SURVIVAL

Stony Brook University Hospital
in the Throes of the Pandemic

By Brianne Ledda

In February of 2020, Gary DeGrijze visited an allergist for a mysterious rash that covered his body. He thought it might be an allergic reaction. He tracked what he was eating and took Prednisone and Benadryl in an attempt to relieve the symptoms. Then he started to cough.

The 49-year-old New York National Guard veteran, army reservist and postal service worker from Bellport called out of work in mid-March and got tested for COVID-19, a new disease — new, at the time, anyway — caused by the coronavirus that had only just reached the United States. 

His wife, 50-year-old postal worker Ana DeGrijze, said the rash was gone by then but he had developed a cough and fever, so she took him to a nearby urgent care center. 

“The lady at the urgent care stopped me from getting out of the car,” Gary recalls. “She said, ‘Stay there. What’s your phone number? We’re gonna call you, they’re gonna have somebody call you.’” 

Within minutes, they were on the phone with someone from the Centers for Disease Control and Prevention. Gary’s symptoms checked all the boxes for COVID-19, but when asked if he had come into contact with someone who had the virus, he couldn’t answer.

He thinks he may have gotten it from a coworker, who came to work sick the month Gary got the rash. There’s no way to truly know. Before vaccines were widely distributed, the United States and other countries struggled to contain the highly contagious COVID-19.

By the end of February, there were 68 confirmed cases — and one death  — in the country. But that was only the beginning. Nobody could have guessed how those numbers would escalate.

The worried couple’s next stop was Southside Hospital in Bay Shore, where Gary’s nose was swabbed for a COVID test and he was sent home to quarantine. He stayed in the upstairs master bedroom, his fever growing higher, his breathing growing more labored. His lips turned purple. He couldn’t lie on his back. 

Almost a week later, the hospital still hadn’t called with the test results. Ana DeGrijze decided enough was enough. She took her husband to the emergency room at Stony Brook University Hospital on Sunday, March 22, 2020. He was immediately put on a ventilator in the intensive care unit — known more colloquially as the ICU. He would stay there for the next seven weeks. “I was fighting to stay alive,” he says.

New York was already in a state of emergency. Two days after Gary was put on a breathing machine, all nonessential businesses were closed. Long Island was a hotspot in a global pandemic that eventually would kill more Americans than both World Wars and the Vietnam War and Korean War combined.

Video by Rabia Gursoy and Brianne Ledda

The Spread

COVID-19 shouldn’t have been a surprise. The World Health Organization warned of a mysterious new illness in Wuhan, China, on Jan. 9, 2020. News about the spread of a novel coronavirus started trickling in — just a wisp of suspicion or fear that was easily swatted away.

The Centers for Disease Control and Prevention (CDC) started monitoring three international airports across the country — including John F. Kennedy Airport in Queens — on Jan. 20, just a day before confirming the first case of the virus in the United States. Days later, travel restrictions trapped a Stony Brook University professor in China before the semester started. Then, dozens of Stony Brook students. On Feb. 3, the Trump administration declared a public health emergency. 

But it would be another month before the country, and Long Island in particular, began to feel the grip of a pandemic that would ravage families, derail the economy and shut down the world as we knew it for longer than anyone suspected. 

The New York City metro area, including Long Island, was dubbed “the most hard-hit area in the world” by a group of Stony Brook doctors in an April article published in the New England Journal of Medicine. 

Between March 8 and April 16, Stony Brook University Hospital on the North Shore of Long Island went from one COVID-positive patient to 437, according to the dean of Stony Brook Medicine. The Journal article, titled “Staying Ahead of the Wave,” puts the number of suspected cases between February and April much higher — at 3,500.

Dr. Kenneth Kaushansky, dean of Stony Brook University’s Renaissance School of Medicine and vice president of Health Sciences at the time, puts it this way. “The numbers of people showing up in the emergency room was something we had never seen before.”  

Kaushansky — a 67-year-old hematologist and former editor of the medical journal Blood — was facing a once-in-a-lifetime scenario. A global pandemic was about to hit his region, and it was going to hit hard. Kaushansky knew from the stories coming out of Europe and China that the hospital was about to see a lot of patients who were “very sick.” He had to make tough decisions — and make them quickly.

On March 1, Kaushansky activated the Hospital Incident Command Center, a twice daily virtual meeting with doctors and administrators across the Stony Brook hospital system to discuss patients, supplies and other medical issues. It was the same day the first case in New York State was confirmed in Manhattan. Suffolk County’s first COVID patient, a man in his early 40s, was confirmed barely a week later on March 8. He was treated at Stony Brook Southampton Hospital.  

Stony Brook doctors claim in the Journal article that the hospital’s first COVID patient came to the emergency department as soon as Feb. 7. That’s when patients started showing up at the hospital with influenza-like symptoms — cough, fever, body aches. All were either admitted or sent home to be isolated.

“We were on the lookout,” Kaushansky says. “Every patient who came in with an ILI, with an influenza-like-illness, was labeled a person under investigation. And in those days testing was very difficult.”

