Episode Overview

Podcast: Becker’s Healthcare Podcast
Guest: Dr. Andrew B. Wallach — Ambulatory Care Chief, NYC Health + Hospitals/Bellevue & Ambulatory Care Chief Medical Officer, NYC Health + Hospitals
Host: Paige Twiner, Becker's Healthcare
Date: January 31, 2026
Main Theme:
Dr. Andrew Wallach discusses NYC Health + Hospitals’ response to the particularly severe 2025-2026 flu season, sharing insights on capacity management, virtual care, staff protection, and practical advice for health system leaders nationwide. The episode explores lessons learned from COVID-19, the impact of early and intense flu activity in New York, and actionable tactics for managing surges.

Key Discussion Points & Insights

1. Introduction to NYC Health + Hospitals (H+H)

• Scope & Mission

  • Largest municipal healthcare system in the U.S.; operates as the city’s major safety net ([00:22])
  • Serves over 1 million New Yorkers regardless of ability to pay or immigration status
  • Provides 60%+ of NYC’s behavioral health care
  • Structure: 11 acute care hospitals, 5 long-term care centers, a federally qualified health center, correctional health services, and MetroPlus insurance plan

• Dr. Wallach’s Role

  • Board-certified internist, former hospitalist, now CMO for ambulatory care

2. The 2025-26 Flu Season in NYC: Scope & Impact

• Severity of the Season

  • “New York City was hit really hard and early this year by the flu outbreak, perhaps earlier than other jurisdictions across the country.” — Dr. Wallach ([02:22])
  • Declaration of influenza as “prevalent throughout the state” on December 2, triggering official flu season response
  • Weekly cases peaked at over 70,000 (vs. 55,000 previous year)
  • Hospitalizations reached highest numbers since records began in 2004 ([02:22])

• Timeline of the Surge

  • Cases and hospitalizations peaked in early January; as of the episode recording, numbers were decreasing ([03:39])

3. Direct Impact at H+H Facilities

• Sites of Strain

  • Emergency departments saw large influxes of patients with respiratory symptoms
  • Virtual Express Care, expanded during the COVID-19 pandemic, managed increased call and patient volumes
  • Outpatient clinics also felt the surge

• Staff Considerations

  • Focus was not only on patients: “...our staff also are protected because they're people, too. They get sick. We're not immune to all things.” — Dr. Wallach ([03:56])

4. Anticipating and Responding to the Early Surge

• Expectations & Surveillance

  • Based on Southern Hemisphere and global data (Japan, UK), the team anticipated a rough season with the subclade K variant but didn’t expect such an early and steep peak ([05:04])

• Strategic Care Coordination

  • Virtual care infrastructure ramped up during COVID-19 enabled rapid and flexible response ([05:58])
    • Patients can now test at home (readily available OTC flu tests) and access telehealth for evaluation and guidance
  • Aggressive staff vaccination campaign, despite imperfect flu vaccine match: “We really… did full court press to let people know how important it was to get the vaccine.” ([07:03])
    • Emphasis on vaccine's ability to reduce severity, hospitalizations, and death

5. Recommendations for Hospital Leaders Nationwide

• Vaccination is Top Priority

  • “Making sure that staff and patients are vaccinated is just so critical. So I just want to say that again and again and again…” — Dr. Wallach ([08:37])

• Surge Capacity Management: The ‘4S’ Framework

  • Staffing: Develop internal float pools for flexible workforce deployment ([10:43])
  • Space: Repurpose nonclinical areas, use temporary structures (e.g., heated tents), and cohort patients with flu for efficiency
    • “You can move towards cohorting together flu patients in a multi bedded room… called respiratory pods or dedicated wards.” ([09:31])
  • Supplies: Proactively manage and diversify suppliers for medications (antivirals), PPE inventory; “Don’t put all your eggs in one basket.” ([13:44])
  • Systems: Implement standing triage-to-treatment orders (e.g., nurses can swab/test and start hydration before provider evaluation) to expedite care and throughput ([11:36])

• Early Testing & Antivirals

  • Importance of early flu testing and timely antiviral administration to reduce severity and promote quicker recovery

• Infection Control

  • Universal masking policy for all direct patient encounters during the surge, regardless of vaccination status ([12:48])

• Supply Chain Resilience

  • Lessons from COVID shortages: multiple suppliers for antivirals and critical supplies ([13:44])

6. Final Executive Advice & Staff Wellbeing

• Essential Takeaways for Executives ([14:27])
  • Tight communications (regular “bed huddles” to track census/discharges, plan for safety)
  • Encourage sick staff to stay home, preventing workplace transmission
  • Leverage standing orders to enhance efficiency per local regulations
  • Prioritize staff wellbeing: “Recognize them, rotate people out… don’t want the same people working in the flu wards day after day. Give folks a break and… have sustainable positions and keep your workforce healthy.” ([15:09])

Notable Quotes & Memorable Moments

• “We operate as a public benefit corporation and essentially serve as a safety net for New York City and provide care for over 1 million New Yorkers regardless of their ability to pay or their immigration status.” — Dr. Wallach ([00:42])

• “Cases and hospitalizations are the highest ever recorded in our region, dating back to 2004, when we started tracking this information. So it hit early and it hit hard.” — Dr. Wallach ([02:55])

• “We really, this year, earlier than ever, really pushed with our staff the importance of getting vaccinated. We really… did full court press to let people know how important it was to get the vaccine.” — Dr. Wallach ([07:03])

• “When hospitals face a sudden surge… you need to shift your strategy from what I call routine care to surge capacity management. I think of it in the 4S framework… staffing, space, supplies and systems.” — Dr. Wallach ([08:53])

• “Be aware of what the toll that has taken upon our staff and, you know, make sure that you recognize them, that you rotate people out… consider that to be able to… have sustainable positions and keep your workforce healthy.” — Dr. Wallach ([15:12])

Timestamps for Key Segments

• [00:22] — Dr. Wallach’s background and system overview
• [02:22] — Flu season surge hits NYC
• [03:56] — Impact on staff and patient care capacity
• [05:04] — Anticipation and planning (global surveillance)
• [05:58] — Virtual care and home testing enablement
• [07:03] — Staff vaccination strategy and its importance
• [08:37] — Recommendations for hospital leaders, 4S Framework
• [09:31] — Cohorting flu patients, optimizing care delivery
• [10:43] — Staffing/flex pools
• [11:36] — Standing orders and expedited care pathways
• [12:48] — Universal masking as infection control
• [13:44] — Supply chain diversification for medications/PPE
• [14:27] — Final executive advice: internal communication, staff wellbeing

Summary Takeaways

• NYC’s flu season in 2025-26 was historically severe and early, overwhelming existing resources and requiring strategic, flexible responses.
• Investments in virtual care, aggressive vaccination campaigns, actionable surge management tactics, and staff support proved crucial.
• The “4S” framework—Staffing, Space, Supplies, and Systems—provides a replicable model for other health systems facing similar influenza or respiratory surges.
• Leaders must balance operational efficiency, staff wellbeing, and rapid adaptation to protect patients and care teams alike.

This episode is a fast-paced and practical playbook for healthcare leaders proactively bracing for or currently coping with respiratory viral surges, blending public health perspective, hospital ops expertise, and frontline compassion.