If the disease spreads at the same pace as it did in China, 1.3 million people in southwestern Illinois and the St. Louis region of Missouri will catch the virus over the next year and 7,430 will require hospital beds, according to Harvard Global Health Institute estimates.
There are roughly 5,350 available beds without expanding capacity in the St. Louis hospital referral region, the health care market that includes the metro-east and much of southeastern Missouri down to the Arkansas border.
“We are just at the beginning,” said Dr. Hilary Babcock, an infectious disease specialist at Barnes-Jewish Hospital in St. Louis.
How bad will it get in Illinois? Health officials say that all depends on how faithfully the public adheres to physical distancing guidelines and stay-at-home orders, and how long the restrictions stay in place. The fewer people who spread the disease, the more likely hospitals will be able to handle the numbers of critically ill.
In a worst-case scenario, Illinois could need more than 9,400 ICU beds and 28,000 additional non-ICU beds, Gov. J.B. Pritzker said Wednesday.
“It’s simple math,” said Danny Chun, spokesman for the Illinois Health and Hospital Association. “There are only so many beds, so many ventilators, so many (intensive care unit) beds available. They can only manage so much at a time.
“We can get through this. Hospitals are ready. But people, you’ve got to stay at home. If you do not comply, you will spread the virus. People will get sick and the health care delivery system will not be able to handle the curve. If everyone stays at home and doesn’t spread the virus, hospitals will be able to take care of the patients who do show up.”
Memorial Hospital Belleville and Memorial Hospital East have 34 ventilators between them, CEO Mike McManus said during a news conference with St. Clair County Emergency Management Director Herb Simmons.
Simmons asked McManus if the hospitals will have enough ventilators.
“Time will tell,” McManus said.
But because the United States is dramatically behind on testing, it’s not yet clear exactly how inundated hospitals in southwestern Illinois will be.
Even if physical distancing measures work and only 20% of the region’s population need hospital beds, the illnesses would have to be spread out over a year to avoid overwhelming the health care system, according to the Harvard Global Health Institute.
Triage for the coronavirus pandemic
COVID-19 has triggered a mobilization of the regional health system not seen since the HIV/AIDS epidemic of the 1980s.
Intensive care beds and hospital wings once used for patients recovering from surgeries have been repurposed for the anticipated wave of infection.
The beds are waiting for patients who may not know they’re sick yet. In two weeks or less, they could fill the system to or beyond capacity.
“Quite frankly, I’ve talked to many of the staff here and said when the HIV/AIDS epidemic started, this kind of reminds me of that,” said Terri Halloran, a critical care nurse at the time and now vice president of patient care services for Memorial Hospital’s locations in southwestern Illinois.
But the analogy only goes so far. HIV and AIDS largely affected a specific population. COVID-19 appears to know no boundaries.
Patients will end up in the emergency room with a high fever, cough and difficulty breathing. They’ll need chest x-rays to see if they have pneumonia. The sickest will need ventilators to breathe.
They’ll be young and old. The elderly will be a higher risk because comorbidities — other diseases or symptoms present along with COVID-19 — will weaken their ability to fight off the viral infection.
Still, even a young person might have such a severe pulmonary or cardiac response to the infection that it kills them.
“It’s really hard to predict,” Halloran said.
Hospitals have set up command centers to work out issues and solve problems, taking data from the U.S. Centers for Disease Control and Prevention and state authorities to drive day-to-day decision-making.
“We take all that information and make sure we’re working the problem, implementing changes and more importantly communicating with staff every night about what we’ve done,” Halloran said. “Things are changing every day. We have to keep them informed so they can keep up.”
When demand outstrips critical care capacity, hospitals will use a triage system to determine who receives treatment.
These protocols are often based on the likelihood of survival, according to a 2019 study in the Contemporary Reviews in Critical Care Medicine journal. In one framework, doctors assign scores to patients based on life expectancy to decide whether they will receive life-saving treatment or end-of-life care.