Reliable COVID-19 tests were difficult to get in the early days of the pandemic. Initial testing kits were flawed — many tests available in early February 2020 offered inconclusive results. A Feb. 6 quality review from the CDC found a potential 33 percent failure rate. The Food and Drug Administration took action to expand testing capacity later that month, but actual testing was still scarce. 

“Basically what they told her is that unless she was at the point where she needed to be intubated and to be hospitalized, she wasn’t going to get a test.”

_{– Alexander Bakirdan, Stony Brook University graduate}

Stony Brook University graduate Alexander Bakirdan went to the hospital for a test right before the campus shut down in mid-March. The 23-year-old had a cough, chest pain and was struggling with shortness of breath — but because he didn’t have a fever and couldn’t point to confirmed contact with someone diagnosed with COVID-19, he was told he couldn’t be tested. 

“They told me … we just don’t have enough tests. And your case isn’t severe enough that we can afford to test you,” Bakirdan recalls. “So they basically just gave me some information. And then they sent me on my way and they sent me home.”

The campus shutdown forced him to travel to his father’s home in Virginia, but he couldn’t get a test there either. Even his mother — who lives in the Bronx and was so sick she may now have permanent lung damage — had to settle for an antibody test a month later to confirm she was ill with the virus.

Bakirdan was never tested for antibodies. His local hospital in Fishersville, Virgina, which only has 14 ICU beds, was overwhelmed at the time. He was bed-bound after he arrived at his father’s home. In the absence of better options, a doctor prescribed an inhaler and medication to treat bronchitis. He suspects his forced departure from campus may have worsened his symptoms. It took him months to regain his stamina, although unlike his mother, he’s not suffering from any long-lasting damage.

Doctors are now finding that many COVID-19 patients, even those who only experienced mild cases, are suffering from long-term symptoms lingering even after they seem to have recovered. These patients have dubbed themselves “COVID long-haulers,” suffering from “long COVID.” Many continue to suffer from fatigue, shortness of breath, insomnia, diarrhea, memory problems and brain fog, among other conditions. For some, entirely new symptoms emerge later — as though they’re suffering from a completely different illness. 

In rare cases, some COVID-19 survivors have experienced new onset psychosis. A Stony Brook physician published a case report detailing a patient who developed COVID-19-associated psychosis and attempted suicide, concluding “that coronavirus exposure may be a risk factor for development of psychosis in susceptible individuals.” The medical community is still learning about the mental health ramifications of the virus. 

In the cases of many COVID long-haulers, doctors can’t find anything technically wrong with their patients. That means those who can no longer work can’t claim disability benefits, even as they suffer for months or longer. Stony Brook Medicine established a post-COVID clinic in Commack last November to treat adult patients recovering from COVID-19. 

Before the end of March, three national health care organizations declared “wide scale shortages of laboratory supplies and reagents” and urged health care professionals to prioritize testing for the elderly, individuals with pre-existing medical conditions, health care workers and first responders. By this time, Stony Brook University Hospital had established testing partnerships with two commercial laboratories and the New York State Department of Health’s Wadsworth Laboratories. 

New York State also opened drive-through testing centers across Long Island, including a site in the university’s South P commuter parking lot on March 18. The white tents jutting from the back half of the lot became a familiar sight for those driving on Stony Brook’s West Campus.  

The hospital had to make other drastic changes to survive the coming onslaught. Kaushansky says the hospital started to prepare before the pandemic even hit Long Island. 

“We had about a four-or-five-day head start on what was going on in Manhattan and we took a lot of time, including those four or five extra days, to prepare,” he says. “We knew from the experience in Seattle, we knew from the experience in Europe, we knew from the experience in China, that these patients were going to get very sick.”

Doctors geared up in personal protective equipment — the Occupational Safety and Health Administration recommended health care workers wear disposable N95 masks, gowns, gloves and goggles or face-shields. Visitation was suspended and elective procedures were postponed. Kaushansky says the hospital typically accommodates about 600 patients; pushing back elective procedures dropped that number to 400. Then, fear of COVID-19 kept enough people away from the hospital that there were only about 200 patients left.

It didn’t stay that way for long. Soon, the empty hospital beds were filled with 437 COVID patients. “Our total number of patients in the hospital at the peak was about 650,” Kaushansky recalls. 

The hospital’s ambulatory surgery center was converted to an ICU and Stony Brook Cancer Center was cleared out in case more beds were needed. Three units with a total of 45 beds were set up for suspected COVID patients and a makeshift triage area popped up in the South P lot, away from the main emergency room to divert the flow of symptomatic patients. 

Stony Brook Medicine graduate Anthony Schramm noted in a 2020 Zoom interview that many people avoided the emergency room, for fear of the pandemic. Video by Brianne Ledda

Doctors tended to more than 100 patients per shift in a field tent, while the most critically ill were treated in the main emergency department. The U.S. Army Corps of Engineers also converted 255,676 feet of space on campus athletic fields to a temporary field hospital that could provide care to up to 1,028 non-COVID and coronavirus patients who did not need acute care. 

