Helping the helpers

Helping the helpers

Russell Berrie Foundation grants target new world of medical care

Doctors and nurses in the COVID-19 ICU at Holy Name Medical Center in Teaneck check on their patients from outside the negative pressure rooms. (JEFFREY RHODE, COURTESY OF HOLY NAME MEDICAL CENTER)
Doctors and nurses in the COVID-19 ICU at Holy Name Medical Center in Teaneck check on their patients from outside the negative pressure rooms. (JEFFREY RHODE, COURTESY OF HOLY NAME MEDICAL CENTER)

Not only is it all about community, but it’s the way that the community responds that shows us what the community is, and who we really are, Angelica Berrie says.

It also helps define leaders, she added.

Ms. Berrie, the philanthropist and activist, who lives in Englewood and among many other activities runs the Russell Berrie Foundation of Teaneck, has begun giving grants in response to the pandemic. These grants, the first wave in what will be at least three, shaped to fit the stage of the crisis, will go toward helping organizations meet their most immediate needs as they work with the most vulnerable populations.

That first wave of grants gives $1.6 million locally and another $1 million to Israel.

Holy Name Medical Center in Teaneck is at the epicenter of the pandemic in New Jersey. That’s not a good place to be. Ms. Berrie has been supporting it not only with the $250,000 her foundation is giving for personal protective equipment and ventilators, but also by “paying for food on a regular basis for staff,” Holy Name’s president and chief executive officer, Michael Maron, said. “She is helping us source PPE, equipment, and ventilators. She and her entire board are remarkable in that way.”

Reflecting on the course of the pandemic so far, Mr. Maron sees some hope, but he cautions that nothing is clear yet. “We have more inpatients than ever, but the rate of growth absolutely has slowed down,” he said earlier this week. That might be because social distancing has begun to flatten the curve, as it was intended to do, but it might be an artefact of the calendar. We’ve just gotten beyond Pesach and Easter, and often people who aren’t sure about whether they should go to the hospital hang on at home until those holy days are over.

Angelica Berrie and Mike Maron celebrated at the Holy Name gala. (JEFFREY RHODE, COURTESY OF HOLY NAME MEDICAL CENTER)

“We’re a little nervous about what might happen next,” he said.

Holy Name, like many other hospitals, has made adjustments. “We have expanded our capacity significantly,” Mr. Maron said. “We normally have 20 ICU beds, but now we have 120. We managed to build five units in two weeks. The big auditorium, Marian Hall, has been totally transformed into three critical care units.

“We also took the top floor, where we had started construction,” back when the world was normal, “to expand our operating room. So we stopped the construction, and those crews built two 20-bed ICUs in that space. And when this is over, we will go back and expand our operating rooms.

Holy Name transformed its spaces to fit in more ICU beds. (JEFFREY RHODE, COURTESY OF HOLY NAME MEDICAL CENTER)

“We’ll leave up the ICS in Marian Hall, though, for at least a year, because a lot of the models are predicting spikes and surges. So until we have either a vaccine or aggressive treatment, we will leave it in place.”

He’s proud of how the ICUs have been built; it’s an innovative design, developed in house, that “we encourage other health systems to come by and see,” he said.

“The engineering feat is that it’s all designed to keep patients in a negative pressure area,” Mr. Maron said. “The entire inside room is negative pressure. That means that it extracts the airflow out of the room at a very high volume. Any virus expelled in that space goes right up a vent, and through a high micron-capturing filter.” The cleansed air is released outside, and the viruses stay trapped in the filter until they die. “We will decontaminate the filters when all this is done, but the virus has a limited life span on inanimate objects, so it will die naturally,” Mr. Maron said.

