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Virus May Stretch Capacity of U.S. Hospitals to Breaking Point

Virus May Stretch Capacity of U.S. Hospitals to Breaking Point

(Bloomberg) -- Northwestern Memorial Hospital in Chicago can convert two entire floors to cope with coronavirus patients. Baltimore’s Johns Hopkins Medicine would triage people in tents outside the emergency department. Respiratory therapists are girding for the worst.

Hospitals large and small around the globe are preparing for the kind of grim scenarios playing out in countries like Italy, where the outbreak has outstripped bed capacity, staffing and emergency supplies. The life-and-death question is where to put all the patients.

The numbers are stark. Epidemiologists say from 20% to 60% of Americans are likely to contract the new coronavirus. Based on the severity seen so far, one in 20 will get seriously ill, requiring a hospital stay and advanced care. That translates to as many as 10 million patients.

Virus May Stretch Capacity of U.S. Hospitals to Breaking Point

Yet there are fewer than 100,000 beds for the critically ill at U.S. hospitals, including those in surgical units, according to the Society of Critical Care Medicine. Hospitals own just 62,000 full-feature mechanical ventilators.

The likely surge in hospitalizations will exceed the nation’s capacity for intensive-care unit beds, ventilators and respiratory therapists, said Irwin Redlener, a Columbia University public health professor who has advised the government on disaster response.

“We’re facing an enormous crisis here,” Redlener said. “It’s almost inevitable that we’re going to end up in a serious crunch relative to ventilators in this country.”

The government can create more beds by reopening hospitals closed for economic reasons and taking over hotels or other residential buildings. The Strategic National Stockpile also has plane-loadable kits of hospital beds with IVs and other equipment ready to ship, so hospitals can set up satellite operations in tents or take over a nearby building to treat less critical patients.

China Warning

Hospitals aren’t waiting for the help. They’re implementing novel approaches to create space before a crush of patients, diverting the worried well and putting beds in unexpected areas for intense treatment.

Doctors and nurses at the 25-bed acute-care hospital in Craig, Colorado, are ready to fend for themselves if a coronavirus strikes hard and fast. No cases have been confirmed in encompassing Moffat County, though Colorado’s total Friday had jumped to 72 from two in just over a week.

A concentrated attack on the remote town of 9,000 could leave dozens ill. The two closest hospitals to Craig’s Memorial Regional Health, just south of the Wyoming border, are also small and unlikely to be of help.

“If they’re full, we’re full,” said Jennifer Riley, the facility’s chief operating officer. “If this were a full-blown epidemic, we’d use all the space we could.”

China, faced with an overwhelming number of patients, built hospitals practically overnight. Italian medical centers set up plastic cots in hallways, and doctors restricted resources like ventilators to patients most likely to survive.

Those harbingers have given U.S. hospitals time to devise a strategy.

Northwestern Memorial Hospital plans to more than double the number of beds in the medical intensive care unit to 36. It could convert two floors that enable negative airflow to isolate patients while also providing recovery rooms for those who can’t go home unassisted.

At the moment, Illinois has 46 cases, a number certain to grow.

“What’s true today may not be going on tomorrow,” said Richard Wunderink, a pulmonologist who directs the medical intensive care unit. Adjusting to an onslaught, which happened in just a few days in Seattle and Boston, isn’t easy. “It’s not just simply flipping a switch. That’s why we are looking at a graduated response.”

Cost-Cutting

After decades of consolidation and cost-cutting, hospitals run lean. Most are already at 95% capacity after the long and lingering influenza season, said Robert Redfield, director for the U.S. Centers for Disease Control and Prevention.

“We really don’t have a lot of resilience in the capacity of our health-care system,” Redfield said.

Ensuring hospitals have enough gear and supplies is another challenge. The sickest patients need early and aggressive care that can tie up beds and equipment for weeks.

Running out of ventilators is a concern, said Shauna Strickland, associate executive director of the American Association for Respiratory Care. Her group found that hospitals have nearly 100,000 devices that help patients breathe in addition to full-service ventilators, while state and federal agencies have stockpiled thousands more. It’s unclear if that will be enough.

“We are concerned and watchful, and we are trying not to panic,” said Strickland.

Hospitals are doing everything they can to free beds.

In Massachusetts, where there are 108 cases so far, Boston’s Tufts Medical Center has begun rescheduling routine appointments. New York Governor Andrew Cuomo said the state may stop elective surgery to free up 25% to 35% of capacity.

“Medical centers are mobilizing teams of people to get ahead of this,” said Aaron Milstone, associate hospital epidemiologist at Johns Hopkins Medicine. “Other countries got taken by surprise, and some of their transmission happened in the hospital.”

Drive-Up Testing

The first step is to stop the worried well from overwhelming emergency rooms. Johns Hopkins started a phone bank and plans to set up triage tents, Milstone said. In the Minneapolis area, M Health Fairview has drive-up testing at four clinics, allowing patients to get swabbed without leaving cars.

Harborview Medical Center in Seattle, where the pathogen first exploded in the U.S., is allowing patients from high-risk locations like nursing homes to be directly admitted, bypassing the emergency room, Maralyssa Bann, an associate medical director, said in a Twitter post. The facility is also sending some patients home, allowing them to finish their recovery where they may be at lower risk.

Virus May Stretch Capacity of U.S. Hospitals to Breaking Point

For the most critically ill, many hospitals are considering “cohorting,” meaning they keep them clustered and cared for by medical staff outfitted with protective gear.

Other options include converting single rooms to doubles and taking over spaces like lobbies, post-operative care units and procedure rooms. At Michigan Medicine, leaders have plans to open a respiratory intensive-care floor.

Parkview Medical Center in Pueblo, Colorado, could convert an eight-bed unit to negative ventilation, supplementing its 12 isolation rooms, said Sandeep Vijan, chief quality officer at the 220-bed hospital. It has a 60- to 90-day supply of protective gear on hand and more on order.

“What we have is what we have,” he said. “We could easily go through those” if there is an influx of patients, he said.

In the end, every hospital has to be prepared for an outbreak on the scale of those in China, South Korea and Italy.

“Hospitals and critical care facilities have known this is coming,” said Craig Coopersmith, interim director at Emory Critical Care Center, a 300-bed ICU. “It will not be a surprise or a shock when somebody shows up.”

To contact the reporters on this story: Michelle Fay Cortez in Minneapolis at mcortez@bloomberg.net;Vincent Del Giudice in Denver at vdelgiudice@bloomberg.net;Shruti Date Singh in Chicago at ssingh28@bloomberg.net;Mike Dorning in Washington at mdorning@bloomberg.net

To contact the editors responsible for this story: Drew Armstrong at darmstrong17@bloomberg.net, Flynn McRoberts, Stephen Merelman

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