The outbreak will test the U.S. health care system, which may not be able to handle the workload.
The ability of the American health care system to absorb a shock — what experts call surge capacity — is much weaker than many believe.
A crucial thing to understand about the threat — and it’s playing out grimly in Italy — is the difference between the number of people who might get sick and the number who might get sick at the same time. The U.S. has only 2.8 hospital beds per 1,000 people. That’s fewer than in Italy (3.2), China (4.3) and South Korea (12.3), all of which have had struggles. More important, there are only so many intensive care beds and ventilators.
It’s estimated we have 45,000 intensive care unit beds in the United States. In a moderate outbreak, about 200,000 Americans would need one.
A recent report from the Center for Health Security at Johns Hopkins estimated there were 160,000 ventilators available for patient care. That may seem like a lot, and under normal circumstances, it is. Pandemics, however, change the calculations.
A few years earlier, the same group modeled how many ventilators would be needed in unusual circumstances. In a pandemic akin to the flu pandemics in 1957 or 1968, about 65,000 people might need ventilation.
Hospitals don’t survive financially in the United States by keeping beds open and equipment idle. They have enough equipment to be cost-effective but still retain capacity to care for extra people in emergencies. But those emergencies do not account for what we are seeing now. It’s very possible that many of the ventilators are being used right now for patients with other illnesses. They’re also not mobile, and local outbreaks will surpass the numbers of ventilators and respiratory therapists quickly.
Moreover, if a pandemic more closely followed the model of the Spanish flu outbreak of 1918, we would need more than 740,000 ventilators.
Many people are comparing this virus to the flu. The thing to remember, though, is that the influenza numbers are spread out over eight months or more. They don’t increase exponentially over the course of weeks, as the cases of COVID-19 are doing right now.
Further, a greater proportion of people who are becoming ill now are seriously sick. According to some estimates, 10% to 20% of those who are infected may require hospitalization. In a metropolitan setting, if enough people become infected, the numbers who may need significant care will overwhelm our capacity to provide it.
The cautionary tale is Italy. More than 12,000 people have been infected there; more than 800 have died. A little over 1,000 have recovered. Many of the rest are ill. And a significant number of them need to be hospitalized — right now.
This has exceeded Italy’s capacity for care. It doesn’t matter what physicians’ specialties are — they’re treating coronavirus. As health care providers fall ill, Italy is having trouble replacing them. Elective procedures have been canceled. People who need care for other reasons are having trouble finding space.
In an unthinkable fashion, physicians are having to ration care. They’re having to choose whom to treat, and whom to ignore.
They’re having to choose who will die.
Italy, especially Northern Italy, has a solid health care system. It might not be the best in the world, but it’s certainly not lacking in ability. It’s just not ready for the sudden influx of cases. There aren’t enough physicians. There’s not enough equipment.
The United States is not prepared better than Italy.
Many health experts expect that a majority of people eventually will be exposed to, if not infected with, this virus. The total number of infected people isn’t what scares many epidemiologists. It’s how many are infected at the same time.
An unchecked pandemic will lead to a quickening rate of infection. If, however, we engage in social distancing, proper quarantining and proper hygiene, we can slow the rate of spread and make sure there are enough resources to care for everyone properly. This also can buy us time for a vaccine to be developed.