Covid-19 patients can FaceTime with their family and friends. (JEFFREY RHODE, COURTESY OF HOLY NAME MEDICAL CENTER)

“The other nice part of it is that all these rooms have big windows, so most of the nursing care is done on the outside.” Nurses can check IV pumps, ventilators, monitors, and all sorts of other high-tech medical equipment without having to get hazmat-suited to walk into the dangerous, virus-laden rooms. That deprives the patients of even more human contact, but because any human contact must be mediated through that bulky, feature-hiding protective gear, the effect is pretty similar to what the patients already experience.

“Nurses and PPE are the two most critical resources, and they’re in short supply,” Mr. Maron said. “This allows us to preserve PPE, because we need to use less of it.” It also saves time for the nursing staff, which they can use to watch over their patients; it’s slow work taking the gear on and off.

Much of Holy Name’s innovation comes from its close collaboration with Shaare Zedek Medical Center in Jerusalem. “Our emergency room was totally rebuilt after 9/11, in cooperation with Shaare Zedek,” Mr. Maron said. “They gave us tremendous insight into how you would deal with the mass casualty events that Israel has to deal with all the time.” That emergency room, built below ground because of Israel’s experience with bombings, is the space now turned into ICUs. “It is very effective clinical care space,” Mr. Maron said.

“The collaboration that we have with Israel has paid back in spades,” he continued. “Because of Angelica and because of that relationship with Israel, we are beginning to use a stem-cell treatment that was developed in Israel to help fight covid-19.

Across the country, like here at Holy Name, staff members undertake quiet acts of heroism many times a day. (JEFFREY RHODE, COURTESY OF HOLY NAME MEDICAL CENTER)

“It’s placenta-harvested stem cells, called Pluristem, that boosts the immune system, and they give them to people with covid. It’s relatively new, and we managed to get FDA approval; it took a week or two to get through the FDA approval process.” As of this writing, one patient had gotten the treatment and two more were scheduled to receive it.

“It helps boost the immune system,” Mr. Maron said. “It’s for people who already are on ventilators. The cells themselves do not directly heal tissue, but they create an immune response that then contributes to enhancing the healing of the tissue that’s already been damaged or swollen. It helps reduce inflammation and that helps heal the tissue.”

Despite the hospital’s greatly expanded capacity, it is far better for patients to be able to stay out of it, Mr. Maron said. “We have successfully sent home patients who tested positive. We feel that with aggressive home telemonitoring, home is the best place to care for them.

“So rather than admit people who have gone to the ER, been swabbed and tested here, we have nurse practitioners call them. Depending on the acuity of their level of illness, they call two to four times a day.

“These are video calls,” he said; everyone has at least a phone, if no other, larger screen. “That has worked very effectively. Using video and telephone, one nurse can manage many more patients safely, and with more limited exposure. So we’re helping people get through these challenging times safely. They’re at home, and they’re not alone.

Overall it has had a very big impact on helping people recover faster and better, and it keeps many more people safe and not exposed to the virus.

“The nurses will put patients through breathing exercises and get them to be more mobile,” Mr. Maron continued. “Being sedentary is one of the worse things you can do, but the fatigue level is quite high. You have to take as many deep breaths as you can to keep your oxygen level up, and the only way you can do that is if someone is calling you and coaching you and pulling you through it. Otherwise, you will just curl up in bed and not want to move.

“I can attest to that personally.”

Mr. Maron got the virus. “I am okay now, but it took me about two weeks, and I lost 20 pounds. My doctors here caution me, because when I give interviews I’ve been saying that I had a mild case, but my primary care physician said, ‘Mike, you lost 20 pounds. That alone tells me that it was not mild.’

“You do not want to get this disease. Listen to me. I can tell you firsthand. You really do not want to get covid.

“In my lowest point, I was teetering on the edge of being admitted and having to go on a ventilator. That was a very scary moment. The mortality rate is just too high.”

Don’t fool yourself, Mr. Maron said. “I was one of those people who never gets sick. I never get colds. I never get the flu. I don’t think I called in sick out of work in 28 years. I was just one of those people. But this knocked me off my feet in a big way.

