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What U.S. Hospitals Must Do To Prepare For The COVID-19 Surge


To another coronavirus question now, which is, are America's hospitals ready? That is one of the most urgent questions public health experts are trying to answer right now. Other places in the world where the coronavirus outbreak appears to be just ahead of here in the U.S., they have already seen their hospitals overwhelmed. Think Italy. NPR's Selena Simmons-Duffin and NPR's Nurith Aizenman have this report on preparations here in the U.S. Here's Nurith.

NURITH AIZENMAN, BYLINE: Here's why hospitals are so anxious to get ready for what's coming. When a hospital is flooded with more critically ill patients than it can handle, more patients die.

SELENA SIMMONS-DUFFIN, BYLINE: The stakes could not be higher. I wanted to find out what hospitals need to be doing, so I went to a really busy one in Washington, D.C.

CRAIG DEATLEY: We are currently in what we call our ready room.

SIMMONS-DUFFIN: That is Craig DeAtley. He is director of Emergency Management at MedStar Washington Hospital Center.

DEATLEY: Over to your left, you'll see there's a cart that has our training powered air purifying respirators. This is our optimum level of respirator...

SIMMONS-DUFFIN: It looks like a warehouse with exposed pipes, fluorescent lights, drains in the floor. They use it for training, storage or whatever the latest emergency calls for. When I visited, they were getting ready to move carts of supplies out to turn this room into a patient screening area. So if you show up and think you have COVID-19, you might be screened here or in one of the tents they're pitching in the parking lot.

DEATLEY: When you present yourself, you'll see signage that reminds you, please maintain your distance. You'll be given a mask quickly and asked to put it on.

SIMMONS-DUFFIN: Even if triage goes smoothly, that is just the first step. People who are really sick will need to go to intensive care units, ICUs.

AIZENMAN: Yeah, this could be the real choke point for many hospitals in America.

ERIC TONER: For the average American city, we would probably need twice the normal intensive care capacity than we normally have.

AIZENMAN: That's Dr. Eric Toner of Johns Hopkins Center for Health Security. He and collaborators at Harvard University and Nanjing Medical University in China - they looked at what happened to intensive care units in Wuhan, China, the first place this outbreak hit, where they saw tens of thousands of ICU patients. Toner estimates if the U.S. sees the same rate of spread, every hospital here would have to take drastic steps to meet the need.

TONER: Normally, we'd put a pneumonia patient in a medical ICU.

AIZENMAN: But they might have to commandeer any free beds in the ICUs of all sorts of specialized departments - neurology, pediatrics - a challenge.

TONER: Those units are pretty full.

AIZENMAN: So already, he says, some hospitals are planning to remodel other rooms, even expand into larger spaces like auditoriums. Then there's the equipment.

TONER: People on ICU need all kinds of specialized equipment. They need IV pumps. They need monitors of various kinds.

AIZENMAN: And most important, for really sick people with COVID-19, you need ventilators, machines that essentially breathe for a patient. Across the U.S...

TONER: We have a finite number of ventilators.

SIMMONS-DUFFIN: DeAtley told me at Washington Hospital Center, they have extra ventilators ready to go.

DEATLEY: We have 12 here in the corner. I have another six in the back room.

SIMMONS-DUFFIN: He feels fairly confident about their supply, and nationally, there's a stockpile - several thousand ventilators that hospitals could pull from. But there's the issue of finding or training staff to provide all this extra care.

DEATLEY: Each hospital would have a surge plan of not only finding more beds but also then finding the staff to be able to staff those beds.

AIZENMAN: Which brings us to the problem of keeping health workers safe. Nahid Bhadelia is medical director of Boston University School of Medicine's Special Pathogens Unit.

NAHID BHADELIA: Our health care workers are the most precious resource in this response.

AIZENMAN: She says if health workers can't protect themselves, more and more of them will start to fall sick.

BHADELIA: And so you're going through your cadres of health care workers until you get to a point where you cannot provide the kind of care you want to the patients.

AIZENMAN: They're going to need personal protective equipment - masks, goggles, gowns. Hospitals in Washington state have already turned to the national stockpile for those things. Bhadelia says her hospital has enough protective gear right now.

BHADELIA: You know, if you asked me in six months, I don't know what the scenario might look like. But nobody knows how many months this might go on for.

AIZENMAN: Overall, Toner at Johns Hopkins concludes that hospitals in the U.S. will just about meet all these various needs, but that's on the macro level.

TONER: In some communities, they will be OK. In other communities, they will be just making it. And in other places, they will be totally overwhelmed.

SIMMONS-DUFFIN: Even at a big, sophisticated place like MedStar Washington Hospital Center in D.C., they feel they have to get ready for the worst. DeAtley, the emergency preparedness director, says they have an ethics plan for how to make heart-wrenching decisions.

DEATLEY: Who gets a ventilator versus who gets a bag valve mask versus who doesn't get either one of the two?

SIMMONS-DUFFIN: Doctors are already making those choices in Italy based on age, likelihood of survival.

DEATLEY: Clearly, we all hope that we don't see that extreme here in this country, but we have a plan if it came to that. Other hospitals I know have a plan as well.

AIZENMAN: But Toner says what people out in the community do now to slow down the virus - that could change the picture for hospitals.

TONER: I mean, it won't be a walk in the park, but I think it would be manageable.

AIZENMAN: All the social distancing Americans are trying to do now - shutting down bars and restaurants, hunkering down at home - might seem like an overreaction.

SIMMONS-DUFFIN: But those measures could be what makes it possible for hospitals to see us through this crisis to be able to save more lives. Selena Simmons-Duffin.

AIZENMAN: And Nurith Aizenman, NPR News.

(SOUNDBITE OF SQUAREPUSHER'S "TOMMIB") Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Selena Simmons-Duffin reports on health policy for NPR.

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