“The whole reason why we’ve taken all these aggressive mitigation
strategies — whether the travel bans, the recommendations for people,
for communities, for employers — the reason why we’ve taken those
aggressive measures is to mitigate the spread so we don’t put stress on
the health care systems,” Verma said.
But after the testing delays, followed by the increasing spread of
the disease and a still-unknown level of transmission, some officials
are willing to entertain bleak scenarios.
“I believe that if we have a major outbreak, we are definitely
vulnerable to shortages," Dr. Anthony Fauci, head of the National
Institute of Allergy and Infectious Diseases, told a House panel on
Wednesday, referring to ventilators.
Some local officials suggested that, if the ongoing efforts to keep
people from congregating fall short, America’s immediate future might
look like Italy’s present day: An overwhelmed system, a fearful populace
and highly restrictive emergency measures.
That’s partly because, after years of reducing hospital beds to treat
more illnesses at home or in outpatient settings, there are worrisome
limitations on critical care beds and the number of health care workers
to staff them, public health officials said. Many hospitals have come
close to the breaking point even in a bad flu season. This is shaping up
to be far worse.
“The fears that the United States could become like Italy — that’s
the worst case scenario that people worry about,” said Elaine Batchlor,
CEO of Martin Luther King Jr. Community Hospital, which serves mostly
poor patients in South Los Angeles. She and other health officials
stressed that bungled testing and flawed travel screening policies have
allowed the disease to spread already and cost precious time.
Rapidly training large numbers of health workers about coronavirus —
including drawing in some who would not normally be frontline in a
respiratory illness — is an ongoing challenge, they said. Given the
social restrictions to limit the spread of the disease, they can’t fly
to a Covid-19 conference or watch a PowerPoint presentation over a
buffet.
“The main thing for the health care work force is not just how do you
screen a person under investigation and get them safely into the
appropriate isolation and care that they need,” said Dr. Vineet Arora,
who specializes in training at the University of Chicago Department of
Medicine. “It’s also, do you make sure the workforce protects
themselves, with both personal protective equipment and social
distancing in the hospital setting.”
Hospitals can reconfigure themselves to take in more coronavirus patients — but even expanded capacity is finite.
“If the number of people infected who go to a hospital cannot be
treated at the hospital — that’s what you want to plan for now,” New
York Gov. Andrew Cuomo said this week. He said New York is looking for
other structures and facilities it can tap as temporary Covid-19 centers
to prepare for a surge. Mayor Bill de Blasio has said New York City
might end up putting temporary treatment sites on parking lots.
Some of the larger hospital systems and academic medical centers can
quickly expand capacity. New York’s Mount Sinai Health System, which has
eight hospitals, for instance, could turn ambulatory surgical centers
into acute care units, and by halting elective procedures could free up
more beds, said its president and CEO, Ken Davis. The system was already
tested after catastrophes like 9/11 and Hurricane Sandy.
Batchlor’s much smaller MLK Community Hospital in Los Angeles can also reconfigure beds, but that may not be enough.
“We’re planning for where we will put patients if we have a large
influx,” Batchlor said. That could meaning putting some non-coronavirus
patients in hallways, if they don’t need to be isolated, and erecting
tents for triage and treatment.
Brent James, a nationally known health care quality expert who spent
most of his career at Intermountain Healthcare in Utah, said a
competent, well-managed hospital system should be able to expand bed
capacity by 30 to 50 percent. But “competent,” he said, is the magic
word.
Rural hospitals are more crunched, no matter how well-run they are.
“We are actually very concerned about surge capacity,” Maggie
Elehwany, vice president for government affairs at the National Rural
Health Association, said in an email. The organization has written to
lawmakers about urgent needs, including more telemedicine and small
business loans. Rural populations are older and sicker than the rest of
the country, making them high-risk for severe coronavirus.
Meanwhile, hospital associations in hard-hit areas like California
and Washington state are sharing lessons learned in real time with their
counterparts elsewhere.
“They literally have just been sending us everything that they’ve put
together,” said Patti Davis, Oklahoma Hospital Association president,
who said it’s extremely helpful as her state prepares for “the great
unknown.”
One of the most powerful tools to address the high-tech medical
shortage is decidedly low-tech — getting people to stay home and not
congregate in crowds, that “social distancing.”
The NBA’s decision to suspend its season and the growing list of
celebrities who have been infected by Covid-19 may have catalyzed more
people to change their behavior than any number of public service
announcements from people in white coats, some health officials said.
Changing behavior is essential — and some preliminary research shows
it could help at least slow down the spread of the virus, so that not so
many people get sick all at once and flock to hospitals.
It’s hard to model an unprecedented situation, but one group of
scientists did some estimates on the impact of social distancing in
Seattle — and found that even rather minor changes in behavior can save a
lot of lives.
The Seattle-area Institute for Disease Modeling
found
that even relatively minor changes in social interaction can save
lives. For instance, if there were 400 deaths in Seattle by early April,
a 25 percent reduction in social interaction could bring those deaths
down to 160. A 75 percent reduction — of course, much harder to achieve —
could bring it to 30.
Dan Goldberg, Brianna Ehley, Alice Miranda Ollstein, Tucker Doherty, and Rachel Roubein contributed to this report.
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