If the nation sees a major spike, there could be almost six seriously ill patients for every existing hospital bed, according to an analysis by USA TODAY.
"We want to keep space open for folks and don't want them exposed," said Kim Walsh, chief nursing officer and senior vice president of hospital operations at Signature Healthcare Brockton Hospital.
Between Brockton's two hospitals, Brockton Hospital and Good Samaritan Medical Center, there are about 480 hospital beds, at least 30 of which are in the intensive care unit.
In Massachusetts, there could be as many as 100,600 people with severe or critical symptoms, including nearly 23,000 people who are 60 or older, according to estimated infection rates by USA TODAY.
The state has 15,649 beds, but only about 5,600 of those are available on an average day. That means, the state could have more than six patients for every bed -- or 18 patients for every bed if you only count those that are likely to be available, according to a USA TODAY analysis.
Even limiting hospital beds to people 60 or older may not improve the outlook much: There could be 1.5 patients per bed or 4 patients for every available bed.
If each person only needs to be in the hospital for 10 days -- slightly less than the average in China -- Massachusetts could manage if cases were spread out over six months more, the USA TODAY analysis shows. To treat just patients over 60, the state would need to spread out cases over one month.
The analysis is based on data from the American Hospital Association, U.S. Census, Centers for Disease Control and Prevention and World Health Organization, is purposely conservative. For example, it assumes all beds nationwide will be empty. Since two thirds of them are not, the reality could be far worse: about 17 people per open bed.
USA TODAY estimates 23.8 million Americans could contract COVID-19, the illness caused by the novel coronavirus that first appeared in Wuhan, China. That number is based on an infection rate of 7.4 percent -- similar to a mild flu year. Experts say this infection rate will likely be far higher.
According to an estimate from the Johns Hopkins Center for Health Security, 38 million Americans will need medical care for COVID-19, including as many as 9.6 million who will need to be hospitalized, about a third of whom might need ICU-level care.
The World Health Organization defines a case of COVID-19 as severe if patients have shortness of breath, low blood oxygen, acute respiratory distress and fluid buildup in their lungs.
Most people with the disease, however, will have only mild symptoms. Studies of cases in other countries suggest that some of those responsible for community spread were never identified as infected because they didn't develop any symptoms.
The World Health Organization has classified the coronavirus outbreak as a pandemic.
There are more than 4,000 cases of COVID-19 in the U.S., according to the CDC.
Massachusetts has more than 200 cases, including ones in Brockton and Easton.
A surge of new patients would be difficult any place in America, especially considering that hospitals already are crowded today. Many hospitals are designed to handle peak capacity during winter flu season, not an outbreak on top of that.
Brockton Hospital is coming off of a busy flu season and has been at capacity, Walsh said.
It has 131 medical surgical beds and 16 in the intensive care unit. All of the ICU beds are generally in use, she said.
There are 15 negative air pressure rooms, which have ventilation that would prevent contaminated air from escaping. Walsh said the highest-risk patients would go in these rooms.
During the average flu season day, 10 of the hospital's 16 ventilators are in use by someone with pneumonia or another infection, she said.
"We have to make sure we're using our equipment efficiently," she said.
People are often put on ventilators after surgery. Walsh noted that the hospital's decision to limit non-emergency surgeries during the coronavirus outbreak can help keep ventilators available to those who need them.
The change could impact about 100 patients a week, she said. Non-emergency procedures will be postponed until there is a safer hospital environment.
Health officials around the country cited many creative options for expanding capacity in an outbreak.
Hospital cafeterias can be filled with beds to become a makeshift isolation ward. So can other large buildings, such as school gyms.
Nurses can wheel a second bed into a private hospital room. Some hospitals' emergency plans include setting up tents and cots in a parking lot, where they could triage incoming patients.
At Brockton Hospital, Walsh said there are two inpatient units that can be opened up to add another 24 beds. Repurposing areas around the hospital, like operating rooms and endoscopy suites, could add 10 more beds.
Hospital staff is having daily meetings to review its patient surge plans, Walsh said. The hope is that the social distancing measures that have been widely implemented will prevent that kind of flood patients.
"This is going to be a first step in a marathon of planning," Walsh said. "We have to be able to react to the circumstances of the day."
Brockton Hospital is looking at ways to increase space in the emergency department, she said. Staff is considering how to treat people facing an emergency versus those coming in just for coronavirus testing.
It has limited coronavirus test kits, Walsh said, and the hospital is following guidelines from the state Department of Public Health to focus on people at high risk. Brockton Hospital has received test kits from DPH and some from Quest Diagnostics, a laboratory the the hospital works with, she said.
Starting Monday, Morton Hospital in Taunton has been running a COVID-19 outpatient clinic to test patients. Patients will need a note form their physician or medical provider to be swabbed at the clinic, which runs through March 27, according to the mayor's office.
Good Samaritan has developed an emergency management staffing plan, rapid triage procedures to identify and isolate patients and a plan to create an isolation area that can handle a surge of patients.
"(We are) prepared to support our community and safely care for any ill patient -- including the likelihood that patients with coronavirus infections will require treatment at our facilities," the hospital said in a statement.
Representatives from Steward Health Care, which run Good Samaritan and Morton hospitals, were not available for comment.
Good Samaritan has taken steps that include maintaining sufficient levels of protective equipment like masks and gloves and hand hygiene supplies.
Walsh said Brockton Hospital is encountering some shortages of protective equipment. Even cleaning supplies are becoming hard to obtain because of back orders, she said.
Good Samaritan is restricting visitors to one per patient and prohibiting children under the age of 12. Brockton Hospital is also only allowing one visitor and not allowing children under 18.
Both hospitals have set up screening procedures to screen visitors for COVID-19 symptoms and to determine if they have had exposure to the virus through recent travel to a place with active cases or contact with someone who has.
The most important thing for people to know is to call their primary care physician if they have symptoms. Most people will not get sick from the virus or can recover at home, Walsh said.
Some people who have come to Brockton Hospital have been surprised about some of the measures that have been put in place, she said, but once they're educated about them, they understand.
"People might be inconvenienced or stressed," Walsh said, "but the decisions we're making are in the interest of patients and staff."
Material from USA TODAY was used in this report. Staff writer Mina Corpuz can be reached at mcorpuz@enterprisenews.com. Follow her on Twitter @mlcorpuz
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