Treating Coronavirus in a Central Park ‘Hot Zone’

Treating Coronavirus in a Central Park ‘Hot Zone’

Rubber boots hung from a tree of wooden pegs in soggy Central Park after being sterilized with chlorine. Workers observed a one-way flow into and out of what they referred to as “the hot zone” of patient treatment tents. Step by step, they removed their isolation suits in a designated area, as a monitor barked instructions.

“I like to liken it to a checklist that a pilot goes through before he starts the engine,” Dr. Elliott Tenpenny, the unit’s medical director, said on Monday. “You do it exactly the same way every single time.”

The field hospital began treating patients on April 1 for Mount Sinai Health System and is directly across Fifth Avenue from one of its main hospitals. The tents, which are operated by the evangelical Christian relief group Samaritan’s Purse, have the look of an Ebola treatment unit in the Democratic Republic of Congo, where some of its staff have previously been deployed.

The group has set up field hospitals in wartime Mosul, Iraq; after an earthquake in Ecuador; following a hurricane in the Bahamas; and during a diphtheria outbreak in Bangladesh, among others.

The Central Park tent hospital, in America’s coronavirus epicenter, is the group’s first medical deployment in the United States. While Gov. Andrew M. Cuomo has said that the worst is over if residents remain vigilant, and that hospitalization figures continue to flatten, medical institutions in New York are still struggling to treat critically ill patients in numbers far exceeding typical capacity.

“We will be here as long as we are meeting a need,” said Melissa Strickland, the organization’s communications director.

The 68-bed field hospital in Central Park has 10 I.C.U. beds and ventilators, seven of which were being used at the beginning of this week. The facility had treated 130 patients as of Tuesday, according to the group — a similar number to the Navy hospital ship Comfort, which arrived March 30 and has space for as many as 500 severe coronavirus cases. At least five patients at the field hospital have died.

The clinical staff — more than five dozen emergency response volunteers drawn from the organization’s nationwide roster — work 12-hour shifts. The infection control protocols they rigorously enforce are different and appear stricter than those being used to treat coronavirus patients in American hospitals, where protective equipment has run short, health workers are not always trained to use it, and many have contracted the coronavirus, with some dying. Thus far, Samaritan’s Purse leaders said, none of its workers have fallen ill at the New York field hospital or at a similar one in Cremona, Italy.

While the virus that causes Covid-19 is spread differently from Ebola, and different protective equipment is needed, “the principles are similar,” Dr. Tenpenny said. “We just go over and above a little bit,” he added, having been able to design the hospital from scratch just over two weeks ago in a green field.

“You have the privilege of being here in the middle of Central Park. We also want to take it as a burden on us not to allow anything to spread.”

The organization knows the cost of health worker infections. One of its doctors, Kent Brantly, was among the first Americans to contract Ebola in Liberia in 2014. Samaritan’s Purse arranged for a private flight back to the United States, and he was treated successfully at Emory University Hospital in Atlanta.

For the New York field hospital, the group brought its own isolation suits, face shields, rubber boots and gloves, which workers wear in a double layer. Unlike other hospitals in the city, it has not had to ask for government assistance with these supplies or donations from the public. “We had stockpiled,” Dr. Tenpenny said. “We have enough.”

While the field hospital maintains a laboratory and pharmacy and is able to perform X-rays and provide intensive care, about a tenth of its patients have had to be transferred to another facility for more specialized treatments. On Monday afternoon, one of the patients was being transferred out of the tents to an I.C.U. at Mt. Sinai. “They can provide a higher level so we’re back and forth all the time,” Dr. Tenpenny said. That higher-level care includes extracorporeal membrane oxygenation, or ECMO, which uses a machine to oxygenate a patient’s blood directly, temporarily replacing the function of the heart and lungs.

On Monday morning, Dr. David L. Reich, president of Mount Sinai Hospital and Mount Sinai Queens, sang out a hello to Samaritan’s Purse workers in the Upper East Side hospital’s lobby, who were being trained to use the hospital’s glucose monitors. “Your team has been extraordinary,” he said, offering his elbow for a bump instead of a handshake. “We’re just delighted.”

“Pray for the tents,” he said that morning at a command team meeting, discussing the weather forecast and plans for potential evacuation. “We have stretchers ready to cross Fifth Avenue if necessary.

Dr. Reich said the field hospital was considered an extension of Mount Sinai Hospital, which as of Tuesday evening was treating 669 people confirmed to have or suspected of having the virus. The severely ill were spread across newly created Covid-19 units throughout the hospital, which is also running studies to test potential treatments and a simulation laboratory with mannequins to develop new ventilator technologies.

The larger Mount Sinai health system has redistributed some patients from hard-hit areas of Queens, Brooklyn and South Nassau, on Long Island, where its hospitals have been overwhelmed. “They’re closer to nursing homes and socioeconomically depressed areas of New York,” he said.

A number of patients from those hospitals have been sent to the tents in Central Park, which on Tuesday had 47, according to the relief group.

“The beauty of the Samaritan’s Purse relationship is they come with staff,” Dr. Reich said, “and very good staff.” He added that doctors aim to assign patients to the tent who are “likely to have a stable course of care that does not involve I.C.U.-level care.”

Mount Sinai’s vice president for emergency management, Don R. Boyce, a former federal health official, was familiar with Samaritan’s Purse and its international aid efforts and made the initial connection between the institutions after the group offered a field hospital to the state.

Still, the group’s presence in New York City has drawn controversy. Samaritan’s Purse is led by the Rev. Franklin Graham, the son of the pastor Billy Graham. Its employees must endorse a Statement of Faith that opposes same-sex marriage. Mayor Bill de Blasio said at a news conference that Samaritan’s Purse had affirmed that it would not discriminate in providing treatment, and organization leaders made public statements to the same effect. On Tuesday, Mr. Graham accused elected officials and advocates of harassment, saying his organization had never discriminated against a patient.

The workers at the tents said New Yorkers had overwhelmingly been welcoming. A man who lives on Fifth Avenue and was walking his dog when the tents were being set up organized a team of volunteers to spread mulch. And staff members joked that eating all the baked goods and pizzas sent by the hospitals neighbor’s would make them gain “the Covid 20.”

Ken Isaacs, the organization’s vice president of programs and government relations, remarked on how friendly New Yorkers had been. “It sort of shocked me,” said Mr. Isaacs, who has worked in emergency response for over three decades and said the level of gratitude was unusual. The nightly practice of people beating pots and pans, clapping and waving to thank essential workers, brings him to the point of tears, he said. “It’s enormously affirming.”

He added, “Being in New York City, the hallowed ground of Central Park, deploying in the United States — these aren’t things we ever thought we would do.”

Setting up required assistance from the Central Park Conservatory, Con Ed, Mount Sinai, the mayor’s office and the state. The New York Police Department maintains the perimeter. Before the hospital could open, a ditch had to be dug across asphalt to install the electrical system. A tent on a hill houses a chlorinated water mix, and pipes run down to the field hospital for workers to sanitize their hands and equipment.

On Monday, as workers in protective suits stopped to strap down the tents with additional weights in the driving rain, Dr. Tenpenny sloshed through wet ground to help ensure that the field hospital, whose manufacturer said it was rated for 65-mile-an-hour winds, was secure. “We’ve weathered bad things like that before,” he said, citing hurricane deployments. “We know how to do it. But it’s just the first time in New York City doing it.”

A less hardy staff tent had already lost its canopy. Ms. Strickland said the group was ready to move patients to safety if it came to that. “We’re praying it doesn’t, obviously.” It didn’t.

Latest Category Posts