YNHH Plans Testing Surge, Bleeds Revenue

Yale New Haven Health is planning a tenfold surge in Covid-19 testing by mid-June — and losing $1.5 million a day as the pandemic continues.

Top YNHH administrators and health care officials delivered that news Thursday morning during an hour-long, coronavirus-related virtual town hall held online via the Zoom teleconferencing app.

The digital press conference was the sixth such question-and-answer session that the regional hospital system has conducted since the start of the Covid-19 pandemic in Connecticut in mid-March. Click here, here, here, here, and here for stories about previous YNHH-hosted virtual town halls over the past two months.

YNHH CEO Marna Borgstrom and YNHH Chief Clinical Officer Thomas Balcezak said that the regional health care system, which includes seven hospitals in Connecticut and Rhode Island, is currently conducting roughly 1,000 Covid-19 tests a day system-wide.

“By next week, we have a plan to increase that to over 3,000 a day,” said Balcezak (pictured). ​“By the middle of June, we should be able to get to 10,000 a day. And by the middle of summer, we should get to 20,000 a day.”

He said that the expected surge in testing will come thanks to ​“the careful planning of our laboratory and virology staff” around the collection of samples from sites like the one at 150 Sargent Dr. on Long Wharf; the use of YNHH’s own lab-developed test, which he said was the first in the country to be approved by the federal Food and Drug Administration (FDA); and YNHH’s current access to commercial testing kits and platforms developed by such companies as Cepheid, Thermo Fisher, and Roche.

Borgstrom said that the challenges that YNHH faces in expanding testing capacity ​“has nothing to do with knowledge, talent, or will,” but rather with securing adequate supplies of equipment, re-agents, laboratory space, lab techs, and other staff.

She called on Gov. Ned Lamont to help hospitals like YNHH ​“get preferential access to equipment” as the state gradually re-opens in the coming weeks and months. Borgostrom said that the governor has set a goal of having 30,000 tests done a day statewide ​“fairly shortly” in order for government officials and public health experts to be able to identify where the virus is in a community, who needs to quarantine, and who needs to isolate in order to stem community spread of the disease before a vaccine is developed.

“That’s a very tall order,” Borgstrom said about the 30,000-tests-a-day goal. Particularly considering that YNHH as a system has conducted roughly 35,000 tests in total since mid-March.

Borgstrom (pictured) also said that the hospital system, which includes Yale New Haven Hospital’s campuses on York Street and Chapel Street, is losing around $1.5 million a day as the pandemic continues.

The reasons for such a significant, sustained operating loss are primarily twofold, she said: ​“We have not been doing elective procedures,” which tend to ​“bring in more revenue.” And ​“Covid-positive patients are very complex, critically ill medical patients” who require intensive, and costly, levels of care.

She added that, thanks to the ​“bizarre ways that health care is paid for” in this country, the care provided for those sickest of patients is ​“less well reimbursed.”

Add on top of those two overriding concerns the costs associated with converting more hospital spaces into negative pressure rooms and intensive care units (ICUs), supporting social distancing, and increasing coronavirus testing, ​“We have outspent our budget.”

“We’re spending more, and we’re making less money,” she said. ​“That’s the basic gist of the story” regarding YNHH’s finances.

She said the hospital system expects to end this year with an operating loss. How large of a loss that will be depends on how much in loans and aid it receives from the state and federal governments.

According to YNHH’s 2018 annual report, the hospital system ended that year with a $4.6 billion in net revenue.

Other updates included:

• Of the roughly 35,000 tests YNHH has conducted system-wide since mid-March, 9,000 have produced positive results.

• YNHH currently has just under 600 Covid-positive patients in hospital beds throughout the health care system. Borgstrom said that number is down from over 700 coronavirus-positive inpatients last week. Around 360 of those current in-patients are at Yale New Haven Hospital in New Haven, which had a high of 460 in-patients at one time in late April. Greenwich Hospital currently has 54 Covid-positive patients, down from a high of 126. And Bridgeport Hospital currently has 151 Covid-positive inpatients.

Borgstrom said that the hospital system has discharged more than 2,000 patients who have partially or wholly recovered from Covid-19, and a total of 370 coronavirus patients at YNHH have died over the course of the crisis. For families who have lost loved ones during the pandemic, she said, ​“this has been a tragedy of unbelievable proportion.”

• Balcezak said that virtually 100 percent of coronavirus-positive patients admitted to YNHH over the past two months have presented with a fever, roughly 75 percent have had a dry cough, and roughly half have suffered from ​“extreme fatigue.” He said that level of extreme fatigue can sometimes last for many weeks, even after the fever and cough go away.

He said that the latest studies that his staff have read from around the world indicate that 80 percent of those who contract the virus have mild symptoms, 15 percent need further supportive care and are admitted to the hospital, and about 5 percent, ​“the sickest of the sick,” require ICU care and, occasionally, mechanical ventilation.

He said YNHH has seen similar breakdowns in its own care and patients.

• YNHH Chief Operating Officer Christopher O’Connor said that the hospital system has a management in team in place specifically charged with guiding the hospital’s preparations for how to handle the evolving outbreak as Connecticut moves past its first hospitalization peak into the summer and fall. He said that team is ​“pivoting from a response effort to a recovery effort” with the recognition that YNHH will be treating coronavirus-positive patients for some time as long as there is no vaccine.

Borgstrom estimated that the hospital system will have ​“a couple of hundred cases total on average” at any given moment in the coming weeks and months.

She and O’Connor said that the hospital system is planning now how best to sequester Covid-positive patients and the staff who treat them so that the hospital can continue with all of the other care it provides without endangering staff or patients.

O’Connor said the YNHH coronavirus management team is focused on making sure that the hospital system has adequate supplies of personal protective equipment (PPE) like masks, gloves, and gowns, not just to support the work of caring for patients right now but also ​“to build the necessary stockpiles to support ongoing care.”

He said YNHH recently opened a ​“regional operational center” in West Haven, where YNHH has ​“a large warehouse where we are able to support stockpiling equipment.”