Re: 'NYC's hospitals will either be overwhelmed in the next two weeks or they won't. The flu that so many of the article's "experts" reference in trivializing COVID-19 hasn't managed that feat in a hundred years.'
March 26, 2020
Hospital Capacity Crosses Tipping Point in U.S. Coronavirus Hot Spots
Epicenters resort to patient transfers and a makeshift morgue to cope as coronavirus infections mount
By Melanie Evans and Stephanie Armour
wsj.com
Workers construct a temporary expansion out of tents behind a hospital in New York City on Wednesday.
Hospitals in U.S. pandemic epicenters have passed a tipping point in the fight against the new coronavirus as the relentless climb in infections forces some to move patients to outlying facilities, divert ambulances and store bodies in a refrigerated truck.
New York, home to the nation’s largest outbreak of Covid-19, the illness caused by the new coronavirus, is rushing to build a temporary hospital in a Manhattan conference center in the hope of staying ahead of the fast-spreading disease.
Hospitals in parts of New York City have become so full of critically ill patients that they have steered ambulances elsewhere. The full-to-capacity morgue at Elmhurst Hospital in Queens is using a refrigerated truck to hold some of the dead. Thirteen people died in the hospital in the last 24 hours, said NYC Health + Hospitals, which operates Elmhurst.
New York Gov. Andrew Cuomo said Wednesday that hospitalization rates are showing signs of slowing, but he cited a continued rise in the rate of infection.
In the Seattle area, where the West Coast’s largest outbreak has claimed 94 lives, according to Johns Hopkins University data, hospitals are transferring patients to where beds are available.
“We’re not completely drowning, although it feels like that at times,” said John Milne, who oversees the hunt for space for Renton, Wash.-based Providence St. Joseph Health and said the company’s Swedish Issaquah Campus hospital has run out of beds for incoming Covid-19 patients. “We’re on the threshold of being overwhelmed.”
Efforts to cope in two metro areas that have seen rapid increases in people stricken with Covid-19 realize concerns of health officials that the pandemic will overtake hospital space and supplies of essential equipment.
Doctors in the two hot spots say their experiences are a warning for other cities and hospitals that may soon be grappling with greater numbers of infections.
“They have time,” Brendan Carr, chairman of emergency medicine for the Mount Sinai Health System in New York, said of communities where the number of infections isn’t as high as in some U.S. cities. “They have the privilege of knowing.”
More federal aid for hospitals is expected, but those in slammed cities said time is running short.
In New York and the Seattle area, hospitals with available beds are taking patients from those without space or the level of care needed for patients. Public and hospital officials are tracking capacity to prepare for rapid overflows.
“Things are moving very quickly,” said James Lawler, executive director of the Global Center for Health Security at the University of Nebraska Medical Center and an infectious-disease expert. Cases of new coronavirus can double within days, reports elsewhere in the world show, he said.
In New York, Mr. Cuomo said during a press briefing Wednesday that data suggest the spread of the disease is slowing in his state. “The evidence suggests that the density-control measures may be working,” Mr. Cuomo said. On Sunday, the number of people hospitalized for Covid-19 was projected to double every two days. As of Tuesday, it was projected to double every 4.7 days. Mr. Cuomo said the trend could change but he called it a positive sign.
Nearly 31,000 New Yorkers have tested positive for the virus, state officials said at the briefing, and 3,805 were hospitalized. Of those, 888 are in intensive care units; 285 New Yorkers have died. New York accounts for more than half the infections in the country.
Confirmed cases in the city totaled about 15,600 as of Wednesday, Johns Hopkins University data show, dwarfing numbers elsewhere in the country. That is partly because New York has succeeded in rapidly expanding its testing while other states struggle to do so.
New York’s density is also a factor in the spread of the illness. A physician at Bellevue Hospital in the borough of Manhattan described the risk in crowded city households as palpable as she called to update the family of a patient. “I call her family and they are a big family that all lives in a small apartment,” the doctor said. “Another family member has symptoms. Another family member is pregnant. Is there any way to get distance in the house? Of course not…. You get this sinking feeling that they don’t stand a chance.”