“Seeing where they set up all the patients that were vented — walking into it for the first time — it was kind of nerve-wracking,” paramedic Michael Kelly says.  

“Vented” is medical jargon for patients on ventilators. The 25-year-old first responder from Lindenhurst hadn’t even been a paramedic for a year when the pandemic blew up in Suffolk County. Patients were intubated, on ventilators, sedated. The sight, Kelly says, “hit hard.”

ICU nurse and 41-year-old Greenport mother Amy Lee Pacholk watched people suffer what she describes as “long, horrible deaths,” including those who were too young to die, even as she worked to save them. In that first overwhelming wave, mortality was at 13 percent. Now, it’s slightly less than half that. 

“If you saw these people — they were horrible,” she says. “We still see that. Like, you can close your eyes and you can still see these people.”

A Pandemic Battlefield 

Stony Brook students and staff — including nurses who stayed at the Hilton Garden Inn on Circle Drive during the pandemic — can trek to the hospital through a red-painted tunnel from the university’s West Campus. One of the hospital’s more iconic buildings, a towering multi-story cube with rounded corners, is hard to miss from the neighboring campus or the adjacent highway. 

The hospital and the maze-like assembly of buildings and parking lots surrounding it are only one cog, albeit a large one, in the university’s umbrella of health-related enterprises known collectively as Stony Brook Medicine. The 818-bed health care system encompasses four hospitals, a veterans home, several clinical centers and institutes, hundreds of affiliated practices, and five health sciences schools and academic centers that stretch from Montauk on the eastern-most tip of Long Island, to Manhattan in New York City. The university hospital, which includes a trauma center, is the only tertiary care hospital in Suffolk County and before the pandemic, about 34,000 patients were admitted and more than 100,000 treated in its emergency department every year. 

With access to more resources than many other hospitals in the county, it’s no surprise Stony Brook fronted the battle against the pandemic when it first hit Long Island. The hospital, which opened in 1980 with just 30 beds and an ambulatory pavilion, has become a nationally ranked institution and one of the seven largest employers on Long Island. 

“We’ve had hurricanes, we’ve had earthquakes, we’ve had floods, but the pandemic is nothing like I’ve ever experienced.”

_{– Carol Gomes, CEO Stony Brook University Hospital}

Over the years, Stony Brook Medicine has earned a reputation for its research and clinical services, which have continued during the pandemic. Doctors conducted research testing the efficacy and safety of different treatments for the virus and more recently, the hospital participated in clinical trials for the two-shot Novavax vaccine. 

At Stony Brook and around the world, it didn’t take long for doctors to realize that the virus causes blood clots that can lead to amputations, pulmonary embolisms or heart damage. Stony Brook ICU doctors saw many patients — including those with no history of heart disease — having strokes and heart attacks, and Stony Brook physicians studying patients who died from the virus found excessive clotting in their blood vessels. 

“As soon as we saw blood tests revealing blood clotting, we started thinning their blood,” Kaushansky recalls. “The patients who we were much more aggressive with, survived much better.”

Frontline doctors started aggressively thinning patients’ blood with D-dimer-driven anticoagulants, resulting in a drastically improved survival rate. A Stony Brook study of 240 critically ill COVID-19 patients found those treated aggressively with blood thinners survived about 73 percent of the time, as compared to 42 percent among those who were not.

The Toll

By the end of March, Stony Brook gastroenterology fellow Rashmi Advani knew life wouldn’t go back to normal any time soon. The 30-year-old physician isolated herself in her Patchogue apartment, cutting off physical contact with friends and family to avoid potentially spreading the virus. Her partner was the only person she saw for months. It took a “toll,” she says.  

Before the pandemic, Advani — who has been a physician for five years — felt that as long as she was in control, she’d be okay. Her patients would be okay. She’d know how to help people based on her knowledge and experience, and her belief in science and modern medicine. But her life was no longer predictable. 

Suddenly, there were no answers — especially in the beginning, when doctors knew very little about the virus and how to treat it. The symptoms seemed unpredictable and there was no standard treatment protocol. 

“Now I feel like, I don’t know. I’m like relinquishing some of that control,” she says, “… and relinquishing a little bit of that anxiety that came along with it.” 

Advani, who has expressed herself through writing ever since she can remember, turned back to the hobby as a way to cope. She has published at least three articles about her experiences as a doctor during the pandemic. 

“We, doctors, sat there and couldn’t begin to imagine what was yet to come. We were not prepared for this; no one was,” she wrote on a medical blog called Kevin MD. Her April 10, 2020 post — titled, “A physician’s letter to coronavirus” — continued: “We were fearful for our most vulnerable patients, our friends, families, colleagues, and all health-care workers.”

Meanwhile, she wrote, she watched the coronavirus “snatch away hopes, dreams, and futures” from doctors, patients and their loved ones.

“You attacked what was most dear to our hearts as you toyed with our psyches, instilling turmoil into our everyday lives while you continued to stomp all over without remorse,” Advani wrote, addressing the coronavirus.

