How many coronavirus patients can Idaho hospitals take? Will a bad outbreak overwhelm them?
It took weeks for Italy’s outbreak of the novel coronavirus to strain the country’s health care system to its limit. Doctors and nurses in Italy went from being able to care for patients with the novel coronavirus two weeks ago, to being forced now to choose which patients get life-saving medical care, The Atlantic reported Wednesday.
So, what happens when Idaho has its first confirmed case of COVID-19? What happens if the coronavirus spreads, despite the best efforts of state and local public health agencies? How many patients would it take to overwhelm Idaho’s health care system?
The vast majority of people who get COVID-19 survive. But an estimated 10% to 20% of patients need to be hospitalized. Many of them need intensive care or a ventilator — specialized care and equipment that isn’t in limitless supply. That’s why health care experts are sounding the alarm about the nation’s ability to handle its growing number of coronavirus cases.
Their worry isn’t just that a large share of COVID-19 patients end up in the hospital. Or that those patients may need weeks of hospital care. Their worry is what happens when hospitals are inundated with those patients — and still need to help people who show up with influenza, heart attacks and other critical health problems that don’t stop occurring when a new virus shows up.
Idaho has tested 93 people for COVID-19 as of Thursday and still has found no confirmed cases. (Not everyone with COVID-19 symptoms is being tested. Priority for tests is going to patients sick enough to be hospitalized and who have a higher risk of coronavirus exposure.)
Idaho Gov. Brad Little assembled a coronavirus working group earlier this month to organize the state’s prevention and response efforts. That group includes health care industry representatives Brian Whitlock, CEO of the Idaho Hospital Association, and David Pate, retired doctor and retired CEO of St. Luke’s Health System.
The working group is starting to look at hospital capacity, Whitlock said. But the group hasn’t yet made projections or put together models to determine how long it will take an Idaho outbreak to fill up hospitals.
“The work group has a plan for what happens when we have our first case identified, what’s the protocol, what happens when it starts to spread,” Whitlock said. “There are certain protocols that will happen if there is a larger overall outbreak. (The group is figuring out) who has authority to do what and what resources are available.”
How many isolation rooms for contagious patients?
The state currently has 300 hospital beds in isolation rooms, or “negative pressure rooms,” mostly in Idaho’s large hospitals, according to Whitlock.
Those rooms limit air flow, to keep tiny organisms like a novel coronavirus from escaping to the rest of the floor. Hospitals put patients there who have airborne contagious diseases like tuberculosis.
There is potential to add 60 more of those beds statewide — for a total of 360.
Based on the hospitalization rates seen in other places, Idaho would need about 1,800 to 3,600 cases of COVID-19 to create enough seriously ill people to fill those beds. That’s about 0.1% to 0.2% of Idaho’s population catching the virus around the same time.
Pate — who stressed that he’s speaking from his own experience and observations, not as a spokesperson for St. Luke’s or the governor’s working group — said hospitals have surge capacity to handle more patients in a crisis.
“We can take units or floors of hospitals and dedicate them to these patients, so there are no other patients in proximity to them,” he said. “We have the ability to take other facilities and convert them to use.”
That has happened in other places. Sixteen temporary hospitals were created in Wuhan, China, the epicenter of the novel coronavirus. A county in Washington bought a motel to use as a quarantine facility for COVID-19 patients.
“Things would have to get unimaginably bad — that, I don’t think will happen in Idaho with the preparations we are doing,” he said.
Worst-case scenario? It is possible to tap Idaho’s military resources and set up medical tents where doctors and nurses would be able to care for critically ill patients, he said.
“All of those scenarios are extreme and very unlikely,” he said. “My point is, we have tremendous surge capacity if, God forbid, we get (there).”
Pate said it is premature to assume anything about the outcome of coronavirus in Idaho.
Experts are learning new things about the virus and its disease every day, he noted. And it’s likely, he and many others say, that the rates of hospitalization and death aren’t as dire as they seem, because minor cases may go unidentified, skewing the numbers.
“I do think we’re very well prepared,” Pate said. “I certainly am not worried about that right now, even with all I know. Yes, (we are) planning, because we’d be foolish not to plan, but I’m not worried.”
Nonetheless, he and others stress the importance of delaying an outbreak in Idaho.
“At the end of the day, the capacity (of local hospitals) is an important question,” said Beth Toal, vice president of communications and marketing for St. Luke’s Health System, the largest hospital system in the state.
Toal said Idahoans can do their part by staying out of the hospital unless they have a medical emergency or severe symptoms.
“Unless you’re in a situation where you do need to be hospitalized, is coming to the emergency department with sniffles the best thing to do?” she said.
The surge in demand for ICU beds, isolation rooms and ventilators can be mitigated if people follow guidelines to slow the spread of a virus.
It’s important to wash your hands, stay home when you’re sick, keep your hands away from your face and develop other habits that help prevent all kinds of disease. There is some debate about when social distancing measures — canceling large events, limiting travel, sending students and employees home — become necessary, but they are among the recommendations by the World Health Organization to mitigate outbreaks.
“The longer we go without presumed or confirmed cases, the better shape we’re in,” Pate said, referring to Idaho’s lack of cases identified in the community.
This story was originally published March 13, 2020 at 5:30 AM.
