Gearing up for outbreak’s peak
State and hospital officials prepare for expected surge of COVID-19 cases around New Mexico
The surge. It’s what every state in the union might soon face and what the entire country is trying to marshal enough resources to withstand. In New Mexico, much is still unknown about the anticipated spike in COVID-19 cases. But the picture became clearer this week as officials revealed more precise estimates and hospitals spoke about their preparations.
Projections indicate it’s an undertaking of mammoth proportions.
To take one data point, health officials are estimating New Mexico could face between 250,000 and 1.25 million cases of the disease. The low end of that range would be around one-eighth of the state’s residents, while the upper end, a worstcase scenario, would be more than half.
“We’re going to have to really think about how we do things differently,” Gov. Michelle Lujan Grisham, a former state health secretary, said Tuesday.
The estimates are hard to envision, let alone accept. For instance, the state predicts, based on modeling, that it may need anywhere from 2,175 to 3,000 intensive care beds. Its current capacity is 365.
New Mexico officials estimate the state needs to boost its supply of general hospital beds from 2,500 to 3,498, while increasing the number of ventilators from 471 to around 630, Human Services Department Secretary David Scrase said. “So, we’ve got work to do,” Scrase said. Officials said it’s difficult to pinpoint a deadline for the state to reach those goals. The peak of the outbreak in New Mexico could be as soon as next week in some areas, such as northwest New Mexico, and as far away as six to eight weeks in other areas, according to state officials.
Currently, the state has yet to hit capacity, as the Human Services Department said it still has 131 available ICU beds.
But new numbers released by the state Wednesday were troubling. New Mexico’s COVID-19 cases stood at 363, and the Governor’s Office reported the death of a Sandoval County woman in her 90s with underlying health problems. Her death was the state’s sixth. Hospitalizations also rose: 31 people were receiving treatment in a medical facility.
The swath of the problem also was getting wider. As of Wednesday, 21 of
the state’s counties had reported positive cases, though the vast majority were in Bernalillo (148), Santa Fe (48), San Juan (37) and Sandoval (32).
“The problem with the peak, whenever it occurs, is it’s likely to overwhelm our delivery system,” Scrase said. “… Social distancing flattens that and allows more people to be sick and taken care of in the hospital without overwhelming the delivery system.”
Indeed, state officials have been clear about the importance of social distancing and obeying the stay-at-home order — saying the measures are the main reason New Mexico has slowed its rate of new cases. As of Tuesday, the total number of cases was doubling every 3.25 days, whereas it used to double every two days.
But surge preparation is another essential part of the plan. And while the social-distancing strategy depends on all New Mexicans complying, getting ready for the peak is largely up to state officials and health care providers.
Getting ready
To propel efforts forward, the state has rolled out its Medical Advisory Team led by Dr. Michael Richards, vice chancellor for clinical affairs at the University of New Mexico Health System, to manage resources and work on increasing the health care system’s capacity statewide.
Richards has been meeting with directors of the major Albuquerque providers and regional hospitals to hammer out plans, and the team has more than 115 members and subgroups in areas such as ethics, communications and clinical care, state officials said.
The team is creating a “patient triage call center” that will help transport and treat patients from around the state, and it’s helping hospitals expand their licensed bed capacity.
That kind of coordination is important, said officials with the New Mexico Hospital Association, because different parts of the state will see surges at different times.
“I think we’re at that point where none of us are isolated anymore,” said Jeff Dye, president and CEO of the association. “We’ve come to learn that the disease spreads regardless of boundaries.”
Each major hospital has its own individual surge plan and has been activating it.
“There are a few places that are starting to increase their number of COVID patients, but we’re still in a bit of a calm before the storm because hospitals have done a great deal already,” Dye said.
Lovelace Medical Center in Albuquerque is bringing in and training additional staff, such as medical specialists whose clinics are temporarily shut down, plus retired physicians and nurses.
“There’s lots of activity going on to just make certain that we have enough in the way of supplies as well as people to be able to manage a large influx of patients,” said Lovelace
Chief Medical Officer Dr. Vesta Sandoval.
The hospital also is prepared to transform other units of the hospital into additional ICU space, which could bring its capacity from 32 to 128 intensive care beds under a worst-case scenario.
“So there’s that type of planning where it’s kind of a step-wise cascading fashion,” Sandoval said. “As you reach a certain tipping point, then you have to open the next unit.”
Finding alternatives
In Santa Fe, Christus St. Vincent Regional Medical Center staff members have been conducting preparedness planning and “tabletop exercises” in conjunction with local agencies and other health care providers
“to ensure we are prepared and in active communication when there is a surge of patients,” spokesman Arturo Delgado said.
The hospital currently has 10 ICU beds and 24 ventilators.
“We continue to assess other options within our facilities in the event of a surge,” Delgado said.
Presbyterian Healthcare Services, which has facilities in Santa Fe, Española and elsewhere in the state, said it’s also repurposing areas of its facilities and retraining staff members. Dr. Jeff Salvon-Harman, chief patient safety officer, said it’s already seen increased numbers of COVID-19 patients.
“The important thing for the public to know is the state is faring better than neighboring states and we’re taking preparations seriously,” Salvon-Harman said in an interview.
He added that preparing for a surge isn’t easy because capacity is always fluctuating and the provider has to ensure enough room for patients without coronavirus as well, particularly as it’s still the end of flu season.
“It’s not just a simple, straightforward bed availability versus COVID demand,” Salvon-Harman said.
All three of the providers said they currently have enough personal protective equipment such as masks, gowns and gloves, but some said the availability of supplies has dropped.
Cities and states around the country are facing shortages of such equipment, and the federal government’s emergency stockpile is now nearly completely depleted, the Washington Post reported Wednesday.
“PPE is, of course, on everybody’s minds and everybody is trying to be proactive in how they use it,” Sandoval said. “We have to protect staff, but we have to be cognizant that we will be able to make certain that we’re using it in an appropriate fashion.”
Christus St. Vincent has enough protective equipment and ventilators on hand at the moment, but its supplier shipments have been delayed by two to three weeks and recent deliveries were reduced by as much as 30 percent “due to demands nationally,” Delgado said.
Salvon-Harman said Presbyterian also was seeing a decrease in the availability of supplies related to COVID-19.
“I think that’s the question of the day,” Dye said when asked if health care workers will have enough protective gear. “‘Enough’ will be determined by how big the surge is, and we’re doing all we can to mitigate the surge so that there will be enough.”
Some of the extra health care needs could be satisfied by a U.S. Army field hospital the federal government has approved for New Mexico. Officials also plan to set up a health care facility at the former Lovelace hospital site on Gibson Boulevard in Albuquerque.
The governor and health officials continue to reiterate the importance of social distancing, saying that New Mexico’s ability to withstand a surge is directly tied to residents’ willingness to stay home.
“If we do this together, we will save so many New Mexicans’ lives,” Lujan Grisham said, “and we will hold up and respect to a greater degree our first responders and health care workers who are gearing up for this challenge.”