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What Massachusetts doesn’t want to become is Italy, where hospitals are now so overwhelmed that they have gone on something approaching a wartime footing, rationing care and space. The death rate from Covid-19 in Italy is at least 5 percent (some estimates put it as high as 6 or 7 percent); 50 percent of those testing positive require hospitalization and 10 percent end up in intensive care units. (The World Health Organization estimates a global average death rate of 3.4% for this coronavirus pandemic, but Dr. Anthony Fauci of the National Institutes of Health last week estimated a death rate more like 1% for the United States.)
So when health care professionals talk about using “social distancing” to “flatten the curve” of new infections, what they mean is that with some real luck new infections will be spread out over a longer period of time, and be lower at the peak of the epidemic, so as not to overwhelm the existing health care system — and maybe even give researchers time to come up with new treatments.
The numbers alone are sobering. Dr. Ashish Jha, director of the Harvard Global Health Institute, said in an interview with WBUR that epidemiologists estimate that between 40 and 70 percent of adults will get the infection. Even taking that lowest number that means some 2 million adults here in Massachusetts could get infected. Using China’s data that would mean 400,000 hospitalizations.
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“At any given time in Massachusetts, we think there are 3,000 to 4,000 hospital beds open at most,” he said. “And so if you start doing the numbers, you very quickly realize we do not have anywhere near capacity to take care of tens of thousands of people who might need hospitalization.”
A lean health care system — where unused beds and underutilized facilities are discouraged — has been the public policy goal for several decades. But how will it respond in a crisis, how can it create “surge capacity"?
In this instance, at least the private sector is light years ahead of the public sector in its ability to respond to the current crisis. With the White House having taken far too long to finally declare a state of emergency on Friday and the Baker administration seemingly flummoxed, it certainly helps that the hospital industry here has taken the lead.
Massachusetts General Hospital has literally written the book on dealing with pandemics — its experience in dealing with the 2002-2003 SARS outbreak and its role as one of 10 medical centers equipped to deal with Ebola infections provided ample experience. Their handbook now widely distributed and available on the Massachusetts Hospital Association website offers chapter and verse on how institutions can cope in the weeks and months ahead.
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But according to the MHA, there are some 14,596 staffed beds in Massachusetts’ acute care hospitals and only about 1,112 in various ICU units (not counting specialized pediatric and burn units).
“The bottom line here is to free up hospital beds, and that should have been done yesterday,” said Eugene Litvak, president of the Institute for Healthcare Optimization, which has long specialized in managing patient flow. “If we did that, we would be in much better shape now.”
And while some in the industry fear the state is already about six weeks too late, there are some well established protocols for dealing with the crisis.
- Hospital beds can be “repurposed” — transitioned to different levels of care. A post-op recovery room can become an all-purpose ICU.
- Community hospitals and health care facilities can be used for patients requiring lower levels of care.
- Elective surgeries can be cancelled or postponed. Or as one doctor put it, “You don’t want someone getting a hip replacement requiring days and days of care and nursing staff” in the middle of a pandemic.
On the latter issue, while hospitals are currently free to make their own judgment calls on when or if to call off elective surgeries (some patients wanting to be as far as possible from hospitals are already making those calls on their own), there is a role for the public sector here too. An executive order from the governor would at least put hospitals on a level playing field and show a level of pro-activity.
“What this data shows us is without very aggressive action, we are in pretty serious trouble in terms of hospital capacity in eastern Massachusetts,” Jha told the Globe.
Making those decisions sooner rather than later — and making them with some leadership from the governor’s office will better prepare this community for the inevitable trauma ahead.
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Hospitals must now plan for pandemic’s worst - The Boston Globe
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