Have you ever been to an emergency department? If so, you know that ERs are very busy places. The wait can be interminable unless the triage nurse thinks you are having a heart attack or a stroke. If you need to be admitted, it can take a long time for the hospital to get a room ready. During flu season, there may be a question if your hospital will even have a bed to spare. Now, with COVID-19 spreading like wildfire, will the local hospital have a bed for you if you catch the coronavirus?
How Prepared Are U.S. Hospitals for COVID-19?
Are hospitals and other healthcare facilities ready for the coronavirus pandemic? Doctors, nurses and other allied health professionals rely upon N95 face masks when they are taking care of potentially contagious patients.
There is concern that the need is already outstripping supply. These protective masks fit tightly on the face and filter out most particulate matter. They are staples for tuberculosis care.
Now, however, many hospitals are having a hard time ordering adequate supplies. The federal government has a strategic National Stockpile that includes N95 face masks, but the amount is far less than may be needed.
The U.S. Hospital Bed Shortage:
It has been estimated that the United States had about 1.5 million hospital beds in 1975. But over the last 25 years the number of hospitals in this country has declined by over 12%. Hospital beds are down almost 40%. We now have around 900,000 beds. Of course, we also have a lot more people in the country, so the ratio is even worse.
Let’s put this into perspective. A frequent guest on The People’s Pharmacy syndicated public radio show is Dr. Aaron Carroll. He is a professor of pediatrics at Indiana University School of Medicine and a frequent contributor to the New York Times. His most recent article in The Upshot section of the Times (March 12, 2020) is titled:
“Here’s the Biggest Thing to Worry About With Coronavirus”
The subtitle of his article states:
“We don’t have enough ventilators and I.C.U. beds if there’s a significant surge of new cases. As with Italy, the health system could become overwhelmed.”
Dr. Carroll notes that South Korea has 12.3 hospital beds for every 1,000 people. China has 4.3 beds per 1,000. Italy has a puny 3.2 beds per 1,000 citizens and they are totally overwhelmed. Guess where we stand in the U.S.? According to Dr. Carroll:
“Our country has only 2.8 hospital beds per 1,000 people.”
In China, they built two brand new hospitals in Wuhan in just over a week.
Here is how the Wall Street Journal (Feb. 6, 2020) described it:
“The 1,000-bed Huoshenshan facility, on which construction began Jan. 23, received its first patients Monday. The 1,600-bed Leishenshan Hospital, which broke ground Jan. 25, was finished Thursday, according to China’s state-run Xinhua news agency. It was less than two weeks ago that plans for the hospitals’ construction were first announced.”
“The new hospitals add capacity to a city straining to keep up with the growing number of patients. In addition to the two new facilities, officials are converting gymnasiums, exhibition centers and sports centers into temporary hospitals.”
We find it hard to believe that any country could build a hospital in a week. Here are two time-lapse videos:
What About ICU Beds?
Here is where it really gets scary.
There is also growing concern that there may not be enough hospital beds, oxygen or ventilators to take care of large numbers of people who could become extremely ill.
Here is Dr. Carroll again:
“It’s estimated that we have about 45,000 intensive care unit beds in the United States. In a moderate outbreak, about 200,000 Americans would need one.”
Please note his use of the word “moderate.” It has been estimated that if a lot of people catch COVID-19 and the illness is very severe, we might need ten times that number or over two million ICU beds.
What About Ventilators?
The Johns Hopkins Center for Health Security has estimated (Feb. 14, 2020) that there are in the neighborhood of 160,000 ventilators in U.S. hospitals. If millions of people catch COVID-19 we could need over 700,000 ventilators! And ventilators can help save lives when people develop severe pneumonia as a result of the coronavirus.
Chinese physicians reported on their experience with critically ill patients in Wuhan (Lancet Respiratory Medicine, Feb. 24, 2020):
“We report on 52 critically ill patients with confirmed SARS-CoV-2 infection, characterised by severe hypoxaemia. 32 (61·5%) of critically ill patients had died at 28 days. Of all included patients, 37 (71%) required mechanical ventilation and 35 (67%) had ARDS [acute respiratory distress syndrome].
“Mechanical ventilation is the main supportive treatment for critically ill patients.”
“The severity of SARS-CoV-2 pneumonia poses great strain to hospital critical care resources, especially if they are not adequately staffed or resourced.”
The People’s Pharmacy Perspective:
We suspect that many hospitals in the United States are “not adequately staffed or resourced.” The next several weeks will tell the story. We hope the public health authorities in your community will not have to ask: will your hospital have a bed should you need it?
Given all the uncertainties, though, we would encourage you and your loved ones to do everything possible to avoid catching the coronavirus. You have already heard more than enough about hand washing, social distancing and other good hygiene practices. We will not insult your intelligence by repeating these recommendations.
If you do come down with COVID-19, especially if you are older and have other health problems, please get to a hospital quickly so that you can benefit from the ICUs and ventilators that are available! If you suspect you might have a COVID-19 infection, call the doctor’s office or clinic first, so they will be ready with protective gear when you arrive.
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