Crisis expands on N.Y.'s Long Island, straining emergency-response systems

For much of the past month, as calls for "shortness of breath" or "trouble breathing" started spiking in Nassau County, medics and technicians had been stepping up to fill overtime requests. Kris Kalender, who heads the union representing about 150 county paramedics, said his members saw the extra work as a gesture of community pride and a chance for some extra money amid the spate of gloomy news. 

But as March dragged on, the call volume kept growing. The patients also got sicker and sicker. Nassau paramedics now respond to about 450 emergency calls each day - nearly double their usual volume - and more than 60 percent of them are related to the coronavirus pandemic, he said. 

Then Kalender saw something he doesn't recall ever seeing before: On Sunday, no one responded to a request for extra manpower. It's "mental stress," he said, adding, "They just need a day off, and time to recuperate to regain their composure, and just one day where they are not responding to such sick people."

The strain on Nassau County's police medic force - its main ambulance service - reflects the next phase in New York's struggle against the virus. The number of cases on Long Island has begun to surge, testing the health-care and emergency-response systems even in some of the state's wealthiest communities. 

In recent days, as New York City has remained the center of attention amid a national response to the pandemic, state and local officials have been shocked at how quickly the caseload is also rising Nassau and Suffolk counties, the two counties that make up suburban Long Island - with a combined estimated population of almost 3 million. 

For the second consecutive day, New York Gov. Andrew Cuomo announced Friday that both Nassau and Suffolk had confirmed 1,000 additional coronavirus cases. Combined, they now have more than 22,000, meaning about one of out every 12 coronavirus case in the United States is located there. 

"Long Island does not have as an elaborate of health-care system as New York City," Cuomo said. " ... And that has us very concerned."

The spike comes after New York's worst infection rates had initially been confined to Westchester County, a northern suburb of New York City. But after the virus quickly spread throughout the metropolitan area, Long Island officials said they had been bracing for their caseload to also surge. 

Nassau County Executive Laura Curran characterized it like this: "It's as if you are on a roller coaster that is going up a hill, and it's just slowly getting higher and higher."

With the disaster's full impact expected to hit in the coming days, she and other leaders across Long Island are rushing to try to shore up their strained emergency-response and health-care system. Curran is requesting that the Federal Emergency Management Agency quickly deploy a disaster-assistance tent city, and she wants FEMA to send 25 out-of-state ambulances to buttress the county force.

As of Friday afternoon, Curran said there were about 1,620 patients hospitalized in her county, an increase of about 200 over the day before. About 325 were on ventilators, a device that helps critically ill patients breathe. Curran has requested an additional 100 ventilators, but so far only five had arrived. 

In neighboring Suffolk County, County Executive Steve Bellone said 1,300 patients were hospitalized as of Friday afternoon, an increase of 244 in 24 hours. There were only 648 unoccupied hospital beds in the county, including just 43 in intensive care units, Bellone said. 

"This is where the battle is happening, and this is where we need supplies," Bellone said at a news conference.

To help address the needs on Long Island, Cuomo took the extraordinary step Friday of signing an executive order that allows the state to seize ventilators from public and private hospitals in upstate New York that so far have fewer coronavirus patients. Cuomo dispatched the National Guard to retrieve them.

"There could be several hundred excess ventilators in hospitals that don't have a covid response right now," said Cuomo, who also announced the state had surpassed 100,000 coronavirus cases. "I am willing to deploy the National Guard to save several hundred lives."

At Northwell Health, which operates 11 hospitals on Long Island, 70 percent of coronavirus tests administered on patients now come back positive, said Terry Lynam, a spokesman. Northwell's hospitals have reached such capacity that patients are being placed in auditoriums, conference rooms, lobbies and tents, he said.

"Every hospital in the 'hot zone' is feeling the pressure," said Joseph Greco, operations chief for NYU Winthrop Hospital in Nassau County, which set up a triage tent in its parking lot and an intensive care unit in a former conference room.

Kalender said EMS units in Nassau are also overwhelmed. 

About 100 of Nassau County's 4,000-member police force have been diagnosed with the coronavirus, and another 172 are quarantined due to possible exposure.

Matthew Chase, executive director of the National Association of Counties, said the strains on resources now facing Nassau and Suffolk counties offer a preview of the challenges counties across the nation face. 

Nationwide, county governments operate over 1,900 public health departments, nearly 1,000 hospitals, over 800 long-term care facilities and 3,000 police and sheriffs' departments, Chase said. 

"They are absolutely stressed to the max," Chase said. "We get pleas every day from our state association in New York calling out to peers across the country to send ventilators and personal protective equipment."

Before the pandemic, Nassau County medics were doing intubations - opening an airway to help a patient breathe - about once every two days, Kalender said. 

County medics now perform the procedure up to five times a day, he added. 

"Some of them are so very sick, to the point where you can just look at them and you can immediately know what's coming for them," Kalender said. "Other patients, they look like they're OK - they are talking perfectly fine - but then you measure their oxygen saturation ... and it's like, 'Oh, you are going to be going down soon, too.' "

So far, the coronavirus has lead to the deaths of 138 people in Nassau County and another 96 in Suffolk County. As the death toll mounts, Kalender said the number of county medics needing grief counseling and other mental health services will further hamper staffing plans.

"There is going to be a lot of PTSD," said Kalender, referring to post-traumatic stress disorder. "We're only three weeks into this, and I anticipate things are going to get a lot worse and I don't really see the county having a backup plan."

Curran, the Nassau County executive, concedes that emergency medical resources are really stretched, with "so many ambulances now on the street." 

While she waits to see if FEMA will respond to her request for more ambulances, Curran noted some villages and towns in Nassau County maintain their own volunteer ambulance services. Some volunteers, Curran said, are keeping vigil at the firehouse because they know it won't be long before they are needed to respond to a call. 

"We need you," Curran said of the volunteers. "We need you now more than ever."