Overwhelmed hospitals: planning for crisis
Some history
Compared to COVID-19, we have a great deal of experience with flu. But talking about flu as though it’s a single entity is misleading, of course. After all, there are “bad” flu seasons and “good” ones. The range is fairly wide:
Influenza spreads around the world in yearly outbreaks, resulting in about three to five million cases of severe illness and about 290,000 to 650,000 deaths… Death occurs mostly in high risk groups—the young, the old, and those with other health problems.
In the United States, the range of deaths per year from regular seasonal flu is between 12,000 and 61,000. Then there are pandemic flu years such as 1957, 1968, and 2009:
In the 20th century, three influenza pandemics occurred: Spanish influenza in 1918 ([worldwide] 17–100 million deaths), Asian influenza in 1957 (two million deaths), and Hong Kong influenza in 1968 (one million deaths).
The death tolls from these pandemics in the US were much higher than in ordinary flu years, particularly in 1918. However, the death toll from 2009’s flu pandemic H1N1 (as estimated by the CDC) ended up being not as bad as originally predicted; it caused the death of between 8868 and 18,306 Americans.
It’s possible that COVID-19 will end up with a death toll no higher than the toll in a “bad” flu year. Or it could be worse than that, even much worse. In addition, there is the huge economic toll of the extreme strategies used to combat it. How will we know if they will have been worth it? Some day the number crunchers will analyze the data and come up with an answer – actually, several competing answers from which you can probably pick and choose.
In pandemics such as the terrible flu of 1918, many hospitals were overwhelmed by the number of patients in desperate need, although medicine was so limited then that ventilators weren’t just scarce – they hadn’t been invented yet. But what about recent years of seasonal flu, or a relatively mild pandemic such as H1N1 in 2009? Surely we had enough resources then, and didn’t have to worry?
Remember this from October of 2009? I didn’t either, but take a look:
If a third of people wind up catching swine flu [H1N1], 15 states could run out of hospital beds around the time the outbreak peaks, a new report warns Thursday.
The nonprofit Trust for America’s Health estimates the number of people hospitalized could range from a high of 168,000 in California to just under 2,500 in Wyoming.
The public health advocacy group used government flu computer models to study how quickly hospitals would fill up during a mild pandemic, like the kind the swine flu — what doctors prefer to call the 2009 H1N1 strain — is shaping up to be.
It based its estimates on the mild 1968 pandemic, suggesting up to 35 percent of the population could fall ill.
Even though only a fraction would be sick enough to be hospitalized, health officials are bracing: When H1N1 first appeared in the spring, more than 44,000 people visited emergency rooms in hard-hit New York City, the report noted. Just sorting out which patients are sick enough to be admitted from the vast majority who need to go home is a big job. And hospital capacity varies widely.
By the outbreak’s peak, the new report suggests Delaware and Connecticut hospitals would fill up soonest. Also on that list: Arizona, California, Hawaii, Maryland, Massachusetts, Nevada, New Jersey, New York, Oregon, Rhode Island, Vermont, Virginia and Washington.
But it never came to pass, fortunately; the H1N1 flu was not as bad as epidemiologists had originally feared.
And what of a “regular” flu year? This is from January of 2018, entitled “A severe flu season is stretching hospitals thin. That is a very bad omen”:
A tsunami of sick people has swamped hospitals in many parts of the country in recent weeks as a severe flu season has taken hold. In Rhode Island, hospitals diverted ambulances for a period because they were overcome with patients. In San Diego, a hospital erected a tent outside its emergency room to manage an influx of people with flu symptoms.
Wait times at scores of hospitals have gotten longer.
But if something as foreseeable as a flu season — albeit one that is pretty severe — is stretching health care to its limits, what does that tell us about the ability of hospitals to handle the next flu pandemic?
Good question, isn’t it?
More:
That question worries experts in the field of emergency preparedness, who warn that funding cuts for programs that help hospitals and public health departments plan for outbreaks and other large-scale events have eroded the very infrastructure society will need to help it weather these types of crises…
A dozen years ago or so, government officials placed pandemic influenza preparedness efforts on the front burner because of fears that a dangerous bird flu strain — spreading quickly across Asia at the time — might trigger a catastrophic pandemic…
Then in 2009, the first flu pandemic in four decades did hit. But instead of bird flu, it was a swine flu virus called H1N1. There were not mass casualties…
Pandemic influenza lost its big, bad bogeyman status. And in the years since, budgets for preparedness work have suffered…
Hospital and public health preparedness programs have sustained cuts in the order of about 30 percent in recent years, said Dr. Oscar Alleyne, a senior adviser with the National Association of County and City Health Officials, adding: “The level of funding is a concern to us.”
…In a bad pandemic, hospitals might have four times more people in need of a ventilator than they have ventilators, and far too few intensive care beds for the seriously ill.
…Getting help from elsewhere — as a community will often do in the case of a major medical disaster — isn’t really an option during flu epidemics, because other places are either dealing with their own or steeling themselves for a wave that’s about to hit.
