The Morning Jolt

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A Hard Look at the Remaining Hospital Capacity across America

Patients suffering from COVID-19 coronavirus in an intensive care unit at the Oglio Po Hospital in Cremona, Italy, March 19, 2020. (Flavio Lo Scalzo/Reuters)

On the menu today: States are racing against the clock to increase capacity, but they might not be fast enough; what steps states are taking in preparation; and some unfortunate news from the direction of the New York Jets.

Some States Are Dangerously Close to Capacity

You are hearing a great deal about rapid increases in the number of coronavirus cases in New York, Seattle, and Los Angeles, and for good reason. The most cases are there, and the Big Apple appears to be entering one of the city’s most difficult hours. The U.S. Army has already deployed three military hospitals to Washington State and New York.

But there are a lot of corners of the United States where the coronavirus outbreak is starting to hit smaller cities, with fewer hospitals, beds, intensive-care units, and ventilators.

Atlanta mayor Keisha Lance Bottoms said in a television interview with the city’s CBS affiliate Tuesday afternoon that the city’s hospitals are at capacity. But I notice this interview is not the lead story on the affiliate’s website, nor is that news anywhere in the Atlanta Journal-Constitution as of this writing.

Elsewhere in Georgia, we can find more specifics about a hospital in the state’s eighth-largest city that no longer has room in their ICU units:

Dr. Steven Kitchen, chief medical officer at Phoebe Putney Memorial Hospital in Albany, said during a televised briefing Tuesday that the hospital’s three ICUs are filled and the hospital improvised a fourth 10-bed unit for non-COVID-19 patients. He said that unit is full too, and that on Monday, doctors had to discharge ICU patients to make room for five patients with worsening conditions.

“We continue to see an increase in the number of COVID-19 patients in our care,” Kitchen said. “We’re quickly approaching the point of maximum capacity. We need a relief valve.”

Perhaps the most ominous public statement is from the state of Alabama:

Alabama Department of Public Health officer Dr. Scott Harris, at a press conference Monday, again urged Alabamians to take the COVID-19 pandemic seriously and abide by social-distancing restrictions the state has ordered.

A number of hospitals in the state are already “nearing capacity,” as the number of cases in Alabama continues to rise.

The governor of Louisiana declared in a letter to President Trump that he fears the state’s hospital capacity will hit its limit on April 4.

A few days ago, the Dallas-area hospital association wrote a letter to Governor Greg Abbott warning that “if nothing changes, more than 200,000 Texans will be hospitalized by the middle of May — far outpacing some 50,000 beds available.

It is not just the southern states that are finding themselves approaching their limits. In southeastern Michigan, one chain of eight hospitals declared they are approaching capacity:

Beaumont Health is caring for 635 patients with confirmed or suspected COVID-19, putting pressure on the eight-hospital system as it nears capacity for staffing, protective equipment and ventilators, the Royal Oak-based health system said Tuesday.

The health system has been transferring patients between hospitals to find space and is beginning to convert some operating rooms into intensive care units, Beaumont Health Chief Operating Officer Carolyn Wilson said.

Beaumont Health system officials said they currently have enough ventilators to treat seriously ill COVID-19 patients, “but that could change as more people become infected,” according to the health system.

That group of hospitals cumulatively has more than 3,000 beds.

This is all focusing on parts of the country that have hospitals. I ran across this jaw-dropping statistic: “In Idaho, Oregon, Colorado and New Mexico, more than 19,000 citizens over the age of 65 live in counties without hospital beds.” In fact, “1.8 million people 65 years and older (4% of all U.S. seniors) live in a county without a hospital. Eighty-six percent of counties with no hospital beds have greater than average senior population, and most of those counties are rural.” Then again, if a county is sparsely populated enough to not have a hospital, it probably doesn’t get a lot of travelers and there might be lesser chance of anyone in the county contracting coronavirus.

The state that has the highest percentage of seniors living in a county without a hospital is . . . Virginia, at 24 percent. Obviously, patients can go across a county line to get care at a hospital. (Presuming, of course, the neighboring county hasn’t attempted to “close its borders.”) But this means some hospitals have to handle the patients of the surrounding counties, not just their own.

In the Hot Spots . . .

Meanwhile, closer to the New York area, the situation is as dire as many feared. Holy Name Medical Center in Teaneck, N.J., is “nearing its capacity and supply stock,” according to Dr. Suraj Saggar, the hospital’s chief of infectious disease.

On Suffolk County on Long Island, N.Y.:

The news comes as local hospitals, including Stony Brook Southampton Hospital, rush to comply with Governor Cuomo’s mandate to increase hospital capacity by more than 100 percent across the state. But there is still a shortage of staff and equipment. [County Executive Steve] Bellone said the 25 new ventilators coming soon to Stony Brook University Hospital are going to be “woefully inadequate” when COVID-19 cases peak.