“The superman mentality just doesn’t work.

“I have seen far too many young people in their 20s and 30s, who were otherwise fit and healthy, lose their lives. This disease does not discriminate. We do not know why some people succumb and others do not. But it can happen in hours. You can go from breathing on your own, just struggling a little bit, to having to be on a ventilator.

“You have to take that seriously. You have to self-quarantine.”

Mr. Maron commends the leaders of the Jewish community for being so quick to ask for self-quarantining, and so thorough and unyielding in their recommendations. “The rabbis were way ahead of the curve, and they took a lot of heat for it, but we are seeing very positive results from it now. They should be applauded and thanked for their willingness to take the heat and to lead.”

It’s hard to remain in hiding from a virus, but we must stay the course, he said. “Our concern is that the human spirit has only so much sacrifice that it can give, and people are reaching the end of their rope. The virus is still very active.” We might be at a point where the rate of infection declines, but we have to be very careful, he said, and in fact we might be nowhere near that point, our great desire to be there notwithstanding.

“I know that people are hurting, and we are in a very painful state economically, but when you take all the pain together, when you see how devastating this virus is, you see that this is the lesser pain. It’s the lesser of two evils.”

The Berrie Foundation also has given a grant to the Bergen Volunteer Medical Initiative.

“We’re a nonprofit health care center in Hackensack,” the group’s president and CEO, Amanda Missey, said. “We provide free primary health care for people who are working but not earning much money, who live in Bergen County and don’t have health insurance.” The nonprofit has about 75 volunteers — health care professionals, including several specialists, she said. “In normal times, it is just like a regular doctor’s office.” But nothing is normal any more.

Back before the pandemic, Bergen Volunteer Medical Initiative’s Michelle Kaye, RN, its nurse manager, is on the phone. (COURTESY BVNI)

Because their patients have neither much money nor much time, “they often live in small spaces with other people, and they often had low health literacy before this started.” That put them at even higher risk for covid-19 infection than luckier, wealthier people have been. So not only do their patients suffer from a full range of health issues, exacerbated by low income and a history of infrequent access to health care outside emergency rooms, now they face the threat of this virus.

“The Berrie Foundation is providing us with a very sizable grant for a telehealth program,” Ms. Missey said. “We have about a dozen nurses and nurse practitioners who want to be part of it, as well as our own clinical staff.”

When the crisis first hit and social distancing began, “when we were closed for those first two weeks, we really were just doing phone triage. We’d take the calls, order them in priority, and then dispense with them.”

Now, though, the new platform allows patients and professionals to see each other. (“Everyone has a phone, even if it’s a pay-as-you-go one,” Ms. Missey said.) It’s not the same as being in person — there are nuances that are not visible over the phone, although body language and facial expressions can be; “obviously, for example, you can’t do a gynecological exam by telehealth,” Ms. Missey said. But there are many check-ups and check-ins that are as useful by phone as in person, and require a lot less of the patient’s time.

That’s why this new system will be useful even when the crisis is over. “We have been talking about telehealth for a long time,” Ms. Missey said. “But you’re busy doing stuff every day, and so you can’t make time for a new project, even when you want to. So this kind of forced our hand.

“We’ll have the technology in place because of the grant, and we will be able to expand our capacity once this is all over, and we settle in our new normal.

“There really are a lot of benefits to us from this. There aren’t many silver linings to covid-19, but this is one of them.”

Dr. Robin Goland is the director of the patient care and clinical research programs at the Naomi Berrie Diabetes Center at Columbia University; the center is named for Angelica Berrie’s late mother-in-law.

The Berrie Center “provides care for and clinical research on 14,000 children and adults with diabetes,” Dr. Goland said. “This is a very high-risk time for diabetics; diabetes is one of the highest risks for covid-19.

