In the mad dash to meet Gov. Larry Hogan’s call for 6,000 new hospital beds for a potential surge of coronavirus cases in Maryland, patients with COVID-19 could end up in a new wing, an alcove or even a tent.
But for now, most new beds won’t actually be new. Hospitals are canceling surgeries or moving patients and their procedures to outpatient facilities. General medical beds that were once near full are now about a third empty.
“Our hospitals have over 900 beds available now, and very few COVID-19 patients — thankfully,” said Bob Atlas, CEO of the Maryland Hospitals Association. “We’re prepared for a surge; we expect it in the weeks to come.”
This doesn’t mean that there will be a lot more new beds coming immediately, even though Hogan spoke late last week on TV news shows about 900 “new” beds already available.
Some hospitals have announced plans. Mercy Medical Center in Baltimore recently received emergency approval to add 32 beds in the next 2½ months. LifeBridge Health also reported Friday that Northwest Hospital in Randallstown would add 20 beds to an unused unit and 70 beds at Grace Medical Center, the former Bon Secours Hospital, in Baltimore, by the end of next week.
The pressure remains on hospitals, however, to keep beds open while providing emergency care to heart attack, car crash victims and others.
But despite guidance from federal and industry sources and their own temporary new policies against “elective” procedures, many hospitals will continue to also provide services that are not for emergencies. Hospitals are judging which services are urgent enough to continue in a hospital and whether more routine procedures may still be offered in outpatient facilities.
“In the meantime, hospitals need to keep functioning,” Atlas said. “They are making sound judgments, using established clinical criteria, to determine which procedures can and should continue.”
Continuing nonemergency procedures has led to some private grumbling among medical staff and a couple of complaints on Twitter, some under the hashtag #DoTheRightThing.
The U.S. Centers for Medicare and Medicaid Services, which pays a large portion of hospital costs, recommended last week delaying “non-essential” medical, surgical and dental procedures to preserve beds, as well as personal protective equipment and ventilators that are in short supply nationwide.
“These hospitals are playing a very delicate game," said Tinglong Dai, an associate professor of operations management and business analytics at the Johns Hopkins University Carey Business School.
He said they want to be perceived as “good citizens” during an unprecedented public health crisis, but there is a business side to health care that “swings them” to do different things.
“If they play the game well and time things right, they may be able to shift to take care of COVID-19 patients when the number of cases peaks,” he said. "However, maintaining a high utilization means leaving very little margin for error and limits their responsiveness in such a highly fluid situation. It also consumes dwindling resources required for combating COVID-19.”
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It’s still not clear how many beds will be needed. So far, there have been 149 cases confirmed in Maryland, though testing is still ramping up and public health officials expect more cases despite closed schools, workplaces and malls and calls for people to keep their distance from one another.
Maryland has 9,400 beds of all kinds, including for children and psychiatric patients, including 1,200 intensive beds for the most serious cases of the respiratory disease.
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. That would mean thousands of extra beds would likely be needed in Maryland.
Health and hospital officials say modeling now shows that the need for 6,000 new beds is a worst-case scenario.
Hospitals are unlikely to ever fit them all within their walls, hospital officials say. That could mean reopening shuttered hospitals, though they said no plans are final.
For now, there are 1,400 beds available, according to a daily census conducted by the Maryland Institute for Emergency Medical Services Systems, which coordinates emergency services in the state.
“We have available beds; it’s looking quite good,” said Dr. Timothy Chizmar, state EMS medical director for MIEMSS. “State leaders are ensuring we have some capacity and planning for the eventuality that it may not be enough.”