The luxury of working from home is not an option for our patients. Commuting to work on the 7 train for a night shift, I still see plenty of workers returning from their jobs in Manhattan, using the cheapest form of transportation available to them. Our patients cannot shelter in second homes or purchase private ventilators. An entirely different part of the health care system serves that slice of society.
Rather, our patients ask how they can avoid spreading the virus to their older parents or young children in their small apartments. I have no good answer. The neighborhood has among the highest rates of severely crowded housing in the city. Landlords convert single-family homes into cramped, poorly ventilated apartment units. Years ago, an ambulance brought to our hospital two unconscious girls and a man almost unrecognizable from his burns — the victims of a house fire in a subdivided building. An additional victim was not discovered until the next day, dead in the attic where he had been living. Such living conditions leave little room for social distancing.
New York City’s public hospital system serves more than a million New Yorkers each year, regardless of their ability to pay. Beyond the undocumented and uninsured, Elmhurst Hospital serves other vulnerable populations neglected by the private medical system: prisoners, the homeless, the drug-addicted and the mentally ill. Public hospitals are where the police bring those too mentally ill and violent for the shelter system, where desperate families bring demented older relatives whom they can no longer properly care for.
Not infrequently, patients come to me with notes from medical professionals at other hospitals who told them to come to us for an essential but nonemergency procedure. Ostensibly, these referring hospitals also receive tax exemptions and nonprofit status for the indigent care they provide, but in the profit-driven, competitive landscape of New York City hospitals, the public system picks up the slack in caring for the vulnerable.
Queens has 1.5 hospital beds per 1,000 people, compared to 5.3 in Manhattan. Typically serving what the health care industry calls an “unfavorable payer mix” and as a result dependent on government funding, public hospitals often lack the resources of the parallel nonpublic hospital system in New York City.
Even during normal times, patients at Elmhurst Hospital experience long waits for mundane medical concerns, which is indicative of their lack of access to more reliable primary care. Inpatient hospital beds are often full, as are the intensive care units. And so it is wholly unsurprising that this hospital would be overwhelmed now by an enormous surge of patients.
President Trump has expressed a hollow-sounding allegiance with the plight of this community, claiming to have “grown up” in the neighborhood, a surprising acknowledgment given his antipathy to immigrants. The president’s neglect of his hometown is as disappointing as the broad incompetence of his administration’s Covid response. The peak of the Covid pandemic is still ahead of us, but one day it will pass, and when that happens, I hope we remember the social failures that enabled Covid to so extensively affect communities like Elmhurst.
Ben McVane is an emergency medicine doctor at Elmhurst Hospital Center.
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