“It’s not that they are more at risk for getting the infection, but that if they get infected it destabilizes their diabetes regimen, and the high blood sugars that ensue make it much harder to fight off the infection. And it seems to be emerging that high body weight” — which often but not always is associated with diabetes — “is also a big problem.”

Given the dangers posed to its patients, and the impossibility of continuing as they had, in the face of the virus, “we essentially have taken the large in-person practice model and moved it so it can function remotely,” Dr. Goland said.

“There are huge operational barriers to doing this; economic, technological, and emotional barriers. And the Berrie Foundation immediately leapt into action and supported us, our staff, and our patients, in making this enormous transition.

“All of our visits are provided in virtual settings, on iPhones, and if we can’t do that on iPads, and if we can’t do that on FaceTime or Zoom, or if all else fails, on the phone. That required the staff all having the technological wherewithal that they just didn’t all have.” All the challenges — with the office, the patients, the regimens — “it’s just mindboggling.

“The Berrie Foundation helped us meet this huge challenge, so we could be there for our patients.”

Like Ms. Missey at Bergen Volunteer Medical Initiative, going virtual, at least for some things, had been an idea that Berrie Center leaders like but upon which they had not had the time to focus, Dr. Goland said. “And then it started, and it was a like a revolution. A tsunami. It is a remarkable transition, and we couldn’t have done it without them. And the speed!” she marveled.

Ms. Berrie wants as much publicity as possible for these and the other ventures that her foundation is supporting. That’s not because her name is attached to it, but because “the whole point is that it’s a call to action,” she said.

“We can’t do it alone. There are many others who have stepped up to do a lot.”

She quotes the writer and activist Rebecca Solnit. “It’s about falling together instead of falling apart.

“It’s about how a community comes together in a crisis, instead of being like Lord of the Flies, where each one of us is in it only for ourselves.”

Any friendly (or for that matter not-so-friendly) competition between institutions might drive each to greater heights during normal times, but “competition is not helpful right now,” she said dryly.

This situation is bringing out the best in most people, and the worst in others. “Mike Maron can tell you how many people are looking to sell the hospital stuff, and some of them are price gouging, and taking advantage of this dire situation,” she said. “The community is being tested by this crisis. It is how we respond that will determine its character and resilience.”

She talked about the institutions that her foundation is supporting with this first wave of grants, which also includes the local Diabetes Foundation, the Bergen Volunteer Center, and the Jewish Federation of Northern New Jersey; support also goes to seven Israeli nonprofits, all to help disenfranchised, elderly, or otherwise marginalized people there, and $1 million for Ogden Social Finance, which gives loans to small for-profit and non-profit businesses and groups in Israel.

“The common thread in this first round is to help in the emergency, and not just by giving them cash.” Much of the funds allocated on this first round will go to help organizations go virtual, helping them buy equipment that they can use once the emergency is over. Other funding goes to providing food to hungry people, and beyond that studying the issue of food security to make more structural changes. As that shows, “we are already doing the homework for the second round, for more midterm needs,” Ms. Berrie said. “It’s what we call the fuzzy middle.

“There’s the initial response, the fuzzy middle, where you don’t know what the needs will be, and then the long-term needs, which hopefully will be sustainable and will create a resilient infrastructure before the next crisis.”

Ms. Berrie thinks a great deal about leadership, about the importance of leading by example, because “leadership matters.” She cites governors Andrew Cuomo and Phil Murphy as providing great examples of that leadership. And she does what she can in her world.

“I am encouraging people in my sphere of influence in philanthropy not to think about their portfolios,” she said. “We are here to do the most good we can, wherever we can, and we just have to do it, even if we have to spend more now. Even if our portfolios have taken a hit, we have to do it.

“This is the time to lead.”

When she first converted to Judaism, she said, she asked about the value of doing a mitzvah, like giving tzedakah, publicly. “Why should you allow yourself to be honored for doing something that you would have done anyway?” But a friend explained that “it’s because you have to set an example.”

That she’s done.

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