He could not say how many virus cases Suffolk County is projected to have over the coming weeks, but called the hospitals’ directive “a herculean task” and said the county is doing everything it can to support them.

Craig Spencer, director of global health in emergency medicine at New York Presbyterian/Columbia University Medical Center, wrote in the Washington Post yesterday: “Hospitals are nearing capacity. We are running out of ventilators. Ambulance sirens don’t stop. Everyone we see today was infected a week ago, or more. The numbers will undoubtedly skyrocket overnight, as they have every night the past few days.”

The Connecticut Public Health Department “has confirmed 415 positive cases and 10 deaths in Connecticut. As testing is becoming more prevalent the numbers are increasing at a rapid pace and hospitals, especially in Fairfield County, are nearing capacity.”

As for California, hospitals are expanding capacity as fast as they can, but the virus is likely to keep pace and could well overtake them.

At most local hospitals, there isn’t much room for new patients. Gov. Gavin Newsom said Monday that 50,000 additional hospital beds would be needed statewide to cope with the outbreak. In L.A. County, 90 percent of ICU beds are already occupied, even with facilities in recent days doubling the number of available beds for patients.

Last Friday, some people who had contended the country was overreacting insisted, “hospitals are fine.” I’m afraid that is not the case. Once again, wanting something to be true does not make it true, and that kind of thinking is probably what is most dangerous in an evolving crisis.

There are some corners of the country that still have significant unused capacity, according to recent statements from government officials.

If you need access to a hospital, right now you would probably like to be in Ohio:

Ohio’s more than 200 hospitals are at 60 percent capacity, according to Ohio Department of Health Director Dr. Amy Acton. Acton says they’ll still have to expand intensive care unit capability by 50 percent, and will likely have to turn to hotels and college dorms for space. There are more than 560 confirmed cases in Ohio. More than 25 percent of those people have been hospitalized and 62 of them in intensive care. Acton is expecting cases to surge in the coming days.

Capacity levels are similar in Illinois: “As of March 23, 57 percent of the state’s ICU beds, 28 percent of the state’s ventilators, and 51 percent of the state’s non-ICU beds were being used.

Continuing the signs of significant preparation in the upper Midwest, the state of Minnesota already expanded its capacity:

Since Wednesday, March 18, the number of empty hospital beds available across Minnesota has gone from 1,941 on Wednesday, March 18, to 2,413 on Sunday, March 22, representing a 24 percent increase.

The number of adult intensive care unit (ICU) beds, which will be most critical at the height of the pandemic, has gone up 20 percent, from 197 on Wednesday, to 238 on Sunday.

And the number of beds that could be made available during a medical surge — when the pandemic strains hospital resources — went from 1,011 beds to 1,355, up 34% in just five days.

But the biggest surprise of all is the supply of ventilators, which would help the most critically ill breathe.

In what is the first real snapshot of the availability of ventilators statewide, these new numbers show there were 800 ventilators available in Minnesota hospitals as of Wednesday, and that number had grown to 1,190 by Sunday, representing a 49 percent increase.

Officials in Maine are worried about a coming surge, but at least for now, they are well below capacity.

As of Tuesday, there were 118 confirmed cases of coronavirus in Maine, with 15 patients hospitalized, up from 32 cases and three hospitalizations a week ago.

Maine CDC Director Nirav Shah said on Tuesday that 77 intensive care unit beds and 248 ventilators are currently available in Maine. Shah said the state was hoping to acquire an additional 300 ventilators in order to meet anticipated future needs.

Reading all this, a lot of people are probably feeling helpless.

We cannot control conditions at our nearest hospitals. What we can do is stay at home if we are able to, practice social distancing as much as we can if we are not, order something nice to be delivered to the doctors, nurses, EMTs pharmacists, and other critical responders that we know, order take-out and delivery to help keep our local restaurants and eateries operating, and wait.

As a feature in the New York Times put it a few days ago, “if it were possible to wave a magic wand and make all Americans freeze in place for 14 days while sitting six feet apart, epidemiologists say, the whole epidemic would sputter to a halt. The virus would die out on every contaminated surface and, because almost everyone shows symptoms within two weeks, it would be evident who was infected. If we had enough tests for every American, even the completely asymptomatic cases could be found and isolated.”

The closer we can get to that two-week minimal-movement-and-interaction state, the closer we get to the end of the coronavirus threat.

ADDENDA: Look, world, I feel like I’ve dealt with a lot of bad news lately. Was it really too much to ask to see Robby Anderson remain with the New York Jets? A man can only bear so much!

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