US hospitals are scrambling to prepare for a potential surge in coronavirus cases, as one in Washington already reports depleting supplies
US hospitals are using a variety of tactics to deal with the growing coronavirus outbreak with limited supplies and hospital beds. Some of the measures, like pulling doctors out of retirement, have been used in other COVID-19 impacted countries like Italy. The US only has 2.8 beds for every 1,000 people, while Italy and China have a slightly larger capacity. Some experts estimate that millions of Americans may need hospitalization and that the US is short on need ICU beds and ventilators. Several hospitals have already started setting up "COVID Cabanas" to treat suspected coronavirus cases.
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Hospitals across the country are using multiple approaches to deal with the new coronavirus pandemic as more cases are expected in the US. According to the Associated Press, hospitals have looked to measures like calling doctors out of retirement, setting up tent units outside their main facilities, and even canceling elective surgery procedures. Governors of New York and Colorado have called on "former" health care professionals to be on reserve if other workers should get sick on the front lines. The number of cases in the US surpassed 2,300 but some estimates project that millions of Americans could potentially be infected with the new virus that causes COVID-19. A leaked presentation from a webinar hosted by the American Hospital Association, showed that one expert estimated 96 million Americans could be infected, with 4.8 million needing hospitalization and a little less than 500,000 deaths from the virus. At least 50 people have died from COVID-19 in the US as of Friday. Douglas Wise, a former deputy director of the Defense Intelligence Agency, told Newsweek the US could expect to see a spike in cases similar to what happened in Italy, which could overwhelm the healthcare system. Italy's Lombardy region, which is the epicenter of the outbreak there, was so strained it began pulling doctors out of retirement and pushed up the graduation date of nursing students so they can help combat the outbreak. Italian doctors have had to prioritize saving the young and relatively healthy COVID-19 patients because they don't have the capacity, supplies, or hospital beds to treat everyone. There have been close to 18,000 infections and more than 1,200 deaths in Italy. Back in the US, experts also said hospitals are short on needed ICU rooms and supplies. The US has 2.8 beds for every 1,000 people, the Organization for Economic Cooperation and Development reported, compared to Italy's 3.2 and China's 4.3. "What is happening in Italy can happen here. There is no question," Juliette Kayyem, former assistant secretary for intergovernmental affairs at the Department of Homeland Security, told Newsweek. According to a Center for Health Security at Johns Hopkins report from last month, the US has 160,000 ventilators ready for use in hospitals, and another 8,900 held in a national reserve. However it's estimated that almost one million Americans may need a ventilator during the course of the outbreak. Some hospital doctors are worried they'll have to "ration" medical care if the outbreak gets worse, the AP reported. The US has 95,000 ICU beds but Dr. Irwin Redlener, director of Columbia University's national center for disaster preparedness, told Reuters that if a "full-blown outbreak" were to occur, the US would be short 75,000 to 100,000 ICU beds. "Normally they wouldn't pay attention to available beds and personnel in civilian hospitals, but they would during a global medical crisis," Wise told Newsweek. According to the AP, some patients could end up waiting on stretchers in the hallways of emergency rooms as they wait for an open bed or sharing rooms with other COVID-19 patients. Canceling things like elective procedures can reduce the strain on the hospital. According to The New York Times, most hospitals have disaster preparedness plans in place for several situations including new infectious disease. Other initiatives they may take to expand their ability to meet the demands of this outbreak include sending patients home earlier or renting space in other facilities for makeshift hospital rooms. Hospitals are already facing shortages of supplies and other obstacles in providing care for the anticipated growing number of COVID-19 cases, the Times reported.
A hospital in Seattle area has sent out a note to staff, shared with me, suspending elective surgery and warning that "our local COVID-19 trajectory is likely to be similar to that of Northern Italy." The hospital is down to a four-day supply of gloves. — Nicholas Kristof (@NickKristof) March 14, 2020
C. Ryan Keay, the medical director of the emergency department at Providence Regional Medical Center in Everett, Washington, where the largest outbreak in the country is unfolding told The Times that their hospital is always full, and "it doesn't take much to tip us over the edge." Keay explained that other medical procedures in the hospital could be affected by the influx of coronavirus patients. For example, x-ray rooms have to close for 30 minutes after a someone gets a chest x-ray so they can be sanitized. When a lot of patients need x-rays, there are delays. Keay also told The Times that the need to sanitize facilities used by suspected COVID-19 cases to CDC standards also slows down the process. Gabrield Cade, a doctor at Blue Ridge Regional, told the AP that what happened in Italy was a "huge eye-opener." "We've really got to ... expect that this is going to be bad," Cade told the AP. SEE ALSO: Hospitals are setting up 'COVID cabanas' to prep for influx of potential coronavirus patients Join the conversation about this story » NOW WATCH: A podiatrist explains heel spurs, the medical condition Trump said earned him a medical deferment from Vietnam
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Hospitals hit hard by the coronavirus are looking to restart surgeries and procedures as soon as this week. We spoke with 3 health systems about how they plan to do that.
