Nishad Abdul Rahman, MD; Kayla Guidry, MD; Elizabeth Danielle Brining, MD; David Liu, MD; Ngunyi Sandra Leke-Tambo, MD; Adrian Antonio Cotarelo, MD; Miriam Kulkarni, MD; Norman Mok, MD; Raffaele Milizia, MD


Western J Emerg Med. 2022;23(2):129-133. 

In This Article


Not since the 1918 "Spanish" influenza has a pandemic been comparable in clinical severity or transmissibility to coronavirus disease 2019 (COVID-19).[1–3] There has not been an opportunity in modern literature to record the intricacies of hospital surge planning required to withstand a pandemic of this nature. Early reports from China[4] and Italy[5] addressed pandemic surge changes made due to lack of critical care resources. A more recent, American-based model specific to community hospitals, the most common practice setting in the United States,[6] has not yet been reported.

Westchester County, New York, was the US epicenter of the initial viral surge, with the second greatest rate of COVID-19 cases per capita of any county within the state.[7] Our hospital, in the county's largest city Yonkers,[8] was severely impacted by the pandemic. Our institution is comprised of two acute care hospitals, St. John's Riverside Hospital – Andrus Pavilion (SJRH-AP) and St. John's Riverside Hospital – Dobbs Ferry (SJRH-DB) with a total of 150 inpatient beds in a community setting, outside the resources of the larger New York City tertiary care centers. Considering that community hospitals – defined as non-federal, short-term, general hospitals – comprise 85% (5198/6146) of all hospitals in the US,[6] our experience may provide translatable insights.

We present the challenges that SJRH faced and the key facility changes that were implemented during pandemic surge planning in our Westchester County community hospital as we progressed through our initial COVID-19 pandemic surge from March–July 2020.

Current Literature

Specific changes made at individual Chinese and Italian hospitals to counteract COVID-19 have been documented.[9,10] However, there has been limited literature published concerning how individual hospitals responded to COVID-19 within the US. Information gleaned from this experience could prove to have utility in the ongoing worldwide battle against COVID-19, as well as potential future infectious disease outbreaks.

Westchester County COVID-19 Pandemic Impact and St. John's Riverside Hospital

As of July 1, 2020, the global cumulative confirmed COVID-19 cases totaled 10.6 million with 526,208 deaths. In the United States, >2.6 million cases were confirmed and >127,000 deaths were attributed to COVID-19, with cases continuing to increase at the time of writing.[7] Within New York State, Rockland County had the highest per capita case rate (4165 cases/100,000 persons), Westchester County had the second highest at 3604/100,000 persons, and New York City had the sixth highest with 2607 cases/100,000 persons.[7]

Our emergency department (ED) has approximately 46,000 annual visits. We are an academic site functioning as a teaching hospital, with two residency programs - emergency medicine and internal medicine. Yonkers is the largest city in Westchester County with 200,000 residents.[8]