That turmoil was felt by health care workers across all levels. Nikhil Bamarajpet — then a full-time pre-medical student at Stony Brook University and a part-time employee in the Division of Information Technology — pulled an additional 20 hours per week as an EMT in the Stony Brook Volunteer Ambulance Corps and the Central Islip-Hauppauge Volunteer Ambulance Corps. 

The relatively empty Stony Brook campus meant there were fewer emergency calls during the pandemic, Bamarajpet says. But that wasn’t the case in Central Islip. 

While on a shift there, he watched a patient — a 50-year-old man with a wife and two kids — die from cardiac arrest. Though the patient didn’t test positive for the virus, Bamarajpet thinks his death was almost definitely related to COVID-19.

“You go into a call, and you try to stay somewhat emotionally distant from it, right. You’re there to provide care, you’re there to take care of the patient,” he says. “However, it was after the call, when I was really thinking about the impact of it, where … I was just like, wow, this is disastrous.”

Impossible Problems 

There was an almost pervasive fear, especially in the early days of the pandemic, that hospitals would run out of ventilators. In late March, then New York Governor Andrew Cuomo called on the federal government to supply the state — by then the epicenter of the pandemic — with 30,000 ventilators, in anticipation of a cresting wave of critically ill patients.

“There was just one day where I remember the respiratory educator, she kept saying, ‘Oh, my god, we only have three vents left, we only have three vents left, we only have three vents left,’” ICU nurse Amy Lee Pacholk recalls. 

The hospital’s 68 respiratory therapists responded to three times the daily number of response calls as the intensive care units filled with COVID-19 patients on ventilators. The neonatal ICU was the only unit left untouched by the virus, as the hospital pulled together as many ventilators as it could — even adapting anesthesiology machines from operating rooms to breathe for patients. Faculty from the College of Engineering, School of Medicine and School of Health Technology designed and tested a new ventilator prototype in just ten days.

Stony Brook University Hospital CEO Carol Gomes describes how challenging it was to gather the supplies needed during the pandemic. Video by Brianne Ledda and James D’Elia

Pacholk, who has worked in the ICU for 12 years, said she used some “funky” machines that looked unlike any others she’d ever seen. According to Kaushansky, the hospital even bought and sterilized parts from Home Depot to invent a splitter that could treat two patients on one ventilator at the same time — though they never had to use it.

“We were presented with … six impossible problems before breakfast every day,” he recalls. “We were always having to come up with these solutions.”  

The hospital never ran out of personal protective equipment, known as PPE — just one of many coronavirus-related words and phrases to enter the daily lexicon. Nor did it run out of ventilators or critical drugs, although Kaushansky said he reached out to the hospital’s ethics committee for help deciding what to do if they did. He doesn’t know if they ever came to a decision. 

“I’d be surprised if they actually did, because at the end of the day, it’s really hard to create hard and fast rules … My nightmare scenario is to have to make those decisions.”

_{– Kenneth Kaushansky, dean of SBU School of Medicine/vice president of Health Sciences during the pandemic}

In fact, the situation was such that other hospitals in the area — Eastern Long Island Hospital, Southampton Hospital, Mather Hospital, St. Charles — transferred their sickest patients to Stony Brook. 

But when it came to people power, Stony Brook, like other hospitals across the country, was short handed.  Ordinarily, a disease like COVID-19 would be treated by an internal medicine physician, who specializes in managing internal illnesses. Plus, the worker deficit was exacerbated as hospital staff started contracting the virus. More than 400 workers fell ill between March and June. 

To get around that problem, intensive care unit doctors and nurses were placed in charge of teams of physicians and nurses. Most of the hospital’s approximately 750 hospital residents were cross-trained to treat COVID-19 patients, regardless of their specialties. Some filled in for other residents pulled from critical duties to care for COVID-19 patients. Physicians were sent to help wherever they were needed most.

Nearly everyone was “redeployed in some way, shape or form,” Advani says. Schedules sometimes changed from day to day. Physicians weren’t sure if they would continue to treat the same patients. “I didn’t know what was coming next. Every day was new.”

Dr. Kenneth Kaushansky describes how the hospital restructured its staff during the pandemic in a January 2021 Zoom interview. Video by Brianne Ledda

Though Advani lost vacation days, she didn’t work extra hours the way health care workers in the ICU, like Pacholk, did. “That burden, unfortunately, fell onto the internal medicine residents and the ICU attendings,” she says.

Carol Gomes, the hospital’s chief executive officer, says staff worked around the clock without thinking “about the fact that that might not be in their job description.” The Stony Brook Council, a 10-member oversight and advisory body, awarded Gomes a University Medal for Exemplary Leadership and Service for her work during the pandemic. 

“I just can’t believe the level of expertise that was demonstrated and how people went above and beyond the call of duty,” she says.

According to Gomes, the hospital provided a “resiliency room” for its frontline workers that included psychological services, snacks, water and a place to rest. Advani used the room, a quiet space in what was previously a children’s psychiatry unit. “I gotta say it was like, pretty nice to have a place where you didn’t feel like you were, like, bombarded with overhead lights and you could be away and with your thoughts for a little bit,” she says. 