Please read the whole thing, as well as this article about how California’s plans for preparedness fell by the fiscal wayside.
Preparedness costs money, and in non-pandemic times people are loathe to spend a lot of it for a crisis that seems remote or that never may occur. Then, when the crisis hits, the media and politicians are quick to whip up fear if it suits their purposes.
[Neo is a writer with degrees in law and family therapy, who blogs at the new neo.]
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Comments
Unfortunately there are fewer hospitals than 10-20 years ago because so many (including illegal aliens) have skipped out on paying bills.
Wonder what percentage of the population is
hypochondriacs?
Up to 5 Percent of the population are hypochondriacs…..
330,000,000 U.S. population times 5% =
16 1/2 Million hypochondriacs……..
If you were an enemy of the U.S. devoted to Germ (biological) Weapons/Warefare……… Well need I say more?
https://www.everydayhealth.com/anxiety/understanding-hypochondria.aspx
There is also that bizarre “certificate of need” that hospitals have to get from the government (state level I believe) if they want to expand. Why the govt needs to give its permission I dont know, since I can’t imagine most medical organizations would add 50 beds if they dont think they’d ever need them, and I’d trust them to have a better grasp of community needs for inpatient care better than Hartford, Albany, or any other state’s bureaucracy.
And the attack on the religious orgs that were supporting them were pushed out by corp. main street.
Why spend money on preparing for an inevitable pandemic when that money can be spent on importing shitholers with their exotic diseases to displace our population in contravention of the UN genocide prohibition?
All part of Nancy Pelosi’s master plan.
Show us the video.
What video? The author is talking about something that occurred in 1918, and pandemics of recent periods and drawing conclusions based on similar circumstances. Absolutely none of that would be enhanced by a video, even if one were made.
So is the weekly death rate of 53000 changed?
Best data here:
https://covid19.healthdata.org/projections
There are at least 60,000 full-featured ventilators in the US. The projected peak need is about half that. So ventilators probably won’t be the problem.
ICU beds may be the critical resource in the next few weeks. We’ll probably be short of those by about a factor of 2 at the peak of the epidemic.
There’s also a projected shortage of hospital beds, although not by as big a factor. We’ll have about 70 percent of the needed beds.
Question is drugs. Since we are getting something like 2 M doses, that is like 333 K of people covered. We need like 5 times that amount.
We need fast and accurate testing, so that we don’t expend that medicine on precautionary doses. This disease gets nasty fast. 4-day turnaround misses the window of opportunity to avoid hospitalization.
Also, we should not be waiting for people to be hospitalized before starting treatment. The Drs. sent one man in San Diego home for self-quarantine, and he died shortly thereafter.
We also need to weed out the hypochondriac morons from the prescription process. Yes, I’m talking about the people who will eat aquarium cleaner because it has a similar name. The media has cranked up the hype meter to such a degree that the doctors are going to be swamped with people who may (in their own minds) be really really critical ill I need that thing I saw on the news just write me a prescription doc and my insurance will cover it. One pill-pushing doctor could write the reserves right out from under patients who *need* it in an area.
It is far too easy to peg the needle on either side of the dial on this. We can’t afford to fling pills (which HAVE serious side-effects if not monitored) at random people just the same as we can’t afford to lock up every pill in a big vault and declare victory.
HEAR HEAR!!!!!!!!!!!!!!!
Half of our cases right now are in the New York/New Jersey area. Shipping ventilators could become a problem.
From what I have read, the quantity of ventilators in New York City won’t be a problem, but finding enough qualified people to operate them will be.
I don’t think the virus has anything to do with that.
Yes, Gov. Cuomo hide tens of thousands of ventilators in NJ ware houses.
With DEMS that is SOP.
Remember this is exactly what the DEMS did in Puerto Rico with the hurricane relief aid.
They had warehouses stuffed full of relief supplies from President Trump.
But all the evil DEM politicians went about screeching that President Trump didn’t send aid.
Both will be.
Not true. The state stockpile is a few thousand, but if the projected peak comes to pass tens of thousands will be needed. That is what this is all about.
And no, there was never any proposal years ago that the state should increase the stockpile by enough to cover a 1918-sized crisis.
The problem of dealing with infectious diseases is a product of the medical profession.
First of all, the blind belief in the effectiveness of modern vaccines has caused the medical profession to rely upon prophylactics which are not as comprehensive in their effectiveness as the industry would have the populous believe. Flu vaccines are only 25-40% effective. So, this caused medical facilities to reduce stocks of supplies needed for treatment of infectious diseases.
Second was the industry’s move away from treating sudden injury and disease and into the much more lucrative market of elective procedures, which have an in-hospital turn around time of from 0-48 hours. Also,, such procedures alllow the facility to cut nursing staff, as infrequent monitoring of the patient is all that is required.
Third is the elimination of staff, especially nursing staff, to increase profits. This is done by reducing the number of patients needing intense monitoring as well as using electronic monitoring to eliminate the need for a human presence, unless a problem occurs. However, if multiple problems occur, simultaneously, then the shortage of nurses can become critical.
