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Coronavirus Strains Our Ability to Manage the Crisis

Hospital Surge Capacity is a crucial issue to monitor

By Jeff LivingstonPublished 4 years ago 3 min read
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Photo by Rob Curran on Unsplash

As the US begins to scale community testing, the number of cases will quickly rise. We are woefully behind much of the world in testing, treatment guidelines, and hospital admission criteria.

What will we do if too many are sick at the same time?

What is surge capacity?

Hospitals and health systems are required to have documented surge plans in the event they are faced with challenges beyond normal daily operating capacity. Natural disasters and human-caused events such as 9/11 are examples.

Surge planning is a core component of running a hospital. The Joint Commission requires all hospitals to have a plan. Today’s critical question is:

What happens if most US hospitals must activate their surge capacity plan all at once?

Surge Capacity is not only about Coronavirus

Hospitals must continue to care for everyone else. People will still come to the ER with heart attacks and strokes. People will fall and fracture their hips. Kidney stones, gallbladder attacks, and appendicitis do not disappear. Pregnant women will go into labor.

We are still in flu season, and many refuse vaccination for this preventable disease. Seasonal flu stresses US hospital systems. Flu shots do more than keep individuals safe.

Flu shots keep the hospital volume suppressed, allowing those with other conditions to get the care they need. Some influenza patients develop respiratory distress requiring an ICU bed, a ventilator, and one to one nursing.

Every preventable flu case ties up valuable hospital resources.

Repurposing physicians

The importance of surge capacity is currently at work in Northern Italy and Wuhan, China. Healthcare workers from all specialties are being deployed to treat Coronavirus. As the infectious disease and internal medicine physicians become ill, they are replaced with other specialists.

Reports are the number of available physicians is not keeping pace with the reported disease. If an Obgyn is repurposed to treat Coronavirus, then there is less capacity to treat patients in labor. If an infected general surgeon is quarantined, then the capacity to remove a ruptured appendix is limited.

Health care rationing is the unintentional result.

Can the US handle a mass surge in Covid-19?

The United States does not have enough hospital beds, ventilators, doctors and nurses to care for an almost certain increase in cases of Covid-19. The estimated number of ICU beds in the United States is 45,000. We have 160,000 ventilators available.

In a moderate outbreak, about 200,000 Americans would need ICU beds, the report says. And in a severe outbreak, the researchers say, that number would soar to 2.9 million. HuffPost Jonathan Cohn

Guidelines and protocols

The number of US cases will increase as we improve testing. US providers to not have established treatment protocols. The CDC and tertiary care centers are equipped with resources and rapidly evolving data. Rolling out admission criteria to community hospitals will be a challenge.

The culture of US health care will likely lead to aggressive treatment and hospital ICU admissions. Each admission will tie up beds, providers, and equipment. Fewer resources will be available to all other areas of hospitals.

Mild cases of Covid-19 may do better at home. Home management reduces the risk of infecting others. Who qualifies for home management? We don't know because we don't have the data. It will likely be challenging to convince patients and physicians without evidence-based guidelines.

What do we do now?

Never forget the basics. Wash your hands frequently for at least 20 seconds. Get a flu shot. Get a pneumonia vaccine if over age 65. Clean your cell phone. Avoid unnecessary contact by practicing social distancing. Most importantly, if you are sick, avoid exposing the public and contact a physician for testing.

Originally published on Medium.

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About the Creator

Jeff Livingston

Dr. Jeff Livingston is an Obgyn, husband, father, and entrepreneur. Writing about women’s health, parenting, and self-improvement. CEO of Macarthur Medical Center.

Connect on Twitter @jefflivingMD

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