“You have to deal with taking care of basically somebody who’s actively dying. You know that they’re going to die, but you’re still trying to save them, you know? That’s sort of hard to deal with, mentally speaking.”

_{– Amy Lee Pacholk, ICU nurse}

Nurses from the Upstate Medical Center in Syracuse came to help in early April and the Renaissance School of Medicine at Stony Brook graduated its senior class a few weeks early so these young doctors could join the hospital ranks. Ultimately, about 50 were hired as assisting physicians.

Anthony Schramm was one of those students. He worked at the hospital before taking a position as an anesthesiology resident at Columbia University Irving Medical Center, where he now works six to seven days a week — completely normal hours, he says. Normal, unlike his early and virtual graduation from Stony Brook’s Renaissance School of Medicine, a ceremony he calls “bittersweet.”

“If you were to ask me in the first three years [of medical school], I would have been a little disappointed,” he says, explaining how he felt about his early graduation. “But I think in that moment, we all understood the need for all hands on deck. And, you know, there was a lot of suffering going on, at the peak of it in April and March.”

Isolation

Isolation was, perhaps, one of the bigger obstacles to managing COVID-19. Doctors and government officials urged people to stay home, to wear masks, to avoid seeing people or spending too much time in public places. 

Though many listened, enough did not. Cases dropped that first summer, but as the weather grew colder and the holidays approached, it became nearly impossible to keep visits and travel rates low, leading to a creeping second wave throughout the fall of 2020 into the new year. But isolation took a toll from the beginning — especially on doctors and hospital patients.

Schramm self-isolated while working at Stony Brook, sticking with FaceTime to communicate with family and friends. He had a roommate, but they didn’t see each other too often. It was lonely, he says. “It’s kind of this, you know, universal feeling that we all have, but I think you cope with it the best you can.”

Dr. Rashmi Advani describes how the pandemic was as isolating for health care workers as it was for patients in a 2020 Zoom interview. Video by Brianne Ledda

That loneliness was an issue for patients, too. For the most part, visitors weren’t allowed in the hospital during the height of the pandemic. Although those rules were relaxed when cases were low, the hospital didn’t begin a return to normalcy until the following year. Stony Brook issued guidance on May 4, 2021 allowing patients one visitor per day, during limited hours.  

Schramm says that, even as doctors, they tried to limit their in-person contact with patients. “What really stood out was, you know, usually during a time of dark, you know, illness and suffering, you’re able to surround that patient with those who love them. But with coronavirus, that wasn’t really possible.”

Once again, Advani put her observations into prose. “Families were exceptionally distraught and were yearning to physically see and touch their loved one,” she wrote in MedPageToday, a clinical news site. 

The hospital put out a call for iPads in an effort to use FaceTime to connect patients with loved ones and limit extensive contact with health care workers. Advani used the devices to help patients FaceTime their families and to provide families with medical updates. 

Pacholk called health care workers “their only source of humanity.” 

After Gary DeGrijze, the patient from Bellport, woke up in the ICU, nurses helped him FaceTime with his family. One nurse visited Gary on her breaks and after shifts to chat or bring food from outside the hospital, acting in a way as his “family … outside of [his] family.” 

“I couldn’t see anybody, no one was allowed to come visit me and, you know, to have that human contact, that was big for me,” he says. 

Even before he was conscious, ICU staff regularly called his wife, Ana, with updates. And even though she couldn’t visit him, she could call at any time of the day — even at three or four in the morning — and someone would answer. 

“I understood they were busy, but they never gave me the impression that I was just like, a no one,” she recalls. “Even if they were busy, they’d say, ‘we’ll call you back.’ Sure enough, they would call me back.”

Second Wave

COVID-19 cases started to wind down during the summer of 2020. Michael Kelly, the paramedic, could track patients as they left because every time someone was taken off a ventilator or discharged, the hospital played the Beatles’ classic, “Here Comes the Sun,” over the paging system.

“I’m checking patients in, and everyone’s like, oh, someone’s going home tonight,” Kelly says. But that was in the summer. 

Exhausted, Pacholk watched with rage and dismay as the numbers in Suffolk County shot up after Thanksgiving. At one point, the county was seeing about a thousand new cases a day. The numbers and hospitalization rates were still low compared to where they had been in the spring — for instance, when the number of COVID patients at the hospital peaked at 437 on April 16. But suddenly, the numbers were high enough to cause alarm. 

The nation saw a surge in COVID-19 cases starting in October, with daily death tolls regularly setting new records. The U.S. reported more than 4,000 deaths from COVID-19 in a single day in early January 2021 — more than the number of people who died on 9/11.

Dr. Rashmi Advani discusses the second wave over Zoom in December 2020. Video by Brianne Ledda

Pacholk, bitter and drained from long hours in the ICU, was infuriated by what she saw as a blatant carelessness on the part of the general public. She blames people who refused to wear masks, follow social distancing guidelines or even believe that COVID-19 exists.