As states start to reopen, hospitals are among the first services that plan to come back...As states start to reopen, hospitals are among the first services that plan to come back to provide care for noncoronavirus patients. Hospitals canceled elective surgeries and postponed procedures during the coronavirus pandemic to make way for a surge in COVID-19 patients who needed hospital resources. While hard-hit areas like New York still have thousands hospitalized as part of the pandemic's first wave, health systems across the US are planning for how they might recover and safely resume procedures that have been deferred, looking into testing and prioritizing care that can't be delayed any longer. Visit Business Insider's homepage for more stories. Medical procedures are among the first round of services starting up again as governors lift coronavirus lockdown orders. Hospitals are eager to resume normal activity wherever they can, to help their patients and because the procedures generate much-needed revenue. During state lockdowns, some hospitals saw surges in coronavirus cases and became overwhelmed, even moving patients to other parts of the hospital to create more space. But hospitals in areas of the US with few coronavirus cases became far less busy. As a result, they took a financial hit that they passed on to their workers in the form of layoffs, furloughs, and pay cuts. The financial effects continue to be wide-reaching. One study from the consulting firm Millman projected the pandemic could reduce the amount of money we spend on healthcare by as much as $575 billion in 2020. On top of that, patients with other medical conditions had to wait for needed care. Regular checkups, vaccines, and elective surgeries — ones that can be scheduled and aren't emergencies — all got pushed back. "Elective procedures aren't just 'people want them,'" Gregory Adams, the CEO of the health system Kaiser Permanente, said. "There are procedures that need to be done within a time frame, and if we don't do them, they can become urgent." There's also evidence that patients aren't going to the hospital, even when they need help. Dr. Tom Mihaljevic, Cleveland Clinic's president and CEO, said the hospital's Ohio location has seen a decline in admissions for strokes, heart attacks, and newly detected cancers. "We know our population of patients have not become healthier over the last two months, but are simply not seeking care," he said. Now, as some patients can't wait any longer and as the pandemic ebbs in parts of the US, hospitals are grappling with how and when to reopen their facilities to more patients without COVID-19, the disease caused by the coronavirus. They know that without a careful approach they risk more patients becoming infected, running out of protective gear, or closing down again. For some, May is a critical month to figure out the right approach. If hospitals don't start to reopen, the financial impact of the pandemic might push some out of business. "If we just stay locked down in our hospitals the way we are through the end of May, there wouldn't be much to come back to," warned Rod Hochman, CEO of West Coast-based Providence St. Joseph Health. Hospitals can't resume elective care without the OK from government Most hospitals stopped or scaled back elective medical care in March following pressure from state and federal officials. The goals were to free up space in case of a surge of coronavirus cases, to conserve supplies, and to protect other patients from being exposed to the virus. Since that time, President Donald Trump has signed two bills into law with $175 billion in relief money to help healthcare providers recoup costs and cover coronavirus expenses. On April 19, the Trump administration put out guidelines for hospitals to resume elective surgeries in parts of the US that have low numbers of coronavirus cases. The guidelines raised several factors for hospitals to keep in mind as they decide whether to reopen, including evaluating whether they had enough staff that could rush in to mitigate a surge, how much protective equipment and supplies they had, and how well they could conduct tests. "This isn't going to be like a light switch," Seema Verma, administrator of the Centers for Medicare and Medicaid Services, said during a recent White House press briefing. "It's more like a sunrise, where it's going to be a gradual process. And healthcare officials across the country and healthcare systems need to decide what services should be made available. And, ultimately, doctors and patients need to make decisions about their healthcare services." But the administration also told hospitals that they would have to work with states to figure out the exact timing and recommendations for opening up. So far, Alaska, Arkansas, California, Colorado, Indiana, Oklahoma, Texas, and Utah are allowing hospitals to resume some elective surgeries. Other states will be starting soon. Ohio Gov. Mike DeWine announced Monday that on May 1 the state will let all health procedures resume that can be done without requiring an overnight stay in a hospital. The Cleveland Clinic team said it was implementing a phased approach in line with what the governor's office stipulated. Cleveland Clinic began planning for how to resume regular