Fourth is the decision not to increase treatment facilities and bed space as the local population grows. Unless an area has a large population which needs institutional care AND has the resources to pay for such care, facility construction and bed space lags behind the community’s needs in an emergency.
The medical profession has had from 7-10 years to stockpile non-perishable items, such as ventilators, masks, gowns and gloves, since the last disease scare. They chose not to. Now they are whining about shortages and blaming it on the federal government.
Now, it is too late to hire more staff. It is too late to construct more facilities. It is too late to lay in more ICU beds. It is too late to lay in sufficient supplies to deal with the potential problem, because the manufacturing of these supplies has been moved off-shore and the global economy has been shutdown. And, with the economy shut down for months, it is probably too late to fund the procurement of the supplies anyway.
So I am still looking for the answer on this? How many ventilators does NY really need? How many are they using now? What is the normal rate of use?
I would love to know if we are still tracking 53000 deaths a week in the US or if it is higher?
Best estimate is that New York will have a peak need of 8,855 ventilators.
Data here:
https://covid19.healthdata.org/projections
Select New York, etc.
We can’t have the answers to those Questions, Mark, because the press wants to luxuriate in asking Trump things like:
How many deaths are acceptable?
Are you accusing hospital staff of stealing masks?
No real reporters; just preeners of the left.
All I know is that my community is reeling from this weekend’s death rate. And the week is looking like it will be worse. This is hitting very close to home.
I just checked the most recent data, and at its current rate of growth we should have about 7,500 additional deaths in the US over the next week, bringing the total up to about 10,000. (Today’s 3/30. If you look at this post in a few weeks, it will be way off.)
I have commented elsewhere that the assumption is that the hospitals are filling up with Chinese Virus patients. I’ve known of several cases earlier this year before the virus (BV) where people close to me were either sent home or redirected to hospitals hours away because there were no rooms in the hospitals. Why? The flu primarily. If we put even a few Covid19 patients on top of the already high number of flu patients and this is what happens.
.
If you listen to the press reports, the only sick people in hospital have the virus.
.
Add to this, the fact that most accidents happen in the home. Where has the regime sent everyone for containment? The most dangerous place on the planet.
California once had mobile hospitals and a ventilator stockpile. But it dismantled them.
https://www.sandiegouniontribune.com/news/california/story/2020-03-28/coronavirus-california-mobile-hospitals-ventilators
Planned Patient (PP)? Wicked.
There will, I hope, be a thorough analysis of spending priorities and policy choices at the state and local level in the aftermath. In addition I would hope that the FEMA guidance to individual citizens, municipal and state governments is much more well publicized than is the case today. Perhaps revised with this event as the standard.
1. Individual citizens should be prepared to feed themselves for a month. This, coupled with limits on # of items purchased can allow the logistics of food distribution to adapt.
2. Return to ‘in kind’ food assistance; end EBT cards and distribute two weeks of food at a time just like we used to do. Additionally, use the facilities we already bought to provide a free breakfast, lunch and take home snack/sandwich for every child. I would wager that the combination of these actually saves money compared to current system. This also creates additional food in homes and distribution network.
3. States and municipalities are the gatekeepers for increased numbers of hospital beds. The payment and pricing of healthcare facilities is likely to be different after this. Look for more transparent pricing for services, no $250 aspirin, but either direct subsidies for extra ‘surge capacity’ beds or additional hospital to be constructed.
4. PPE at municipal level should be about two weeks with 24 hour use. States should have an additional week or ten days worh to distribute. Then the federal government can assist the more impacted areas with their stockpile as well as assisting in coordination of additional new manufacturing.
5. Medical equipment same as 4 above.
6. Population density is obviously good in normal times for purposes of economy of scale and efficiency. Density during a pandemic is not helpful. Some of the more populous municipal areas will need to decide if the risk is acceptable and if so then they will need to be even better prepared to perform self help before asking other areas to pay the cost of folly.
To be clear these are all topics we should be raising once the current wave ends. We shouldn’t refuse to help N.Y. etc as of now. We should be asking them to modify future budgets and policy priorities towards ensuring that their densely populated areas are adequately spending on preparation vs feel good social programs. Certainly every state and municipal government could benefit from taxpayers demanding that funds be spent on real problems and real governmental responsibilities before another dime is spent in grants to some SJW organization.
In California, we “invested” BILLIONS in the “bullet” train from nowhere to nowhere.
Just four points that deserve attention. First, a Stanford expert has pointed out that at least so far the death toll has not been significantly higher than in a bad flu year. 2) politicians pushing a shut down have failed to distinguish between areas with differing likelihoods for large-scale infection–e.g., small towns and rural areas compared to high density cities. 3) Sweden is offering an interesting test case by so far resisting any shut down. 4) much of the hysteria has been due to the media–in many cases motivated by politics, in others by the desire to sell papers or attract listeners.