaders can help keep morale up and try to prevent staff burnout. The following is an edited transcript.
MH: Public health experts predict a surge upon the surge due to people traveling at Thanksgiving and the holidays in December. How worried are you?
Corwin: I’m very worried. Between pandemic fatigue, the whole issue on mask versus no mask, and the politicization of this, it becomes a problem. And then you saw many people traveling over Thanksgiving, which adds to the potential burden. We’re certainly seeing a significant uptick in cases in New York, and of course around the country. Until we get to mass vaccination, we’re going to be struggling with this second wave or a wave across the country to be honest with you.
MH: Are there things that health leaders can do to try to reinforce the necessity of social distancing and not gathering in large groups?
Corwin: We just need to continue to be consistent about the message … that there is a light at the end of the tunnel. That light is the vaccine. And as painful as this year has been, let’s not make it more painful by losing more of our friends and loved ones toward the end of this year into early next year, right when the vaccine is around the corner.
It doesn’t help when public figures say one thing and then do another. It tends to breed mistrust in the system as a whole. It certainly doesn’t help that we’ve had a split in the country in terms of the severity of this crisis and what it means in terms of opening and closing businesses. But we can really see that if we just stick to it, I think that we’ll be OK.
MH: What are you seeing in terms of staffing levels? Are you able to keep adequate levels at this point?
Corwin: In the first wave of the pandemic, we clearly had all hands on deck. We were basically a system of 3,000-some-odd beds, and we had 2,600 of those beds filled with COVID patients and 900 ICU beds filled with COVID patients, with our normal ICU capacity of around 450. It mandated shutting down all electives, anything but the most emergent cases.
This go-round appears to be substantially less. Currently, we’re at roughly 10% of where our peak was in April. We’re able to do COVID care as well as other procedures. If it got substantially worse, we would have to throttle back on non-COVID care other than emergencies.
The problem with staffing is twofold: No. 1, if you get overwhelmed with COVID, you have to pull staff to manage the COVID care. No. 2, with this now being across the rest of the country, the ability to draw (staffing) resources from other parts of the country is severely limited.
MH: At the beginning of the pandemic, you were doing regular video updates with staff. What are you doing now to try to keep people’s morale up and avoid burnout?
Corwin: We are continuing to update our staff and continuing to virtually round with every nook and cranny in our system so that people see the presence of leadership and that we can move forward together as a group and have that sort of sense of unity. We’re all in it together.
You also have to offer the mental health resources to your employees and continue to emphasize that asking for help is exactly what you should do. Then we have the third thing, which is what I would call the light at the end of the tunnel. We can see that these vaccines are effective. It looks like they’re extremely safe. We can get through this together. I know nobody wants to go through this again. I know no one wants to sort of see the suffering that they saw the first go-round; let’s try to climb this last hill.
I’ve had employees tell me across all walks of life—nurses, doctors, environmental service workers, laboratory technicians—“I don’t want to have to go through this again.” It’s heartbreaking because you realize how much we asked our healthcare workers to do the first go-round or in a continuing way. It wears on people. There’s just no two ways around it.
We’ve got to be as cognizant of it as we can. We encouraged all of our employees in our lull, which was in the summertime and early fall, to take vacation time, to spend time with their families, because we said, “We’re going to have to gear up for this getting worse in the fall,” and it has gotten worse.
I don’t think there’s any magic bullet here. Truth telling, talking to your staff, recognizing that some people handle it better than others, encouraging people to take advantage of mental health services, which we’ve made widely available at no cost. Those are important things.
MH: Have you seen an uptick in the use of the mental health services that you’re offering staff?
Corwin: We try not to track it because we do not want to create a stigma associated with it. We really created a firewall. I have no idea who has accessed it. I have no idea whether it’s a doctor, a nurse, etc. We made sure that our employees knew that this was completely anonymized.
MH: We focus so much on the doctors and nurses, but obviously there are staff members, the lab techs you mentioned, the environmental services professionals. Is there a different set of protocols you need to put in place for them as they deal with the pandemic?
Corwin: The important thing for all of us is to recognize that hospitals are intricate time pieces. You need every aspect of a hospital to work effectively, whether it’s environmental services, laboratory technicians, pharmacy technicians, pharmacists. Everyone got a strong dose of reality in the first go-round, including things that no one ever thinks about like morgues being overwhelmed.
That’s why it’s important for us as healthcare professionals to say, “Look, when this vaccine comes, everyone’s going to get vaccinated. If you’re in the emergency department as a social worker or a clerk registrar, or as a security officer, you’re going to be first in line with the doctors and the nurses. We’re not discriminating as to which class of healthcare workers gets preference.”
Hopefully we’ll have enough vaccine to go around. The latest that we’ve heard is we should be able to do the vast majority of front-line healthcare workers in that first or second tranche, and we’re hoping that’s the case.
MH: Will you mandate vaccination for your whole staff?
Corwin: We’re inclined to do that, yes.
MH: How and when do you make that decision?
Corwin: We’ll make that decision once we see how much of the vaccine we get first. If there’s less vaccine than there is demand it’s less incumbent upon us than if there’s more vaccine than there is demand.
I’ll be the first person to get in line for a vaccine. I know that there has been some concern about the safety profile. We’ve got to rely on the scientific evidence on the safety profile. But yes, I would be inclined to mandate it because we don’t want our healthcare workers to get sick, and we don’t want our healthcare workers to infect each other, which can happen, or infect patients, which can happen. That’s critically important.
Now, of course, it’s not been proven as to whether it’s safe in women that are pregnant. They can be excluded. It’s not been proven yet to be effective or safe in children, not that we employ children. Certainly if you had a antecedent religious objection to it or you had a condition that was such that you couldn’t possibly get the vaccine, we would include the usual exclusions. But short of that, it would be unfair to the public to (not have the workforce get vaccinated) to be honest with you.
MH: Beyond your staff, what role do you see New York-Presbyterian playing once a vaccine becomes widely available?
Corwin: We’ll do whatever is required of us by the state and the federal government. We want to be as altruistic as possible. The likelihood is that we’ll be asked to supply personnel to help with the mass vaccination, which of course we would do. I’m sure that the state can decide mass vaccination sites. I don’t think that will be an issue. It will be a personnel issue.
Then, as far as I’m concerned, it’s all hands on deck because if in fact the efficacy of the Moderna and the Pfizer vaccines are what we think and the safety profile is what we think, then the only way the country really gets to the other side is to get to mass vaccination.
We would certainly participate in education. We would certainly participate especially with underserved communities in educating them so that they do not feel that they’re being experimented upon.
There are language issues, which you have to overcome. We have tremendous banks of translator services that we use. We would put everything that we have available to the state to make sure that it happens.
