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Coronavirus could mean even hospital-rich Philly won’t have enough intensive-care beds, experts warn

If too many patients develop severe symptoms from the coronavirus, hospitals may run short of ventilators and staff to operate them, physicians say.

A paramedic leaves a tent in front of the emergency ward of the Cremona hospital, northern Italy. The coronavirus spread so fast in that country that doctors spoke of choices war-time triage medics make in deciding who lives and who dies, and who get access to the limited number of ICU beds.
A paramedic leaves a tent in front of the emergency ward of the Cremona hospital, northern Italy. The coronavirus spread so fast in that country that doctors spoke of choices war-time triage medics make in deciding who lives and who dies, and who get access to the limited number of ICU beds.Read moreClaudio Furlan / AP

Even under the most conservative estimates, perhaps 200,000 to 300,000 adults in the United States could need intensive care due to the coronavirus infection over the coming months, epidemiologists say.

Yet the nation’s hospitals have fewer than 70,000 adult intensive-care beds, three-quarters of which already are occupied.

If the bulk of those gravely ill coronavirus patients get sick during a short period of time, hospitals will be under tremendous strain, said Jeremy M. Kahn, professor of critical care medicine and health policy and management at the University of Pittsburgh.

“If they all get sick at the same time, we’re hosed,” he said Friday.

Seeing how quickly the number of infections rose in China and other countries, U.S. hospital executives are looking hard at their “surge capacity” — ramping up their ability to handle a sudden increase in critically ill patients. That includes upgrading regular hospital rooms with ventilators and other life-saving equipment, scheduling the additional trained staff that are needed to operate it, and postponing nonurgent procedures.

That is why Philadelphia hospital executives have discussed using the shuttered Hahnemann University Hospital to handle any overflow in patients — not necessarily those who are infected with the COVID-19 virus. Or the building could simply be used as a quarantine site, not a place where health care is given — meaning it would not need a license.

Reopening Hahnemann would be a major undertaking, as the facility no longer has beds or a license, but its owners have said they are open to the idea. Kahn called it a smart move.

“Make Hahnemann a low-severity hospital,” he said. “Then at Penn, Temple, Jefferson, every bed in those places can be filled with COVID patients.”

Pennsylvania has about 3,800 critical-care beds, some of which are designed specifically for heart patients but could be used for the type of severe lung problems experienced by a small percentage of those with coronavirus infections, state Department of Health spokesperson Nate Wardle said. New Jersey has 2,000 such beds, according to the New Jersey Hospital Association. But many such beds in both states are occupied.

Philadelphia and its four neighboring Pennsylvania counties had 941 critical-care beds in 2018, the last year for which hospital-level data are publicly available — though Hahnemann, with 52 such beds, closed in 2019.

Some number of hospital rooms designed for noncritical patients can be upgraded to provide intensive care in the short term, said Mark R. Ross, vice president of emergency management for the Hospital and Healthsystem Association of Pennsylvania.

He declined to provide hard numbers but insisted there wouldn’t be a problem.

“This is something we have planned for, trained for, and exercised for for a number of years," Ross said.

For coronavirus patients with severe respiratory symptoms, a key piece of equipment is a ventilator: a sophisticated machine that helps a patient breathe through a tube. In a pinch, hospitals can secure extra ventilators from commercial vendors, Ross said.

State and federal governments also have stockpiles of the devices, but whether the supply will be adequate remains unclear. Asked multiple times Thursday on Fox News if there were enough ventilators to meet any surge in critical patients, a senior Trump administration official did not provide a direct answer.

Seema Verma, administrator of the Centers for Medicare and Medicaid Services, responded instead by describing the travel restrictions and other “mitigation strategies” that are designed to avoid a crisis.

“We don’t want to put stress on the health-care system,” she said.

» READ MORE: How canceling school and public events buys more time for hospitals to fight the coronavirus

Even if there were enough ventilators to handle a big surge in cases, hospitals would not necessarily have enough trained staff to operate them, Kahn said. Nurses, respiratory therapists, and physicians all need special expertise to care for patients on such devices, and they need practice working together, the Pitt professor said.

“The modern ICU is much more about the people than the actual technology or the room,” Kahn said. “This is a learned skill that takes experience. And the team itself gains experience over time. It’s not like we can just throw in random people and expect them to work together well as a team.”

Even using the most conservative assumptions, infectious-disease experts estimate that 300,000 people in the United States will need critical care at some point due to complications from the virus, Kahn said. Some experts say the number could be several times that.

The key is how many need help at the same time, said David N. Fisman, a University of Toronto epidemiologist.

“People on ventilators are on them for about three weeks with this thing," he said. “So that drowns ICU capacity really fast.”

» READ MORE: With viruses like flu and coronavirus, pneumonia often delivers the fatal blow

Philadelphia, with its ample supply of hospitals and providers, may fare better than more rural parts of the country, Kahn said.

Yet hospital officials here are planning for the worst.

At a meeting Wednesday with leaders from the city’s major hospital systems, Penn Medicine chief medical officer P.J. Brennan said the amount of spare capacity was limited.

“I’d be surprised if any of us has more than a few beds on any given day that could be used for COVID-19 patients,” he said.

The idea of using the Hahnemann building arose in a conversation between Brennan and city Health Commissioner Thomas Farley, the pair said at the meeting.

Penn also has explored two in-house strategies to ease any strain from the virus. One is using “nonclinical” spaces such as lobbies to accommodate patients with other, less severe conditions, Brennan said. The health system also has looked into reopening a small number of clinical rooms that are not in use.

How long these tactics need to remain in place is anyone’s guess. No one yet knows when illnesses will peak, and when the pandemic will subside.