Hospitals are bracing for an onslaught of patients as the coronavirus spreads in the United States, with experts warning that a spike in cases could overwhelm the health care system.
Officials are increasingly calling for steps like canceling large gatherings as a way to slow down the spread of the virus. They say such measures are critical to smooth out a spike in cases over time and prevent hospital capacity from being overwhelmed.
In the meantime, hospitals across the country are making plans to try to deal with the influx in patients. Some are concerned there could be shortages of key equipment like masks and gowns to protect health care workers, and even ventilators that allow seriously ill patients to breathe, if the virus’s spread grows severe enough.
Jeremy Konyndyk, a senior fellow at the Center for Global Development who helped direct the U.S. response to the Ebola crisis, wrote on Twitter that the core objective is “slowing spread enough to buy time for hospitals to stay on top of critical cases.”
He added that the situations in Wuhan, China, where the virus began, and the crisis now in Italy offer stark warnings.
“Wuhan-level spread here would overwhelm our hospitals, and undermine intensive care for everything, not just COVID,” he wrote in reference to COVID-19, the disease caused by the new coronavirus. “That's already happening in Italy.”
Rod Hochman, CEO of Providence St. Joseph Health, a major hospital system on the West Coast that treated the first U.S. coronavirus patient, said he is concerned about running out of masks, gowns and other protective gear for health care workers.
“Right now it's getting less and less,” Hochman said in an interview. “That’s going to become more of an issue if we don’t get resupplied.”
Nancy Foster, a vice president at the American Hospital Association, said part of the problem is that China was a major producer of the protective equipment for health care workers, but the supply chain has been disrupted because of the outbreak of the virus there.
The World Health Organization said last week that industry must increase its manufacturing of protective gear by 40 percent to meet rising global demand.
The slow rollout of tests to identify the virus has also been a problem, Hochman said. “We still don’t have enough availability of testing,” he said, adding that despite assurances from officials, “there's a disconnect and I don't know where it is.”
In addition, if health care workers themselves get the virus, hospitals might not have enough workers to care for the influx of patients.
“If we have to take them off the line, we won’t have enough caregivers,” Hochman said.
On Wednesday, Vice President Pence met privately with leaders of top U.S. hospitals at the White House. Pence also traveled to Minnesota to the headquarters of 3M last week to highlight the company's production of more masks.
While hospitals are planning ahead for an influx of patients, they are often running near capacity in normal times, leaving them with a limited ability to deal with spikes in cases.
A shortage of ventilators, machines that allow patients to breathe when they cannot do it themselves, would be particularly damaging.
“Hospitals like ours, we're always 90 percent occupied, a majority of our ventilators are always in use,” said Dr. Stephen Thomas, chief of infectious diseases at Upstate University Hospital in Syracuse, N.Y. “There is some bandwidth, but it’s not limitless.”
A New York State Department of Health report in 2015 planned for using a lottery system as one option if there are not enough ventilators to go around during a pandemic.
An overwhelmed health care system would make the virus take an even greater toll than it normally would.
“If we don't get a handle on this soon, it may grow beyond our control to manage — not because it's so ‘deadly,’ but because it will overwhelm the system's capacity to care for those most affected,” tweeted Dr. Aaron Carroll, a health researcher at Indiana University. “That's the danger here. I wish politicians seemed to understand that.”
Dr. Nicholas Testa, chief physician executive at the southwest division of CommonSpirit, which includes hospitals in Southern California and Nevada, said his hospitals are conducting drills on how to deal with an influx of infectious patients.
He also noted that a shortage of ventilators is a potential concern that hospitals are planning for.
“If push comes to shove, we would stop doing elective surgeries,” he said, and move the ventilators from operating rooms into the intensive care unit to help.
Multiple hospitals said they plan to use tents outside their buildings to screen patients and care for those who are less ill if the virus worsens.
Health officials are also encouraging people who are not seriously ill to avoid going to the hospital if they don’t need to. Some hospitals pointed to virtual visits as a way for patients with nonserious cases to consult with their doctors.
Hochman, of Providence St. Joseph Health, said his hospitals are bracing for more patients as testing capacity slowly catches up with the number of cases.
“There are thousands and thousands of more cases that have not been recognized,” he said.