The Covid 19 pandemic is putting the Hudson Valley healthcare system under unprecedented pressure. As the number of infected people inevitably rises, more deaths will be reported. More protective masks and a greater supply of protective equipment will help only to a limited degree. It is more than possible that a spike in the number of people requiring machine help in order to breathe will overwhelm the limited capacities of an already strained system.
Since there are currently no effective treatments for the virus, all the emphasis is being placed on “bending the curve,” hoping that a combination of draconian public policies and improvements in social behavior will reduce the number of new cases and temporarily see the nation through this healthcare crisis.
“The fact is we’re trying to slow the spread of the virus to a number of months so the healthcare system can deal with it,” explained New York governor Andrew Cuomo last weekend. “So by definition it’s going to be a number of months…I don’t believe it’s going to be a matter of weeks.”
As the number of infected persons in Ulster County continued to increase, more attention in the Hudson Valley and other exurban areas near large cities was being paid to the role of city people with second homes or rentals, B&B and hotel guests, and sightseeing weekenders. At this phase of the crisis, such mobility was causing unwelcome problems.
As of last Saturday, two of the 23 Ulster County residents identified as infected had Saugerties mailing addresses and were being quarantined together in New York City. The other cases, assistant deputy county executive Dan Torres told reporter Christina Coulter, originated within the county.
Other advanced societies were dealing with the same pattern in more aggressive ways. Seasonal homes are very common in the Scandinavian countries, and Norway’s government earlier this month ordered city people in second homes to return to their primary residences or face $2000 fines or 15 days in jail. “Not only would the virus be likely to spread faster, but local hospital facilities might be unable to deal with the volume of sick patients,” reporter Feargus O’Sullivan wrote in a CityLab article. “City dwellers are thus much better off staying home where hospital beds and healthcare will be more widely available if needed, the argument goes.”
In fact, indicators suggest that the entire American residential real-estate market, urban, suburban and exurban, may have hit the pause button. With so much of the economy shut down, the market has become unpredictable.
Six years ago a state study reported 372 physicians in Ulster County, and the number probably hasn’t changed much since. Of the total, 160 provided primary care, and the remaining 212 included specialists in internal medicine, psychiatrists, surgeons and other categories.
The proportion of doctors in primary care was higher in Ulster County than it is in major urban areas. But a 2017 study found Ulster had fewer than half the number of primary-care physicians per 100,000 of population than did Westchester County.
Active physicians in Ulster County tended to be older than in the state as a whole, particularly in the 55-to-64-year-old category. A much lower proportion of Ulster County doctors than statewide worked principally in hospital settings.
Medical doctors are the top of the healthcare pyramid, except for some top administrators (of whom some are also doctors). Some governmental labor censuses, like the Quarterly Census of Employment and Wages (QCEW), don’t contain anywhere near the number of doctors that the medical associations list, I think probably because owners of and partners in medical practices are listed as managers by profession rather than doctors.
The number of healthcare jobs, the largest category of employment in the Hudson Valley, has increased while the overall labor force has not. Ulster County has about 8000 such jobs. In the second quarter of 2019, 3228 employees worked in ambulatory settings, 1531 in hospitals, and 3046 in nursing or residential facilities.
Annual wages for Ulster County healthcare workers averaged about $48,000. That’s far less than local government workers earn.
When it comes to pay, there’s a premium for education and knowledge (some would see it as excessive inequality). The average medical doctor makes over $200,000 a year, while Ulster County home healthcare aides are paid under $28,000 annually. Nurse practitioners make $133,000 a year, registered nurses $75,000, and nursing assistants $31,000.
For the healthcare industry of the Hudson Valley, this crisis is where the rubber hits the proverbial road. In the present situation, no one really knows what the infection curve — the number of new Covid 19 cases — will look like. Will it more resemble the catastrophic example of Italy, with a continuing steep increase of cases that the healthcare facilities simply couldn’t handle, resulting in more fatalities than in China? Or will it be more like Singapore or Taiwan, where after a steep start, the number of infections leveled out and began to decrease?
Though compensation is an important consideration for the healthcare workforce, they are quintessentially service workers. Dedication to public health and the needs of the community are the top priority for the best of our practitioners. We should honor their work and their service.
Alas, there are limits to what they can do, as the present efforts to contain the Covid 29 virus show.
A very recent study of hospital beds by Pro Publica classifies Ulster County and Poughkeepsie as part of the Albany area (Newburgh, Middletown and points south are assigned to White Plains). The Albany area thus defined, with 1.8 million people 17 percent of whom are 65 or over, has 4800 hospital beds, two-thirds of which are ordinarily occupied. There are only 420 beds for intensive care, and the average patient turnover in the ICU units is twelve days.
Governor Cuomo has said he expects 40 to 80 percent of New York’s population eventually to test positive for the infection. Being wildly optimistic, let’s bend the curve. Let’s assume that in this go-round only ten percent of the Albany area population, or 180,000 persons, test positive. Following national trends, 20 to 30 percent of those, 36,000 to 48,000, will have serious cases requiring medical treatment and possible hospitalization.
A large proportion of the hospitalized persons will need a respirator (a mask-like device) to help them breathe. If they need machine assistance to keep breathing, they’ll require a ventilator — and these complex contraptions are and will be in very short supply. Even at the hypothetical low rate of infection of ten percent, it appears to me that a lot of patients will unnecessarily die even in so limited an initial round of the pandemic.
Tell me I’m wrong. I don’t want to be right.
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