The surge in cases has overwhelmed Elmhurst Hospital, where the Federal Emergency Management Agency arrived with supplies Tuesday. Doctors at Elmhurst have relied on ventilators donated from another hospital and less-powerful breathing machines to treat patients who arrive gasping for air, said Colleen Smith, an emergency room doctor there.
Mitchell Katz, chief executive officer of the NYC Health + Hospitals system, said Elmhurst Hospital has been hit hardest but it has enough ventilators. “Every night I check,” he said. “How many ventilators do we have?” He has restocked the hospital’s supply four times, he said.
Elmhurst has redirected ambulances as it became inundated with people who were struggling to breathe, Dr. Katz said. “It was safer for patients in ambulances to be diverted to a hospital less overwhelmed.”
The hospital needed a refrigerated truck for bodies as deaths outstripped its small morgue, Dr. Katz said. Families that unexpectedly lose loved ones need time to make arrangements. “In this kind of crisis everyone can’t immediately come to collect the body,” Dr. Katz said.
Cities and states slammed by escalating numbers of cases are sprinting to open more hospitals, buying and reopening bankrupt or old facilities for bed space, setting up emergency medical tents and pleading for beds from the federal government.
Mr. Cuomo has revised New York’s projected statewide need for hospital beds upward to 140,000, including 40,000 for intensive-care patients. “Those are troubling and astronomical numbers,” he said.
The governor has mandated that hospitals increase capacity by at least 50% and said the U.S. Army Corps of Engineers has identified four sites to convert to temporary hospitals. The Army Corps of Engineers didn’t respond to a request for comment.
“It’s likely all major hospitals are going to become ICU hospitals,” said Dr. Katz, and newly created beds will be used for people who need less intense care or a place to recover.
New beds will need doctors and nurses when hospitals are straining to boost their workforces.
In a letter to health-care workers this week, New York’s Health Commissioner said the state would welcome retirees and those with expired licenses. “New York State will recertify these individuals for immediate deployment,” according a copy of the letter reviewed by The Wall Street Journal.
Doctors at NYU Langone Health, which operates New York area hospitals, received a mandatory survey by email last week, asking them to describe their medical specialties, the hospitals at which they work and other training they could put to use, said a person who received the survey. The first 15 volunteers began filling in at NYU Langone’s hospitals this week.
Expansion consumes valuable time: hospitals must retrofit ventilation in rooms to prevent contagion and train staff who don’t typically care for the most-critical patients, said doctors and hospital executives.
New York’s Mount Sinai Morningside Hospital began two weeks ago to expand its intensive-care capacity and is expected to double those beds within six weeks, said John Puskas, the hospital’s chairman of cardiovascular surgery. The early start allowed the hospital to convert more space before existing capacity fills. “That’s why we’re not underwater just now,” he said.
In Washington, roughly 1,000 hospital beds sent to the state by the U.S. Defense Department are ready to be deployed, said Karina Shagren, a spokeswoman for the Washington Military Department.
Providence’s Swedish hospital system initially sent Covid-19 patients to a suburban hospital, which filled up, said Mr. Milne. Intensive-care units across its five Seattle-area hospitals are largely full and Swedish is sending patients across town to UW Medicine Hospital in a countywide effort to manage the influx of patients, he said.
Swedish is preparing to send its least critical patients to a hotel where nurses will care for them. UW Medicine still has capacity, a spokeswoman said.
California is moving to open as many as four temporary hospitals and is seeking to lease St. Vincent Medical Center, the oldest hospital in Los Angeles, and Seton Medical Center in Daly City outside San Francisco from Verity Health System of California Inc., which filed for bankruptcy protection in 2018. Verity said in January that it would close St. Vincent.
“It’s an immediate escape valve for us,” said Carmela Coyle, chief executive of the California Hospital Association. California’s governor said last week that one model projected demand for as many as 19,000 more beds as the virus spreads there.
Florida has dispatched emergency teams to reopen a closed facility, readied four field hospitals and has asked federal officials for five mobile intensive care units and another 5,000 hospital beds, Florida health-care and emergency-management officials said. The state is also moving to ramp up efforts to open new facilities that were already close to opening their doors, said Mary Mayhew, Florida’s secretary for the Agency for Health Care Administration.
http://www.wsj.com/articles/hospital-capacity-crosses-tipping-point-in-u-s-coronavirus-hot-spots-11585215006
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