activity a few weeks ago. Mihaljevic said the health system's Ohio hospital has been checking off the boxes it needs: waiting until the pandemic is under control in the state; making sure it has enough staff to react to a surge; and ensuring it can test, trace, and contain cases. Cleveland Clinic will be prioritizing cancer and cardiovascular screenings and caring for people with neurological disorders and life-threatening conditions, Mihaljevic said. Reached for a follow-up about its plans for testing, the health system declined to share additional details, saying they would become available later this week. States are all in different places when it comes to fighting the pandemic. For instance, Dr. Janice Nevin, president and CEO of ChristianaCare in Delaware, said that discussions about resuming services were still in the early stages but would be part of the health system's work in the coming weeks and months. "We're not there yet," Nevin said of reopening. "We are still, I would say, in the thick of things." How Providence is looking to restart surgeries in Washington Providence St. Joseph Health, which runs 51 hospitals on the West Coast, has been in the coronavirus fight for three months. Its facilities in Washington were the first to treat the novel coronavirus in the US and feel the effects of the outbreak as it hit nursing homes in the area. Now, the health system has to grapple with how to restart other services. "You're supposed to take care of the whole public," Hochman said. "We want to make sure we're doing that the right way." His worry: people aren't feeling well, but they're not coming into the hospital, either because their treatments have been postponed or they fear getting exposed to the novel coronavirus. Washington Gov. Jay Inslee has said that some restrictions in the state will start to lift on May 4. Among those services to come back online will be elective surgeries, outdoor activities, and certain construction projects. Hochman said Providence has a plan in place for the first week of May. Providence plans to bring back surgeries based on how urgent they are. For instance, people waiting to have a biopsy done will be among the first to get care. The plan will be to test patients and caregivers for coronavirus before they go into the operating rooms. Staying locked down isn't an option for Hochman or for other hospitals he has spoken with. "You want to be sure you're in your community a few years from now and be able to serve them," Hochman said. Hospitals are assuming they'll be fighting COVID-19 for years For Northwell Health, New York's largest health system, the recovery may be just as challenging as fighting the coronavirus, CEO Michael Dowling said. Northwell Health at times had 3,000 patients hospitalized with COVID-19, the disease caused by the coronavirus. "The recovery is going to be as difficult if not more difficult than managing the crisis," Dowling said. The health system began discussing what recovery might look like starting in mid-April. One task will be communicating to patients that it's safe to go back into a hospital. Many patients are ready to go back, while others are fearful, Dowling said. The discussion now is how to contain the COVID-19 cases that are in the hospital, so the rest of the space is coronavirus-free. One of the questions that the health system is discussing now is whether there should be one hospital where all coronavirus patients go to. That way, not every hospital has to set up space to care for COVID-19 patients, ideally keeping them COVID-19-free. It might also mean certain parts of the hospital are devoted to COVID-19, Dowling said. Even as the initial wave ebbs, there'll still be patients who need to be hospitalized with coronavirus for the foreseeable future. "You're going to have COVID patients for a long, long, long, long time," Dowling said.Join the conversation about this story » NOW WATCH: How the Navy's largest hospital ship can help with the coronavirus
Here's what it's like to receive a life-saving heart transplant in the middle of the coronavirus pandemic
Elaine McDevitt needed a heart transplant — and received one — amid the ongoing global coronavirus...Elaine McDevitt needed a heart transplant — and received one — amid the ongoing global coronavirus pandemic. She entered the hospital on January 27 when there were only five COVID-19 cases in the US, and she left on April 6, when the US was experiencing the worst outbreak in the world. Over her two-month stay — when the drugs she took to prevent a heart rejection put her at-risk for a COVID-19 infection — McDevitt saw how the virus changed the hospital, from a moratorium on visitors and hugs to widespread use of protective gear. Visit Business Insider 's homepage for more stories. Elaine McDevitt was going to die. "I thought heart failure was something old people had when they were dying," the 59-year-old of Cumru Township, Pennsylvania, told Business Insider. "I didn't know you could walk around with heart failure." In 2014, after a string of misdiagnoses that lasted 18 months, McDevitt was diagnosed with Sarcoidosis, a rare autoimmune disease that often affects the lungs. In McDevitt, it was causing her heart to fail, which was even rarer. As time went by, things became more serious. Finally, last