Hospitals prepare for surge as more cases spread locally
‘ASSUME THE WORST’: With likely strain on infrastructure, TMC to raise bed count
With last week’s new certainty that the novel coronavirus is loose and being transmitted in Houston, the region’s medical providers are bracing for the current handful of known cases to blaze into an outbreak like nothing in modern memory.
“We had been saying, ‘It’s not a matter of if, it’s a matter of when,’ ” said Umair Shah, executive director of Harris County Public Health. “That’s not the case anymore. It’s now.”
By shutting down events and closing schools, officials aim to “flatten the curve” — to stop too many people from getting sick at the same time and overwhelming the region’s hospitals and medical providers.
Much about the highly contagious new virus remains unknown, and projections of its future behavior vary wildly.
Based on scenarios from the Centers for Disease Control and Prevention, the New York Times estimated that anywhere from 2.4 million to 21 million people in the United States could require hospitalization, “potentially crushing the nation’s medical system, which has only about 925,000 staffed hospital beds.”
For most people, the virus is expected to be mild. But up to 20 percent of cases — mostly people over 60 or with underlying medical conditions — may require hospitalization.
If everyone gets sick more or less at once, area hospitals almost certainly would not have enough rooms, critical care or ventilators. In Italy, where officials waited to control the outbreak, an extraordinary surge of cases has left the medical system on the verge of collapse.
Based on Harris County estimates, County Judge Lina Hidalgo said recently that if 30 percent of Harris County residents were to become sick at the same time and 20 percent of those people needed hospital care, medical infrastructure would be overloaded.
“We simply do not have enough hospital capacity to assume all of those people,” Hidalgo said. “We can’t afford to have a sudden spike in cases.”
Even the best case — a slowed outbreak that continues for months — is almost certain to pose significant challenges to the area’s hospitals, clinics and doctor’s offices.
“We’re planning for a surge as community spread continues,” said William McKeon, president and CEO of the Texas Medical Center. “We have a strong, united view: Go after it fast, assume the worst.”
TMC hospitals have been following COVID-19, the disease caused by the new coronavirus, since it emerged three months ago, said Houston Methodist Hospital CEO and President Marc Boom. “It’s a situation we drill for, prepare for.”
Boom participates in a daily COVID-19 strategy call for the CEOs of all eight TMC hospitals — a level of coordination never before needed, even to face threats such as Hurricane Harvey.
“We do it with one of those Skype things, with televisions,” Boom said. “Normally, with a hurricane, we’d have 30 people in a room watching as it makes landfall. COVID-19 is much slower-moving, more drawn out. We have maybe six or seven people in there. Lots of people teleconference in, and we sit 6 feet apart — social distancing, practicing what we preach.”
The hospitals’ plans include increasing the number of hospital beds available — and in particular, the number of critical care beds for patients needing intensive care. Intermediate ICUs and recovery rooms may be converted to critical care; tentlike mobile ICU units may be set up in parking lots.
The medical center’s hospitals have similar coordination calls to share information, such as sources of supplies, or ways to conserve or find substitutes for hard-to-find personal protective equipment such as N95 protective masks. McKeon said he is reaching out to Houston’s business and research labs, asking them to assess whether, if needed, they could contribute some of their own PPEs to hospitals. The virus poses particular threats to hospital personnel, who will be working long hours under stressful conditions — and facing coronavirus-related personal problems such as a lack of child care due to school closures. In the worst scenario, seen in China, medical personnel become ill themselves, and their colleagues have to take care of them.
Testifying before Congress earlier this month, Dr. Peter Hotez, a Baylor College of Medicine vaccine researcher and infectious disease specialist, urged that special attention be paid to hospital workers.
“If health care professionals are out of work because they’re sick, or if they’re being taken care of by other health care professionals in ICUs, that’s a disaster,” he said.
To date, COVID-19 testing has been a major weak spot in the U.S. response, with too few tests available and too few labs able to process them. Far more cases are expected to be diagnosed soon, as commercial labs such as Quest Diagnostics and LabCorp come online with the tests.
As soon as demand and test-processing capability make it reasonable, TMC institutions plan to begin drive-thru testing like that being done in Colorado, McKeon said. But he cautioned that even those sites have serious limits: “If it takes 15 minutes to do a test, and we run a test site 12 hours a day, that’s only 48 tests per day.”
To slow spread of the virus, many area providers plan to shift as many consultations as possible — in particular those not related to coronavirus — to telemedicine platforms, such as the hospitals’ apps. Similarly, hospitals are beginning to ban would-be visitors, encouraging them to videochat with their loved ones instead. “This is the time to bond by FaceTime,” said Susan McLellan, a professor of internal medicine at the University of Texas Medical Branch.
“There’s only one way I want to look back on this,” McKeon said. “Did we do everything we could to stem the tide? I hope that we’re so blessed that people will someday say, ‘Those measures were too draconian.’ ”