Is Virginia ready for the potential crush of new patients that may be streaming into hospitals across the Commonwealth?
What if 40% of people in Virginia are infected with the novel coronavirus? And sustained social distancing is able to spread out the duration of the disease over six months? And let’s assume most elective surgeries are cancelled or postponed, doubling the number of hospital beds and intensive care unit beds.
Predictive modeling from the Harvard Global Health Institute concluded that even under that scenario, Virginia would still have more than three sick patients for every hospital bed and almost six really sick patients waiting for ventilators for each and every ICU bed.
“The beds are what they are. I mean those numbers are not made up," says Thomas Tsai at the Harvard Global Health Institute. He was part of the team that put together the projections for a range of different scenarios.
“The numbers are scary. But the future and the result doesn’t have to be. But that means that we don’t ignore the numbers. That we hope for the best and prepare for the worst,” he explains.
That means taking steps now to deal with the potential influx of sick people arriving at hospitals in Virginia in the near future. That could mean things like repurposing recovery rooms where people are taken after surgery into isolation wards, for example. He says it’s important to remember that the critical lack of beds does not mean that hospitals are not prepared. It just means they’re not designed to handle the kind of influx that might happen if one fifth of adults who are infected with the coronavirus need to be hospitalized.
“The fact of the matter is that in the United States, we don’t have a steady ratio of beds or ICUs to a population density," Tsai explains. "That’s not how our healthcare system is designed. So in some ways, the areas that are most likely to be hit are also the most-dense areas.”
The numbers are particularly alarming for ICU beds. Even if Virginia cancels or postpones elective surgeries and extreme social distancing spreads the disease out over 18 months, Virginia will still have a 185% need for ICU beds. That’s almost two sick patients waiting for a ventilator for each ICU bed.
“There are other ways to create those ICU settings," Tsai says. "For example, operating rooms have anesthesia machines which could be cross-purposed as ventilators, especially as the elective surgical volume decreases.”
Hospitals across Virginia are already taking measures to prepare for a potential spike in sick patients, cancelling or postponing all those elective surgeries was a first step. Mary Washington Healthcare in Fredericksburg has already opened a field hospital, and other hospitals are considering similar plans. Julian Walker at the Virginia Hospital and Healthcare Association says the numbers compiled by the Harvard Global Health Institute are limited to existing hospital beds.
“There’s also an inventory of other healthcare facilities in the Commonwealth that are not hospitals that also have medical beds that, depending on the severity of the situation, those could also be tapped,"” Walker says.
In addition to that, Governor Ralph Northam is working with the Army Corps of Engineers to look at building makeshift hospitals if needed. And the governor recently issued an executive order giving hospitals more flexibility to expand capacity as they try to figure out how they’re going to deal with the potential crush of new people.
“During this public health emergency, government rules about establishing additional hospital beds have also been relaxed," says Walker. "And so all of the tools that are available are being explored and are being leveraged.”
Hospital administrators are about to be stress tested on something they’ve been preparing for for almost 20 years, ever since 9/11. That’s when health officials and state government leaders joined with the hospital community and first responders to create the Virginia Healthcare Emergency Management Program. Now all that strategic planning and resource coordination is about to be put to use, one hospital bed at a time.
You can find more information about the Harvard Global Health Institute projections here.