August, doctors told her it was time to be evaluated for a heart transplant. They needed to conduct tests to make sure her body was otherwise well enough to receive a heart transplant such as not having cancer or her bones needing to be strong enough — despite years of steroids meant to reduce the more serious effects of her illness — to withstand a transplant. McDevitt waited to be approved and on January 27 — her son's birthday and a day before she was scheduled to be admitted to the hospital — she reached her breaking point: her constant pain and exhaustion sent her to Thomas Jefferson University Hospital in Philadelphia, about 60 miles east of the home she shares with her husband, Tom. "My numbers were very borderline," said McDevitt who was moved to a more urgent status on the list of people in need of a transplant. That day she was admitted, the novel coronavirus was still mostly constrained to China, though it had begun to spread around the globe. It had only killed 106 people and just five people had been diagnosed with the virus in the US. No instances of community spread had yet been reported on US soil. "I had never even thought about it," McDevitt said of COVID-19, the disease caused by the novel coronavirus. But when McDevitt finally left Jefferson on April 6 — more than two months after she first walked through the hospital's doors — the world was different. The virus had infected at least 1,390,511 and killed 80,759 globally. The US now had the worst outbreak worldwide. The city of Wuhan in China's Hubei province, where COVID-19 is believed to have originated, was just two days away from relaxing the city's strict lockdown after 76 days. "When I walked through the halls I could tell which rooms the coronavirus patients were in because of the PPE that the people had on, so I would know," McDevitt told Business Insider of her stay in the hospital. "Because of HIPPA, nurses didn't tell you anything. But I knew what the costumes were." Like most hospitals nationwide, things at Jefferson changed quickly "I always say I came into the twilight zone by myself on the 27th and since then everyone has joined me," McDevitt joked. At the beginning of her more than two months in the hospital, it was business as usual at Jefferson. But in early March, things began to change as US health officials started to offer serious warnings about the possible impact of the novel coronavirus in the US. First, visitors were no longer allowed, McDevitt said, recalling that the restriction was put in place around her birthday, on March 11. McDevitt said her husband, Tom, and daughter, Elyse, still visited her to celebrate her birthday as she wouldn't see them for weeks while she remained in the hospital. She would be alone as she waited for her new heart, when she was rolled to the operating room to have her heart removed from her body, and when she woke up post-surgery, confused from her drug-induced nightmares that the transplant had been ineffective. Her son, Mark, who at the time worked for a Massachusetts congresswoman on Capitol Hill, had already stopped making the trip from DC to Philadelphia to visit his mother even before the hospital officially banned visitors, describing his workplace as a "natural disease vector." "It was obviously the right call, and in a way, it was comforting to know they were taking drastic measures," Mark told Business Insider. "It's not a low-risk procedure." Soon, masks became the norm for all patients and hospital staff. "Even the people who bring you your food wore them," McDevitt said. Dr. René Alvarez, the cardiologist who diagnosed McDevitt with Cardiac Sarcoidosis, told Business Insider that Thomas Jefferson University Hospitals were fortunate in that they weren't facing an imminent shortage in N95 masks, gowns, or other protective equipment needed to protect patients and medical workers from infection. The same can't be said for many hospitals around the country, particularly in areas that have experienced severe outbreaks of the virus. In New York City, for example, which has faced the most severe outbreak of COVID-19 in the US, some hospital staff were told to reuse N95 masks until they were "soiled" or damaged. Nurses, also in New York, have reported shortages of other Personal Protective Equipment (PPE), including gowns and were thus advised to use garbage bags to protect themselves and their patients. It's not just New York, either. Hospitals in Wisconsin on Friday reported having less than a one week supply of goggles, gowns, face shields, N95 masks, and paper medical masks — all worn to protect healthcare workers and their patients from infectious diseases, like COVID-19. Nurses at Jefferson continued their close contact with patients like Elaine, though nurses were assigned to a set group of patients, limiting potential exposure as they were "constantly wearing gloves and changing them," McDevitt said. There was also a moratorium on hugs in the hospital, she said. At Jefferson, doctors no longer came to their patient's bedside unless it was absolutely necessary. Instead, they stood in the doorway to talk to their patients. On March 25, McDevitt was told doctors had found a potential organ donor. Her transplant specialist told her the good news from the doorway of her hospital