Maryland’s four dozen hospitals are scrambling to prepare for a potential surge of patients sickened by the new coronavirus. Officials are upgrading old flu pandemic plans and inventorying protective gear, medical equipment, staff and beds.
They are, however, facing some tough math.
Federal authorities have estimated that a moderate outbreak like the flu pandemic in 1968 would mean 1 million people hospitalized, including 200,000 needing intensive care. If it’s more like the severe 1918 flu pandemic, 2.9 million could need the ICU.
If Maryland had a proportional share of severely ill patients based on its population, hospitals would need roughly 3,700 ICU beds for a moderate outbreak to 53,000 for a severe one. According to the state Health Care Commission from fiscal year 2018, the latest publicly available, the state has only about 1,200 ICU beds.
“We are sprinting to make sure we don’t have to shift to a crisis standard of care,” said Dr. David Marcozzi, who leads COVID-19 preparedness for the University of Maryland Medical System, which has about 200 ICU beds among its 13 hospitals. “We are putting every step in place so that if we do get a surge in patients, we have the ability to maintain a standard level of care.”
Marcozzi said demand for crisis care is what overwhelmed hospitals in Italy.
Maryland has a total of about 9,400 hospital beds, which serve medical, surgical, ob-gyn, pediatric and psychiatric patients. Hospitals will continue to treat patients in need, such as heart attack victims and pregnant women, but could reassess offering elective procedures, officials say.
So far, Maryland only has 12 cases of COVID-19, the disease caused by coronavirus, and few are hospitalized. Several are considered recovered. But the state logged its first case of “community spread,” a case in which a person did not travel to a heavily affected country or knowingly come into contact with an infected person.
More such cases are expected, said Dr. Timothy Chizmar, state EMS medical director at the Maryland Institute for Emergency Medical Services Systems.
MIEMSS, which coordinates the statewide emergency medical system, has been taking a daily census of available hospital beds, as well as things such as ventilators that are likely to be in high demand for COVID-19′s sickest patients, Chizmar said. Since the count began earlier this month, beds have been up to 90 percent full.
Chizmar said hospitals across the country are required by their accrediting agency to plan for surges and be able to add a minimum of 10% to 20% more beds in unused areas of the hospitals. He said they likely could add far more. They also could work with state health officials to move patients that do not need critical care and cancel elective procedures altogether.
Some already have tents set up outside to triage potential coronavirus cases, a measure that adds space and protects health care workers and other inside from infection.
Chizmar said extra medical staff could come from health care positions outside of hospitals or workers willing to add hours.
“There is an element that we don’t know what’s coming," he said. “We have had the opportunity to get a jump start on this, so I feel we have that advantage."
Chizmar said closing schools and businesses and canceling events may seem like an extreme response with so few local cases, but it’s designed to restrain the growth of cases so medical providers don’t have to face an untenable situation in which there isn’t enough care.
Health systems across the country will be tested, he said. There are more than 1,663 cases nationwide and 40 deaths reported by the U.S. Centers for Disease Control and Prevention.
The country has about 46,500 ICU beds and “perhaps an equal number of other ICU beds that could be used in a crisis,” according to a recent assessment from researchers at the Johns Hopkins Bloomberg School of Public Health’s Center for Health Security.
But, it added, “Even spread out over several months, the mismatch between demand and resources is clear.”
Bob Atlas, CEO of the Maryland Hospital Association, said no one knows how many cases there will be, but hospital and state officials are working on “creative and flexible” ways to ensure everyone who needs care gets it.
He added that not every coronavirus patient will need the ICU. Health officials have said about 80% of cases are expected to be mild to moderate and 20% more serious.
“The question is not how many beds there are, but how many places people can be cared for when they’re ill and what is the appropriate level of care for each one,” he said.
“Hospital space can and will be made quickly available with a surge of critically ill patients," Atlas said. “Many hospitals have activated their emergency response plans to be ready for community need. ... Remember that responding to disasters is not new to hospitals. Emergency preparedness is a year-round activity that is done within each facility, health system, and region.”
For now, hospitals say they’re preparing as they go about their business of caring for patients. Johns Hopkins Medicine, for example, said it has not canceled elective procedures, though Hopkins hospitals and many others have limited visitors to protect their patients.
A real concern is the health of medical providers, said Gene Ransom, CEO of MedChi, the state association of doctors. If they get sick they can’t treat patients.
He said it’s critical that people with symptoms do not go to the emergency room, where they can infect staff and other sick patients. They need to call their health care provider or the health department. If they are deemed a candidate for testing, officials will develop a plan, he said.
An issue so far, however, has been a lack of testing, which Ransom said means no one knows how many people already have the virus or where they may spread it, potentially including in emergency departments.
“There is a level of anger at the federal government for how badly they have handled the issue,” he said of the slow rollout of test kits and the narrow parameters of people allowed to be tested.
The Maryland Department of Health reported Wednesday that the state had run tests on samples for about 90 people, resulting in the 12 positives. The state is no longer saying how many tests it’s running. And, beyond the state lab, officials have not said just where the samples can be analyzed after a doctor orders a test and a hospital takes a nose or throat swab.
MedChi is encouraging medical staff to use telemedicine whenever possible. Ransom said such systems even could be used to allow quarantined doctors and nurses to continue treating patients from home isolation if they are well enough.
Mostly, he said, he wants the public and hospitals to all follow guidance to prevent staff or patients from getting the new coronavirus. Hospitals need good screening processes, for example, and plans for when people come in with symptoms without calling first.
“We have to be concerned about this situation,” he said. “No physician alive has dealt with something like this. We need to act as if it’s going to be bad. If it’s really severe we simply won’t have the capacity to handle it.”