Local officials from around the country are worried about the readiness of the U.S. public health system, citing a sharply limited number of ventilators to help some of the sickest coronavirus patients and an inadequate supply of critical care beds in a hospital industry that has gone through years of cutbacks in inpatient beds.
As they prepare for an expected influx of patients, local public health officials painted a picture of a system with only a limited “surge” capacity, and stressed the importance of social distancing as a crucial way to keep the numbers of patients at a level the system can handle.
“It’s about our supply of ventilators, our supply of beds, and of course we have to worry about our health care workers and the general stress on our health care system,” said Dr. Amy Acton, the head of the Ohio Department of Health. “If we stay below a certain threshold, we can try not to overwhelm our health care system. So we need to take aggressive measures now.”
Ventilators, which provide mechanical breathing assistance and can make the difference between life and death for those patients who need them, represent the clearest limitation on the health system’s capacity to handle the outbreak. U.S. hospitals have a total of 160,000 ventilators — 62,000 full-featured ventilators, and 98,000 more basic ones that can be used in an emergency, according to a 2020 study by Johns Hopkins University.
And it’s not just the machines. The respiratory therapists who treat these critically ill patients are also in short supply, several doctors and hospital leaders point out.
There is little the government or local officials can do to increase the ventilator numbers in time to address the coronavirus outbreak: There are believed to be around 20,000 additional ventilators in the national emergency stockpile, according to Dr. Richard Branson, a professor of surgery and the University of Cincinnati and critical care expert who got an overview of the supply when he had a role with a manufacturer. The government has not made public details about the emergency stockpile.
That might not be nearly enough. Covid-19 is a brand new disease, and a lot of the needs assessments are based on long-ago flu pandemics. But estimates range from a manageable 64,000 ventilators, if this outbreak is like the 1957 flu, to around 740,000 if it’s more like the 1918 Spanish flu. Based on early data from China, a little more than 2 percent of coronavirus patients require ventilators.
Trump’s Medicare chief, Seema Verma, avoided a direct response when pressed about whether the country had enough ventilators during a Fox News interview earlier this week. Verma on Friday pointed to Trump’s announcement the government would increase ventilator purchases, saying that measure — along with the national stockpile and efforts to mitigate the spread of the virus — would reduce pressure on hospitals.
“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.
Source: https://www.politico.com/news/2020/03/14/health-system-coronavirus-preparation-129066
Droolin’ Dog sniffed out this story and shared it with you.
The Article Was Written/Published By: Joanne Kenen
! #Headlines, #CoronaVirus, #Health, #Healthcare, #Medicine, #People, #Political, #Politico, #politics, #Trending, #Trump, #Newsfeed, #syndicated, news
No comments:
Post a Comment