Coronavirus: How many cases would it take to fill hospitals?
While there are optimistic signs new COVID-19 cases are starting to level out in Shelby County, virus-related hospitalizations remain near their highest levels of the pandemic, contributing to weeks of high hospital occupancy rates.
Limited hospital bed space is not in and of itself unusual, though winters usually see more hospitalizations than summers, doctors said. And many factors contribute to the number of occupied and free acute and intensive care unit beds on any given day.
But that makes it difficult — if not impossible — to say how many COVID-19 cases it would take to fill Memphis-area hospitals and necessitate the use of the auxiliary hospital built in the old Commercial Appeal building.
“We anticipate a fluctuation, that there will be fluctuation based not only on cases but also, in terms of occupancy at hospitals, other things happen to people,” said Shelby County Health Officer Dr. Bruce Randolph.
In the past two weeks, hospital and ICU occupancy rates have been as high as 93% and 92% occupied and as low as 87% and 85% occupied, respectively. Reported COVID-19 patients have made up between 10% to 12% of acute care patients and 30% to 34% of ICU patients during that time, according to the health department.
“Everyone who’s in the hospital is not infected with COVID-19,” Randolph said during a media briefing. “Trauma occurs, elective surgeries occur, violence occurs, different other reasons for people being admitted to the hospital. So the census of hospitals is going to fluctuate.”
In addition to traumas and elective surgeries, the prevalence of other illnesses, like influenza, in the community also dictates how many people will be in the hospital on any given day. The seasonal nature of many viruses contributes to higher hospital occupancy rates in the winter, giving rise to concerns that if COVID-19 overlaps with a bad flu season, hospital capacity could become particularly stretched at the end of the year and into early 2021.
Staffing levels also determine how many hospital beds are available in the county on any given day. A national nursing shortage has meant that hospitals around the country have at times struggled to find enough medical professionals to staff all the available hospital beds, even at some of the nation’s premier medical facilities.
Dr. Kathryn Hibbert, a pulmonologist and critical care specialist at Massachusetts General Hospital, said in an interview with Becker’s Hospital Review that maintaining ICU staffing levels was the most difficult thing for the hospital when Boston was hit with its first wave of COVID-19 patients.
“Having enough adequately trained staff in the ICU was the biggest challenge this spring, along with staff fatigue and burnout,” she said. “You have to ensure the ICU nurses, critical care physicians and respiratory therapists are not overworked and have a chance to rejuvenate outside the hospital and take a break when they need to.”
In a media briefing last week, Dr. Richard Aycock, chief of staff at Methodist Le Bonheur Healthcare, said nonicu nurses within the system have been cross-trained so they could be shifted into ICUS if necessary and that about 150 new nurses had been hired to ensure adequate staffing if hospitalizations surged.
“That’s (been) challenging because everywhere needs nurses,” he said.
Age, underlying conditions, race factor into hospitalizations
Throughout the pandemic, between six and 10% of known active cases have been hospitalized in Shelby County, based data provided by the health department.
While that can provide a guide, estimating future COVID-19 hospitalizations is much more complex than figuring out what six to 10% of the projected number of future infections would be. For one thing, modeling the growth of the virus is difficult, models can vary wildly from institution to institution and no model has ever proven to be perfect.
Also, whether a person with COVID-19 will need to be hospitalized depends on a variety of factors including the age and relative health of the individual. While it’s not a rule, it’s more likely that older people or people with underlying medical conditions will need to be hospitalized than younger people or people with no comorbidities.
A large uptick in cases might not necessarily result in a surge of hospitalizations if most of the new cases are young people. If a small uptick in cases is largely older Shelby County residents — such as outbreaks in assisted living facilities — that could result in a disproportionately large number of hospitalizations.
Beyond age, the CDC said Black and Latinx people — who make up 58% and 24% of Shelby County’s reported COVID-19 cases, respectively — are almost five times as likely to be hospitalized as white people if they contract COVID-19.
Dr. Steve Threlkeld, co-chair of the infection control program at Baptist Memorial Hospital-memphis, said as of Monday, the hospital had 88 COVID-19 patients in acute care beds and 23 in the ICU, the highest number the hospital has seen since the start of the pandemic.
“Right now our hospital has 111 cases in the hospital, and we’re OK. It’s certainly taxing to the people who take care of them,” he said. “The ability for the nursing staff to just take this on and on has its own cost, no matter how many beds in here you have.”
If hospitals are getting to the point where they are stretched too thin to provide quality care, elective procedures can be canceled again, but there are inherent risks to that as well, Threlkeld said.
He said he has seen models predicting the hospital have 270 hospitalized COVID-19 patients by October but noted that could be a self-fulfilling prophecy as the rate the virus is allowed to spread through the community depends on how much people adhere to infection control practices. But, if the number of hospitalized patients were to double from where it is now, it would present a lot of problems.
“It would be hard on the manpower and the people who are doing it, and it’ll be cramped on space,” he said. “It can be done, but it would be very difficult.”