“I don’t know if I can handle taking care of all of these people knowing that they did this to themselves,” she recalls thinking at the time.

Pacholk, a 41-year-old Greenport resident and mother of a young daughter, took to Facebook on Dec. 5, writing a post that garnered 6,700 shares and more than 500 comments. 

“You are privileged if you can choose to just be ‘over’ COVID because you’re tired of it,” she wrote. “Stop talking about how much wearing a mask for 15 minutes inconveniences you and takes away your rights as a human, when your neighbor next door would give anything to wear full PPE to have the chance to be with their COVID+ family member in the hospital.”

She doesn’t want to relive spring 2020. She compares her experience treating patients at the height of the pandemic to working in a war zone.

“The amount that the staff … have given up for the public? They don’t even seem to realize what we’ve done,” she says. “And you know, some people will say, ‘Oh, well, you signed up for it.’ Well, no, I didn’t. Like that’s not what I signed up for. I signed up to help people who are sick. I didn’t sign up to help folks who continue to not listen to what they’re supposed to do.”

For three months, Pacholk lived in the Hilton Garden Inn on Stony Brook University’s campus, where a number of health care workers stayed during the pandemic. She didn’t want to bring the virus home to her family, especially her 65-year-old mother, who had just finished years of chemoradiation. Her daughter, who is now in fourth grade, has post-traumatic stress disorder from the experience, she says.

Some hospital staff have quit, according to Pacholk; she toyed with the idea herself. She worked between 100 and 130 hours every two weeks during the height of the pandemic — from April to June 2020 and again, from February to April 2021 — caring for the sickest patients she’s seen in her entire career. She doesn’t know if she could handle living under such emotional duress again. 

“I just can’t even imagine dealing with that again,” she says.

Thankfully, she has not had to treat COVID patients at the same scale she did that first spring. By mid-January, fewer than 200 COVID patients were at Stony Brook, less than half the number the hospital cared for at the pandemic’s peak. 

Plus, there isn’t what she calls the “knowledge deficit” the hospital was facing in the beginning, when there was still little known about the virus. It’s no longer a struggle to get PPE and for some reason, people haven’t been getting as sick as they were.

“I’d like to think it’s because we’re a little smarter about how to take care of patients now than we were back then,” Kaushansky says. “There’s no silver bullets here. But we do have a few medical interventions that do make the disease a little less severe.”

“If it’s as bad as it was last time, I think people are going to straight up quit after it’s over, I’m not even kidding. Because there’s only so much as a human you can take.”

_{– Amy Lee Pacholk, ICU nurse}

Hospital staff know how to use steroids and antibodies to treat the disease, he says, adding, “it might be the virus is changing a little bit to be a little less pathogenic.”

But he’s cautious. “We don’t know that for certain … But we do know in the history of virology, that when pandemics progress, it’s not uncommon for the virus to become more infectious, but less lethal.”

Still, Pacholk recalls treating a very sick patient on New Year’s Day — the first day of 2021, bringing the pandemic into another year. That patient later died from the virus. And January 2021 became the deadliest month of the pandemic — with at least 95,000 lives lost and a total death toll climbing past 440,000. 

“We didn’t think we would deal with that sort of sickness again,” she says. “When you see so much death, it’s hard. It’s hard to deal with it. That’s not what we’re supposed to do.”

Now, more than 660,000 Americans are dead and counting — Advani says health care workers will likely deal with “mental health repercussions, for sure.”

“It’s just … to go through this again as health care providers — I think sometimes it might feel that our lives or our well-being are disregarded or taken advantage of by like, I guess people who aren’t in our situation, or haven’t seen COVID’s, like ugly face, and don’t believe in wearing masks,” she says. 

Even though the country was in a different, better place as the summer unfolded, Pacholk said it would “mean the world” if people listened to health care professionals and stopped “politicizing the pandemic.” 

Before vaccines were widely distributed, Gary DeGrijze emphasized a similar message — people needed to wear their masks and respect social distancing guidelines.

“Am I frustrated from wearing a mask? Yeah, I’m tired of it. I think we’re all tired of it. I want to go back to my normal life,” he says. “But I’m willing to wait this out if it’s going to keep us all safe and healthy until we really get a hold on this.”

Stony Brook University Hospital, which started to relax COVID-19 restrictions in the summer of 2020, suspended visitation again on the day after Thanksgiving. Less than two weeks later, a forward triage site was reopened at its Ambulatory Pavilion Center. Patients arriving at the emergency room between 1 p.m. and 9 p.m. were required to stay in their cars to limit potential spread of the virus and reduce emergency room density. The hospital didn’t loosen restrictions again until May 2021.

Vaccine

If there was a flicker of hope in the darkness, it came with the advent of vaccines. On Dec. 11, 2020, the U.S. Food and Drug Administration gave emergency use authorization to the Pfizer-BioNTech vaccine, which has a 95 percent efficacy rate. Just three days later, the first shots were given to health care workers across the country — and the very next day, more than 200 were distributed at Stony Brook. 