This nightmare scenario has already played out in Italy and China. New York is approaching the need for rationing machines and care.
Public health officials hope increased testing and stay-at-home orders will prevent that from happening here.
“Realistically, there won’t be enough supplies. There won’t be enough beds, ventilators or health care workers,” Chun said. “That’s why we must slow down the spread of the virus over a longer period of time, over 12 to 18 months, not just the next two weeks, and reduce the number of people who have the virus.”
In the meantime, at Memorial Hospital in the metro-east, nurses and doctors treat all patients with flulike symptoms as if they had coronavirus because testing is “still very limited,” Halloran said.
“We have to make good choices. We want to know if this is the cause for making them sick.”
Shortages of medical supplies
Regardless of how prepared hospitals are, the state still faces a shortage of test kits that could help measure the outbreak’s severity. Pritzker blames shortages of tests and protective supplies alike on the federal government.
“It’s hard to contain my anger with Donald Trump’s response to this national crisis,” the governor said at a news conference in March. Pritzker has become a regular on morning television as an outspoken critic of President Donald Trump’s response to the coronavirus pandemic.
First responders and health care workers are “begging” for tests so they can identify clusters of the virus and stop it, Pritzker said. But week after week, the tests fail to appear.
There’s an “entire supply chain” behind test kits, the Democrat said Friday. They include swabs, supplies for transporting samples and the machines used to extract and analyze genetic information from the virus.
“There’s a shortage of virtually every one of those items,” Pritzker said.
Trump on Friday invoked his powers under the Defense Production Act, a wartime law that allows him to call upon private companies to fulfill federal orders for supplies. His order mobilized General Motors to build ventilators, essential in treating patients who need help breathing.
The order doesn’t go far enough, Pritzker said. The president should call upon manufacturers to produce more supplies including PPE and test kits.
The state “continues to grow and increase” testing capacity, said Dr. Ngozi Ezike, director of the Illinois Department of Public Health.
“Even if someone knew that they were positive, I think that would affect their behavior. If you know you’re positive, I think you would be more likely to just really withdraw, make sure you stay away from others,” Ezike said Friday.
“It is an important part of flattening the curve and dealing with the pandemic to make sure people are aware and so we can follow the incidents and follow the trajectory and know when we’re getting to a better place.”
Tracking the virus is essential to controlling it, Chun said.
“Look at South Korea. They’ve been testing 15,000 to 20,000 people a day, and that was critical to slowing down the virus. Many of our hospitals, including those in the metro-east, have been working to set up testing processes but they’ve been hampered,” Chun said.
Asked when more tests kits were expected to arrive, Chun said, “You’d have to ask the federal government because every day they say it but then it doesn’t appear.”
The same goes for PPE.
McManus, CEO of metro-east Memorial Hospitals, said staff are using materials “conservatively.”
“The main reason we’re conserving is the uncertainty about the duration and how long this is going to go,” McManus said. “We feel like while its not perfect we feel we’re in an OK spot right now from a PPE perspective. But the shipments haven’t arrived, and until they’re in the warehouse, you don’t want to count on it.”
Hospitals in the metro-east have asked for donations of both clinical and hand-sewn masks, while the governor has pleaded with veterinarians, tattoo parlors and nail salons to donate PPE they may not be using.
Illinois will receive millions of masks, thermometers and other supplies by the end of the week through state-directed contracts, Pritzker said Monday. But in three deliveries from the federal government’s strategic stockpile, Illinois only received a fraction of what it ordered.
“PPE is the first line of defense for our health care workers. It’s not a luxury they should have to ration,” Pritzker said.
The state’s next step is to convert Chicago’s McCormick Place convention center into a 3,000-bed “alternate care facility” to treat COVID-19 patients. Pritzker said officials are prepared to open or convert other locations throughout the state as cases surge outside of Chicago.
“Right now in Chicago alone, the number of cases is doubling every three to four days,” said the city’s mayor, Lori Lightfoot. “It’s truly a race against time and we have no time to waste.”
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