U.S. Hospitals Fear Coronavirus Crunch
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The death toll from the coronavirus in the U.S. has risen to 14 people. And as the virus spreads, a major concern is hospital capacity. Thousands of people have had to wait for hospital beds overseas. The question now is, will there be a similar crunch here in the U.S.? NPR's Martin Kaste reports from Seattle, Wash.
MARTIN KASTE, BYLINE: The Seattle area's most serious cases of COVID-19 have been treated here at EvergreenHealth hospital. The CEO, Jeff Tomlin, leads the way into the emergency department.
JEFF TOMLIN: This is the site that's been set up with reverse flow - you'll have a sense of just - go through a little bit of a wind.
KASTE: That breeze he's pointing out is the special HVAC system sucking germs into the space, rather than blowing them out. Inside rooms with sliding glass doors are more patients with probable COVID-19. Emergency physician Brad Younggren emerges from one of them, and it's an effort to take off all of the protective gear, including a powered respirator.
BRAD YOUNGGREN: There's quite a bit of wind. You just have to speak really loudly so you can hear patients. So everything's a little more clunky. So you have to take it slow.
KASTE: Everything about this kind of care takes more time, more gear and more specially trained people. Things are even more complex up in the ICU, where experimental drugs and ventilator machines come into play. This is all very hard to scale up fast, something Tomlin is well aware of.
TOMLIN: Well, right now, I know for certain we have one critical care bed left.
KASTE: On top of COVID-19, this is still a bad flu season, and plenty of those patients also still need critical care. Mahshid Abir says a lot of American hospitals right now are close to capacity. She's an emergency physician at the University of Michigan.
MAHSHID ABIR: We, in the last few weeks in our health care system, have gotten multiple notifications of the hospital being at full capacity. And I would say this is not unusual for most academic centers across the U.S.
KASTE: She's analyzed hospital preparedness for the RAND Corporation, and she thinks part of the problem has been the ongoing high demand for critical care from patients who don't have good access to health care and come to the hospital when they're already very sick. But that's a bigger problem for later. Right now, the question is, if this turns out to be a pandemic, can our hospitals cope?
RICHARD WALDHORN: The arithmetic suggests that we will outstrip hospital resources, particularly intensive care resources, in waves as the pandemic spreads.
KASTE: Richard Waldhorn is a pulmonary critical care physician who studied hospital preparedness for the Johns Hopkins Center for Health Security. If previous flu pandemics are any guide, there might be anywhere from 200,000 to 2.9 million extra-critical-care patients. The total number of ICU beds in America is about 65,000. And he says it's time to prepare for a potential shortfall.
WALDHORN: We're going to have to face the problem of, how do we allocate limited health care resources in some sort of rational and ethical and organized way with the goal of doing the greatest good for the greatest number?
KASTE: To be clear, things haven't reached that point in Seattle. Local hospitals are quietly preparing to increase their critical care capacity by designating floors or wings for COVID-19 patients. Surgeons have been told not to schedule some elective procedures for now.
CASSIE SAUER: We should not have people in the hospitals who do not need hospital care, and there's a lot of them.
KASTE: Cassie Sauer is CEO of the Washington State Hospital Association. It has long argued that too many people take up beds after treatment because there's no place for them to go, no long-term care, for instance.
SAUER: So we are working very closely with the state and with the health insurers to say those patients need to move - be moved out. That's the No. 1 way to create capacity.
KASTE: There's also a plan to try to divert not-so-sick COVID-19 patients away from the hospitals altogether.
BARBARA RAMEY: No, I do not have coronavirus. And I'm sorry, my nose is dripping.
KASTE: Barbara Ramey is a spokesperson for the county, showing the media a drab portable housing unit that was originally used by workers in the Texas oil fields.
RAMEY: It has four separate rooms. There are beds for two people in each room, but public health is going to determine how many people actually stay in each room.
KASTE: The county's planning to set up more of these, and they've also bought a motel. It's all meant to try to isolate infected people, slow the infection rate and try to flatten out the wave of serious patients hitting the hospitals. Back at EvergreenHealth, Francis Riedo is the doctor who ordered the tests last week that identified the first American coronavirus death. Since then, he's been emailing advice to his colleagues around the country.
FRANCIS RIEDO: Start looking now go out and find your high-risk critically ill patients with unexplained undiagnosed infections and start testing them.
KASTE: Because he says you don't want to just wait to see the size of the coming wave.
Martin Kaste, NPR News, Seattle.
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