Before the end of 2020, the Moderna vaccine, with an efficacy rate of 94.1 percent, also had the FDA’s blessing. The one-shot Johnson & Johnson vaccine, also known as the Janssen vaccine, was approved in February 2021. 

Along the way, Stony Brook Medicine became one of two sites in New York State — and the only one on Long Island — that participated in clinical trials for the Novavax vaccine, which was recently found to have an overall efficacy rate of 90.4 percent. And Stony Brook students have participated in a federally funded study measuring the effectiveness of the Moderna vaccine.

By mid-September, about 69 percent of all New York residents were fully vaccinated — including more than 1.8 million Long Islanders, according to the New York State COVID-19 Vaccine Tracker dashboard. Among adults in New York, that number climbs to a little more than 81 percent.

The World Health Organization said in late May that currently available COVID-19 vaccines appear to be effective against variants of the virus that are emerging in other countries — including the Delta variant. This fast-spreading, potentially more dangerous mutation has become the predominant variant in he U.S. and currently accounts for more than 98% of new cases in New York City. 

Kaushansky thinks that if enough people take the vaccine, life will begin a return to normalcy — and, in May, the U.S. began to see some semblance of that. The CDC issued guidance in mid-May allowing fully vaccinated people to unmask outdoors and indoors, when it’s not required. Suddenly, cinemas and malls were open. Broadway started to reopen in September and musicians are booking tours again. Sports fans are in the stands — the Kentucky Derby, the PGA golf tour, the Indianapolis 500 were all in-person events this spring that would have been unthinkable just a couple of months ago. Major League Baseball is back. Over Independence Day weekend, more than 47 million Americans are thought to have hit the road as states lifted travel restrictions and the summer Olympics in Japan, postponed in 2020, carried on in person.

Stony Brook University graduated more than 7,700 students, its second-largest graduating class ever, in ten individual in-person commencement ceremonies over the course of three days in May. That included 150 new MDs — the largest class in the history of the Renaissance School of Medicine.

Of the 66 graduates moving on to residency programs in New York State, 20 — a record-breaking 30 percent — are staying at Stony Brook Medicine. 

But, Kaushansky warns, “Unless we have, they’re estimating, 80, 85 percent of the population immune to coronavirus, to SARS-COVID-2, then there’s going to be some smoldering infection.

“It wouldn’t be in the people, we presume, who are vaccinated,” he says. “But it’ll continue to run through the community and our hospital and other hospitals will be dealing with it.”

Vaccines protect the community, as well as individuals, Dr. Kenneth Kaushansky says. Video by Brianne Ledda

Regardless, some people expressed initial distrust of the new vaccines. An April poll by Kaiser, which tracks the public’s attitudes about COVID-19 vaccinations, found 34 percent of Americans were hesitant about being inoculated. That number had improved from September, when only about one in two Americans said they were willing to be vaccinated. 

Those who distrust the vaccine say they’re concerned about its safety or potential side effects — but these have been mostly debunked. Although the Centers for Disease Control and Prevention recommends people with severe allergies discuss the vaccine with their doctors, and a handful of people have suffered blood clots after taking the Johnson & Johnson vaccine, there has been no indication that COVID-19 vaccinations overall are unsafe.

“If you look at RNA the wrong way, it will degrade into garbage. So I’m actually amazed that they can keep the RNA intact long enough in the muscle to actually do some good,” says Kaushansky, referring to the mRNA — an acronym for messenger ribonucleic acid — that teaches cells how to build proteins. Genetically engineered versions of mRNA are used in the Pfizer and Moderna vaccines to provide cells with information the immune system needs to guard against the coronavirus. 

Kaushansky’s actions — he has been vaccinated — underscores his words. “I just can’t conceive, as a biology watcher, how a little bit of RNA in your deltoid muscle can in any way, lead to any of these kinds of things that everyone’s predicting doom and gloom around.”

“You protect the community from you. That’s what we why we wear masks also, we wear masks to protect the community from us. And so that’s why I think it’s really important, even if you personally don’t have a huge stake in it. It’s the citizenly thing to do.”

_{– Kenneth Kaushansky, dean of SBU School of Medicine/vice president of Health Sciences during the pandemic}

Stony Brook University, which has the freezer space to store four million vaccine doses, launched a vaccine distribution center on Jan. 18 in its research and development park on Stony Brook Road — but the initial rollout did not go smoothly. About 20,000 people lost their reservations for the vaccine shortly before the center officially opened, after an unauthorized link was spread around the community. 

The university published a notice on Jan. 15 acknowledging some of the issues people had trying to schedule vaccine appointments. It pointed out that the university “does not independently have access to the vaccine” and does not have authority over distribution.

“I’ll just make it clear that that frustration that people [were] feeling … in trying to get onto the Stony Brook vaccination rolls — that’s not us. We had nothing to do with that,” Kaushansky explained at the time. “If we were doing this, it would have been smooth as silk, I promise you.”

Otherwise, he says vaccine distribution went like clockwork. Most hospital staff were vaccinated by mid-January. Eventually, the long waits for appointments and the long lines for shots all but disappeared. By early May, Stony Brook Medicine had distributed 350,000 vaccines at community-based points of distribution across Long Island. 

