Can our hospitals handle the coronavirus outbreak?
A spokesman for the Illinois Hospital Association is urging calm as public health officials figure out the magnitude of the virus locally. But one expert warns “this is going to be a fairly tremendous strain on our health system.”
Rush University Medical Center has set up a triage tent. Northwestern Memorial Hospital and the University of Chicago Medical Center could convert parts of their facilities. Cook County’s flagship Stroger Hospital has been preparing since January.
Chicago hospitals, like those in much of the country, are prepping for the worst as the coronavirus outbreak grows. Some doctors fear hospitals could become so overwhelmed they could be forced to ration medical care, as has happened in Italy.
“This is going to be a fairly tremendous strain on our health system,” warned Dr. William Jaquis, president of the American College of Emergency Physicians.
U.S. hospitals have fewer than 100,000 beds for those most ill, according to the Society of Critical Care Medicine. In Japan, there are 13.4 beds per 1,000 people; in Italy, it’s 3.4 per 1,000, according to a World Bank report.
In the U.S., it’s 2.9 beds per 1,000 people.
As for ventilators, a necessary tool to combat respiratory problems, U.S. hospitals have 62,000 full-feature devices, according to a report last month from John Hopkins University. Another 98,000 are more basic, but can be used in a pinch.
Everything you need to know about the novel coronavirus COVID-19, with a focus on its impact on Chicago and Illinois.
Danny Chun, spokesman for the Illinois Health and Hospital Association, is urging calm as public health officials in the state assess the magnitude of the virus locally, especially since most patients won’t need hospitalization — and, therefore, won’t need a bed.
“Nobody knows what the true number of patients needing intensive care could be,” Chun said. “The data so far from China and the other countries seems to indicate that about 80% infected with the virus may not need hospital care, they’ll have mild symptoms.
“Our hospitals are preparing, planning, holding drills, doing all kinds of preparations to address any needs,” Chun said. “Is Illinois going to be like Washington state or New York state with the clusters? We don’t know yet.”
Chun said comparing various cities’ and countries’ capacity for treatment isn’t productive because the virus spreads in different ways in every location. The most important factor in mitigating further spread and flattening the bell curve of the state’s outbreak, he said, is widespread testing, which he called a “critical need” at this point.
Government health authorities are nonetheless taking emergency steps to waive certain laws and regulations to help hospitals deal with the crisis. Hospitals, too, are getting ready.
Rush University Medical Center is preparing its facilities by raising a tent inside its ambulance bay to test patients in isolation. The tent, put up Monday, is separate from the rest of the facility and gives the hospital an extra layer of protection from the easily spreadable virus.
Its purpose is “forward triage,” which means Rush doctors will determine the priority of a patient’s treatments before they enter the hospital. Air inside the tent and ambulance bay is sanitized before it’s exhausted outside to avoid cross-contamination elsewhere.
“Forward triage is usually reserved for mass casualty events . . . it is usually more of a military term,” said James DeVries, an instructor of emergency medicine at Rush. “In this scenario, we’re taking out the triage process and making it relate to infectious disease — isolating at-risk patients for coronavirus so we can maintain other patients’ safety while providing care.”
Deborah Song, spokeswoman for the Cook County hospital, Stroger, said the facility has been “prepared and ready since January.”
Song said Stroger, the county’s busiest trauma center, knows there will be a surge of cases but expects to be able to handle whatever may come.
“We have the capacity to take patients, and we do have areas we can take patients,” Song said. “From a capacity standpoint, most patients won’t need to be hospitalized. You’re talking about the sickest of the sick [who will be hospitalized].
“We are on the ready,” she said. “We are preparing just like every other hospital to potentially see a surge. This is not something new for us from a public health perspective.”
Northwestern Memorial Hospital has the capacity to convert two whole floors for strictly coronavirus treatment, and likely will double its intensive care beds to 36, the Bloomberg news service reported.
“What’s true today may not be going on tomorrow,” Richard Wunderink, a pulmonologist who directs Northwestern’s intensive care unit, told Bloomberg. “It’s not just simply flipping a switch. That’s why we are looking at a graduated response.”
A spokeswoman with the University of Chicago Medical Center said if the time comes when the hospital sees a surge of patients, they could designate a certain area of the facility for coronavirus treatment. UChicago has 811 licensed beds.
If an outbreak hits, “things that don’t need to be done right now won’t be done right now,” said Dr. Raj Govindaiah, chief medical officer for Memorial Health System, which runs hospitals in downstate Springfield, Lincoln, Decatur, Jacksonville and Taylorville.
In New York state, which has a large outbreak, the health department is accelerating regulations to get nursing students certified to work more quickly and is asking retired doctors and nurses to offer their services, Gov. Andrew Cuomo said.
This week, the American Hospital Association, American Medical Association and American Nurses Association asked for a presidential emergency declaration that would allow doctors and nurses to work across state lines and would waive certain rules to free up hospital beds. Similar declarations were issued during Hurricane Katrina and the swine flu outbreak.
On Friday, President Donald Trump responded by issuing an emergency declaration and said he was giving the U.S. health secretary authority to waive federal regulations and laws to give doctors and hospitals “flexibility” in treating patients.
How bad U.S. hospitals will be hit is unclear, in part because mistakes on the part of the government in ramping up widespread testing for the virus have left public health officials uncertain as to how many people are infected.
The number of cases in the U.S. was put at around 1,700 Friday, with about 50 deaths. But by some estimates, at least 14,000 people might be infected.
Experts fear that when the problems with testing are resolved, a flood of patients will hit the nation’s emergency rooms. But large-scale testing will also give health authorities a clearer picture of the outbreak. “What’s most important now is that we get the testing done,” said Richard Pollack, president of the American Hospital Association.
In hard-hit Italy, doctors have been forced to make agonizing decisions about which critically ill patients get care. Doctors fear that could happen in the U.S., too.
“Studies predict that a moderate outbreak could result in 200,000 patients needing intensive care,” said Dr. Leana Wen, an emergency medicine specialist at George Washington University. “The U.S. only has 100,000 intensive care beds, and most are already occupied.
“If tens of thousands become sick at once, people will simply not receive the care that they need.”
Contributing: Associated Press