COVID surge stretching ICU capacity, Med Center warns
The Texas Medical Center’s intensive care capacity could be exceeded as soon as Thursday because of the surge in COVID-19 patients, the hospital system projects.
A TMC model also predicts ICU surge capacity — extra, temporary beds and equipment used in emergencies — could be exceeded as soon as July 6 if the steep rate of new COVID-19 hospitalizations continues, the most aggressive modeling to date.
Eleven leaders of the system’s member hospitals and medical schools said in a joint statement that COVID-related admissions were increasing at an “alarming rate,” stretching the capacity of ICU units. Texas Children’s Hospital this week began admitting adult patients to handle the surge.
“If this trend continues, our hospital system capacity will become overwhelmed, leading us to make difficult choices of delaying much-needed non-COVID care to accommodate a greater number of COVID patients,” the group wrote.
The leaders urged residents to stay home when possible, practice social distancing and wear masks.
The TMC system reported its intensive care units were at 98 percent capacity on Wednesday. Twenty-seven percent of that total were COVID patients, nearly double the 15 percent benchmark set by health experts.
There are two tiers of ICU surge capacity in the TMC system, said
Dr. James McDeavitt, an executive vice president at the Baylor College of Medicine. There are 373 “sustainable surge” beds, which include general beds converted to intensive care by adding staff and equipment such as ventilators. This level of care can be provided indefinitely.
Should those beds fill, the system has an “unsustainable surge” capacity of 504 patients. This stage includes placing two beds in each room, converting nonresidential areas to makeshift wards and decreasing staffing levels to treat more patients. This level of care can be maintained only for several weeks.
McDeavitt said he is confident in the near term that the system can manage the spike in COVID-19 patients.
“We’re worried, but we don’t have a crisis today,” he said. “If this goes on for another three weeks, and the slope of the virus continues to be what it has been, then we’ll get to a point where we start to dip into that unsustainable surge capacity, and that’s a place nobody wants to go.”
Key metrics for measuring the severity of the pandemic in the Houston area, including the rate of positive tests and the number of new cases and hospitalizations, continue to trend in the wrong direction. Gov. Greg Abbott on Tuesday urged residents to remain home, and the governor of New York said Wednesday that travelers from Texas must quarantine for two weeks after arriving in the Empire State.
The 25-county region surrounding Houston set a new COVID hospitalization record Wednesday with 2,251 patients. That figure has tripled since Memorial Day, putting pressure on health care facilities.
The increase in cases, a fraction of which become hospitalizations, is due to residents coming more into contact with one another since Harris County’s stay-athome order expired at the end of April, said Dr. Umair Shah, the county’s health director. Abbott began reopening Texas on May 1 in phases.
Texas reported more than 5,000 new cases Tuesday and nearly 6,000 Wednesday. The number of infections across the state steadily has risen since Memorial Day. Harris County added 1,365 cases on Wednesday, along with 14 deaths.
Local leaders, including Mayor Sylvester Turner and Harris County Judge Lina Hidalgo, say the state’s reopening was premature and left the region susceptible to a more severe outbreak. Turner said Monday that Houston had squandered much of the success of the stay-at-home period, which health experts had credited for keeping the number of new cases down.
On Wednesday, Turner announced a weekend crackdown on businesses violating capacity restrictions and Hidalgo’s most recent mask order compelling businesses to require their customers wear masks. That strategy, he said, could include the creation of a “Board of Shame.”
“I want to put people on notice now that as we move closer to the weekend we are going to be actively monitoring whether or not people are complying with the occupancy requirement and whether or not they are wearing their masks, because we want to really crack down on people who are not adhering to the rules,” Turner said.
The mayor also left the door open for pursuing more stringent enforcement and restrictions if conditions continue to deteriorate. Abbott has preempted many local measures and strategies during the reopening process, including mandatory mask orders for individuals. He surprised officials last week when he OK’d the issuance of an order in Bexar County that put the onus on businesses to require their customers wear masks.
Hidalgo again urged residents to socially distance from each other and wear masks to slow the spread of the virus, saying that only a collective change of behavior by residents can again bring the outbreak under control.
“The truth is, whichever way you slice it, we’re in a very dire situation,” Hidalgo said. “That hospitalization curve isn’t going to flatten itself.”
Greater Houston Partnership CEO Bob Harvey sounded a similar note, urging businesses to send employees back to working from home, if possible.
Since last week, the worsening pandemic has helped Harris County meet four of the five criteria to move to the worst of four stages on its threat level system. These include a seven-day average of greater than 100 new COVID-19 cases, seven-day increasing trend in daily hospital population and more than three days of greater than 15 percent ICU usage by COVID patients.
The only unmet criteria concerns supply of personal protective equipment for health care workers, which remains ample.
McDeavitt, from Baylor, said there are some encouraging signs. Patients appear to be less sick than those in the spring, in part because they often are younger. Physicians also have had months to gain experience treating the virus. Still, he implored residents to follow health guidelines and minimize contact with others.
“Assume everyone you meet is infected,” he said.