Recovery

Gary DeGrijze has made what his doctors have called a miraculous recovery, even though he still suffers from brain fog and nerve damage in his right hand. But he no longer needs to see a cardiologist for arrhythmias in his heart, which stopped two or three times when he was at Stony Brook University Hospital. His oxygen levels, once critically low, are back in normal range and his kidneys have recovered enough so he is no longer on dialysis. 

His lungs have almost completely healed with very little scarring, and yet as of this winter, he still struggled with shortness of breath. In mid-January, he went for his first run — although he admits maybe he walked some of it. But even his physical recovery isn’t enough to undo the trauma of nearly dying on a ventilator in a hospital ICU. Gary has been diagnosed with PTSD, and is still suffering emotionally from his ordeal.

“At night, I just sit there right before I go to bed … and it’s like, I think … of everything that has happened to me. And I always ask, ‘Why me?’” he says.

Why do some people feel like they have a cold for a few days, and then they can get on with their lives? Why don’t some people have symptoms at all? And other people — well, many haven’t been as lucky as Gary. More than 639,000 Americans — and counting — have died from COVID-19.

“You can tell somebody everything is going to be okay, or you’re here, you’re alive, which is what they say, and yes, I am grateful,” he says. “But the thought of the fact that I might not even be here talking to you right now, you know, is something that goes through my mind constantly.”

Gary DeGrijze, who has four adult children, feels guilty for what his family endured during his illness. He’s in online support groups and seeing a psychologist, and still keeps in touch with the doctors and nurses who cared for him. 

“For some reason, the man upstairs, you know, said hey, you know, it’s not your time yet,” he says. “You know, I don’t know what my plan is or what his plan is for me.” 

But, surviving a global pandemic has taught Gary DeGrijze that every day is a gift.

Moving Forward

As another summer heated up, the atmosphere at Stony Brook University Hospital was one of cautious optimism. More people were working in offices again and eating lunch together. A board near the Health Sciences Center garage listed fewer than 40 COVID-19 patients for a few weeks, a rate reflective of infection in the county at the time. On July 1, only 44 people in Suffolk tested positive for the virus. 

A year before, concern and uncertainty were almost palpable. Health care workers were still embedded in the deadly, daily battle against the pandemic. But now, there’s a greater understanding of the disease and how it’s transmitted. Vaccines are widely available in the United States, when only a year ago, they seemed like a distant hope. The adrenaline can only last so long. For a time, many health care workers could finally begin to relax. 

Kaushansky stepped down from his position as dean of the Renaissance School of Medicine in late January and ended his term as senior vice president of Stony Brook Medicine on June 30. He plans to take a leave of absence for what he calls “a sabbatical of sorts,” to create a new Stony Brook course called “The Future of Medicine.”

He hadn’t planned to stay as long as he did; he said a “very wise, good friend” had advised him when he started his appointments that no one should stay in such major administrative jobs for more than a decade. He held both positions for 11 years. 

“End of June, I’m pretty sure COVID will be in our rearview mirror,” he said in January. “And we will have done, I will have contributed what I can contribute to making sure that COVID is done and we’ve done absolutely everything we possibly can …”

Cuomo lifted most pandemic restrictions on June 15 and ended the state of emergency the following week. It lasted 474 days. But even as Long Islanders resumed some semblance of post-pandemic life, the Delta variant — fueled by relaxed restrictions and continued vaccine hesitancy — drove a rise in cases. In mid-September, the U.S. averaged more than 172,000 new COVID-19 cases a day. Those numbers increasingly include children — prompting President Joseph Biden to issue new mandates that require an estimated 4 million federal employees and government contractors to be vaccinated. The U.S. Labor Department plans to use emergency authority to require businesses with more than 100 employees to require, if not vaccinations, at least weekly testing — a move that will potentially impact another 80 million workers.

As yet another academic year approached, seven out of 68 COVID-19 patients fought for breath in an ICU at Stony Brook University Hospital. A far cry from the 435 COVID-19 patients at the pandemic’s peak, but still. The numbers have climbed higher. Ninety-four percent of positive tests taken from a sampling at the hospital in July showed up as the Delta variant — not a complete picture of local transmissions, but enough to get a sense. The pandemic is not over and it seems increasingly possible that the virus will become endemic.

The exuberant hope that kicked off the summer of 2021 seems to be wavering. And yet, most of the country still clings to the question: How do we move forward?

We don’t know how much of our lives will remain online, if the economy will rebound, or whether we’ll need periodic vaccine booster shots. The hope that vaccination means fewer cases this fall and winter seems less certain and the U.S. — ravaged by death, financial hardships and other problems exacerbated by the pandemic — is still struggling from the consequences of the past year and a half. But as the country and Long Island and the county inch closer to the still-elusive herd immunity we can hope, at least, that things are on the mend — or at least reaching a new, safer normal.

For the first time since the world shut down in March 2020, the future looks a little brighter.

Cue The Beatles. “Here Comes the Sun.” 

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