room while she sat in her hospital room ready to eat lunch. "He was on the phone, and he gestured to me and said 'don't eat your lunch,'" McDevitt recalled. "Right away, I knew what that meant. I had tears in my eyes." Still, McDevitt didn't want to get her hopes up. It wasn't the first time doctors provided a similar heads up. At the end of February, McDevitt's medical team told her they had found a potential heart. They eventually passed on the organ because the donor had recently traveled to a country experiencing a COVID-19 outbreak. Because of issues with COVID-19 testing in the US, her medical team worried the organ donor could be infected by the virus and her doctors didn't want to put her at risk. "You have individuals that — clearly — they can't wait," Dr. Howard Massey, the surgical director of cardiac transplantation at Jefferson University Hospital told Business Insider. "There was no way Elaine could wait to get a heart transplant. She was going to die and that was very evident. If there had been any way possible to delay this in her, we would have, but that was just not an option for her." Despite the threats posed by the disease, doctors still work to provide essential care "We are delivering this care to individuals similar to Elaine on an ongoing basis to the best of our ability," Massey said of the numerous organ transplants that occur at the hospital. Still, he noted, hospitals have made efforts to free up beds for potential COVID-19 patients and to limit the number of other patients in the hospital who could be exposed by other patients or staff. "There are certain risks in coming into the hospital environment, and certainly we are doing everything we can to protect individuals within the hospital," Massey said. "Infections and risks like that are inherent within the hospital, so we don't want to potentially expose someone to a perceived risk unless we absolutely have to." McDevitt had eventually undergone her transplant surgery on March 26. She was intubated and placed on a ventilator, which is common for patients after a transplant operation, amid a nationwide shortage of ventilators needed to help the most serious COVID-19 patients. Despite her successful surgery, McDevitt faced a new risk: the immuno-suppressive drugs she needed to continuously take to avoid transplant rejection and reduce the risk of infection put her at high risk for COVID-19. "I said to my doctors, in tears, 'Am I going to be able to survive the heart transplant and the virus?" McDevitt recalled. Her doctors – both her cardiologist and transplant specialist — told Business Insider that she can survive amid the pandemic, but there are still risks. "If you were to look at the risk of having serious infections related to COVID-19, she would fall in one of the high-risk groups," Massey said, adding "their immune systems are altered from the medication we utilize, but it's still intact and they still have the ability to fight infections." "There are some medications we can utilize to help with that, but it is a balance," he continued. "Unfortunately in transplantation today, it's the balance between too much immune suppression versus too little." Alvarez, McDevitt's cardiologist, said patients and doctors are continuing to adjust medical procedures to protect against the virus. For McDevitt, these changes have meant completing post-op physical therapy in her room and avoiding unnecessary trips in the hallway. Normally, recovering patients are encouraged to walk the halls and take the stairs at the hospital as a means of physical therapy. That could put McDevitt at risk, so her exercises were confined to her hospital room. She also had a virtual conference — typically held at her bedside — with a nurse coordinator and a transplant pharmacist to discuss the new medications she needed to take, Alvarez told Business Insider. Temporary changes like these, he added, could lead to permanent shifts in medical care as the coronavirus pandemic has shown the effectiveness of telemedicine. "I think this COVID pandemic will teach us a lot of things. One, that telemedicine and virtual care works and patients are engaged, and it has been very effective," he said. "It's concerning for Elaine, and it's concerning for all transplant patients," Dana Gonzales, one of McDevitt's nurses said the day McDevitt was released from the hospital. "Of course. I worry for everyone and anyone. But we do all the practices and guidelines the CDC put out, and we just do the best we can do." Luckily, a self-described homebody, McDevitt has no plans of leaving the home she returned to on April 6 and is isolating with her husband. Her home is currently closed to visitors — doctor's orders — despite occasional visits from a traveling nurse and physical therapist. She still hasn't seen her kids. "I miss them," McDevitt said, "but they are super conscious of my condition and we all are thankful for FaceTime." Join the conversation about this story » NOW WATCH: How to find water when you're stuck in the desert
Families say hospitals are rationing medical care for other life-threatening illnesses as India mobilizes its resources...Families say hospitals are rationing medical care for other life-threatening illnesses as India mobilizes its resources to fight the coronavirus.