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
NewYork-Presbyterian
Kenneth L. Davis, MD
President and CEO
Mount Sinai Health System
Michael Dowling
President and CEO
Northwell Health
Robert I. Grossman, MD
Chief Executive Officer
NYU Langone Health
Philip O. Ozuah, MD, PhD
President and CEO
Montefiore Medicine
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1
https://www.cms.gov/files/document/3-13-2020-nursing-home-guidance-covid-19.pdf
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2
https://dmna.ny.gov/covid19/docs/all/DOH_COVID19%20_NHAdmissionsReadmissions_%20032520.pdf
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3 Title 10
New York Codes, Rules, and Regulations, Section
415.26(i)(l)(ii)
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4 42 U.S.
Code of Federal Regulations, Section 483.80
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5
https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html
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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
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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
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SOURCE New York Hospital System CEOs