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With hospital space a national worry, medical experts brace for surge in coronavirus cases

With hospital space a national worry, medical experts brace for surge in coronavirus cases

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As the number of coronavirus cases continues to climb statewide and across the country, the health care industry is bracing for a surge in demand of medical supplies.

On a national level, there has been significant concern about the preparedness of the public health infrastructure to handle an increase in cases. Specifically, a large spike in demand for ventilators, personal protection equipment — now commonly called PPE — and intensive care unit beds is taking place as the number of cases rises and medical organizations prepare for the worst.

“What we’ve seen in Italy is that if you don’t have a sufficient number of ICU beds or ventilators or PPE … you can have increased mortality as a result,” said Julie Swann, department head and professor of the Fitts Department of Industrial and Systems Engineering at North Carolina State University. She has done extensive modeling for other diseases and worked with the Centers for Disease Control in their response to the H1N1 flu pandemic of 2009.

With more than 63,000 cases, Italy has one and a half times more confirmed cases than the United States and more than 15 times more deaths, according to the most recent situation report from the Centers for Disease Control.

Sovah Health-Danville, the hospital for the area which has a service area population of 108,000 residents, has “been preparing for the arrival of COVID-19 in our community for several weeks, building upon the robust emergency operations plan we have in place year-round,” hospital spokeswoman Kelly Fitzgerald wrote in an email.

So far, the hospital is housing one patient who has tested positive for COVID-19.

Fitzgerald would not answer any specific questions about the hospital’s equipment, facility set-up or patient capacity, including the number of ICU beds the hospital has. But she did say the hospital is “confident in our ability to evaluate, manage and treat patients who may have COVID-19.”

One of the biggest concerns among medical professionals is the capacity of hospitals to safely keep critical patients who are infected with the virus without endangering other patients or health care workers.

An analysis by the Washington Post found, on average, the United States has about 3.6 ICU beds per 10,000 people above the age of 16, but that number varies significantly between regions. Danville was not included in the analysis, but surrounding cities like Roanoke, Greensboro and Lynchburg were.

In terms of total hospital beds, Sovah Health- Danville has 250 total beds, according to the company website, which equates to one bed for every 432 people. Data from the Kaiser Family Foundation shows the average hospital in Virginia has 2.1 hospital beds for every 1,000 people, whereas Danville has 2.4.

Another major national concern is the availability of ventilators — machines that help patients breathe by moving air into and out of the lungs. Many severe cases of the coronavirus have led to pneumonia and other significant respiratory illnesses.

Nationally, there are a total of about 160,000 ventilators, according to a February study by Johns Hopkins University.

“The need for ventilation services during a severe pandemic could quickly overwhelm these day-to-day operational capabilities,” the authors of the study wrote.

Gov. Ralph Northam announced Tuesday the state has an agreement with both Maryland and Washington D.C. for sharing ventilators.

“That’s a complicated piece of equipment,” Northam said Tuesday. “So it’s not so easy to quickly change an assembly line and make them. We are working to source more.”

The availability of basic equipment for health care providers, including masks and gloves, is another point of concern on the national and state levels.

Northam said at a news conference Tuesday the state just received its first shipment of masks and gloves from the national stockpile and more will arrive sometime next week.

“We know it will not be enough, and this is an issue nationwide,” Northam said.

There have been some disruptions in the supply chain for pharmaceuticals and supplies needed by health care providers has been relatively small, said Tinglong Dai, an associate professor of Operations Management and Business Analytics at the Johns Hopkins University Carey Business School. The primary disruption has been the suspension of overseas inspections of drugs and devices in China and India, where the majority of raw ingredients used in American drugs are made.

“Without inspection, quality can quickly emerge as a public-health concern, either because of quality issue or because they won’t be able to access the U.S. market due to quality concerns,” Dai said.

Moving forward, he expects both manufacturing and warehousing — the first two steps in the supply chain — will be able to carry on as usual, but he expects the disruptions to come in the third and fourth stages: transportation and retail.

As a result of the increase in cases throughout the state of Virginia and the corresponding spike in demand for supplies, Swann believes this disease could very easily begin spreading among the medical professionals who are taking care of the sick.

“I think that we’ll start to see in another couple of weeks that there will be nurses and doctors who are unable to care for patients,” she said.

Medical experts said the goal of all the social distancing has been to slow the virus’ spread so as not to overwhelm the county healthcare infrastructure.

“It’s counter-intuitive, but we would like the disease spread to slow down and take longer,” Swann said. “If it does take longer, then our health system is more likely to have the ICU beds and ventilators to provide support for patients.”

Added Tara Smith, a Kent State University professor of epidemiology who focuses on the transmissions of infectious diseases: “One of the main points of doing this type of social distancing is … to slow it down so that you don’t have a big surge on the health care industry.”

Another approach South Korea has taken in recent days is to test everybody, quarantining those who test positive and asking anyone who came in contact with the positive case to isolate themselves. However, the United States does not have the testing capacity for such an approach. That’s why the country has all but shut down large gatherings and is encouraging — and, in some cases, mandating — everyone stay home when at all possible.

There have been shortages of testing kits across the country, which experts said might mean the virus has spread to people who likely have no idea they are infected.

“The root cause [for it spreading] is a lack of testing at the very beginning,” Dai said. “For us to be ready now, we should have taken better actions one month ago.”

Even as stricter measures are being implemented on an almost daily basis, the number of cases in Virginia has continued to increase in recent days, reaching a total of 290 cases diagnosed by Tuesday. Of those, 45 have been hospitalized.

One of those patients, a man in his 40s, is in Sovah Health-Danville, the Virginia Department of Health announced Sunday. Fitzgerald said he is stable.

The disease spreads through what Smith calls “droplet transmission,” meaning any drops of liquid, snot or spit that come out of a person have a risk of spreading the disease.

“It’s more infectious than [the flu], but it is less infectious than something like measles,” which can remain airborne for hours, she said.

At this point health officials are still unsure of how much warmer temperatures impede the spread and lifespan of the virus.

“Certainly beneficial, but not by any means a grand cure, a grand remedy for the issue,” Chris Andrews, district epidemiologist for the Pittsylvania Danville Health District for the Virginia Department of Health, said of higher temperatures.

Smith hopes to see officials at every level of government begin developing more plans for what happens after the current period of social distancing, which likely will go on for at least two months.

“This virus is not just going to go away,” she said. “What’s going to happen in the fall when it cools down again?”

Ayers reports for the Register & Bee. Reach him at (434) 791-7981.

Ayers reports for the Register & Bee. Reach him at (434) 791-7981.

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