Overwhelmed health care systems around the world and even in some parts of the United States raise questions about the ability of the health care system to handle the COVID-19 pandemic when it peaks, but officials at the state and local level insist Missouri and Joplin are prepared when it comes to such things as ventilators, beds and other medical equipment.
The Joplin area reported its first COVID-19 case late Friday.
Jackie Gatz, Missouri Hospital Association vice president of safety and preparedness, testified before a joint committee of Missouri lawmakers recently and said that 80% of adult ventilators in the state were available. However, Gatz did not provide a number.
The Society of Critical Care Medicine has projected that 960,000 COVID-19 patients in the U.S. could need to be put on ventilators at some point during the outbreak, depending on its severity. But the nation has only about 200,000 of the machines, by the organization’s estimate, and around half are older models that may not be ideal for the most critically ill patients. Also, many ventilators are already in use by patients with severe but unrelated health problems.
This past week, Dr. Anthony Fauci said while he does not expect massive outbreaks in the United States as occurred in Italy, there is the possibility that the virus could start to overwhelm the health care system, causing shortages of beds, ventilators and supplies.
“And that’s when you’re going to have to make some very tough decisions,” Fauci said.
The nation’s hospitals have collectively about 1 million beds, with 100,000 for critical care patients.
Scott Gottlieb, formerly of the Food and Drug Administration, said if there are multiple epidemics in multiple large cities at the same time, “the system will become overwhelmed.”
President Donald Trump has promised that his administration would coordinate responses with the states, push for construction workers to give masks to health care workers and, if needed, use the Army Corps of Engineers to build more hospital space. He also is using his authority to get factories to shift production to needed medical equipment, but retooling takes time.
General Motors Co. announced on Friday that it is working with ventilator maker Ventec Life Systems to ramp up production. The automaker said it would help with logistics, purchasing and manufacturing but stopped short of saying it would make ventilators in its own factories, which have been idled for two weeks after workers who’d been fearful of contagion put pressure on the company. Crosstown rival Ford, which also suspended factory production along with other automakers with operations in North America, confirmed that it too was in discussions with the Trump administration about helping.
Ford and Rolls-Royce PLC also are working with the British government to see if they can switch over their factories.
Many hospitals also are urging people with elective or nonemergency surgeries to delay them if possible to free up hospital beds, and some cities have begun setting up tents and preparing alternate sites. In New York, the governor has called for using military bases and college dorms if needed, and in Seattle, they are building a tent hospital at a soccer field.
How Missouri’s health care system copes with the pandemic will depend on how widespread it becomes in the state, but based on estimates that 4% of those infected with the virus would require ventilation, Gatz told lawmakers that the Missouri Hospital Association is “very comfortable” that Missouri hospitals would have the resources to serve those patients.
As of Saturday, there were 73 reported cases in Missouri and three deaths, but last week, experts at the University of Kansas Health System warned Kansas City officials that the outbreak will be as severe there in two weeks as it is now in Seattle.
Requests to the Missouri Department of Health and Senior Services for details on the number of beds and ventilators that could be available statewide and in each community, including Joplin, were not answered, but the questions were forwarded instead to a private organization, the Missouri Hospital Association.
MHA’s vice president of media and public relations, Dave Dillon, said he was unable to provide that information.
The state Department of Health does collect information on hospital beds, and their latest records indicate that Mercy Hospital Carthage has 25 medical/surgical beds but no intensive care unit beds, and Mercy Hospital Joplin has 240 beds, of which 116 are listed as medical/surgical and 48 are listed as ICU beds.
Freeman Health System is listed as having 45 medical/surgical beds and four ICU beds in Neosho, and 338 beds at its west campus, with 228 of those listed as medical/surgical beds and 52 listed as ICU beds. State figures also indicate there are 72 additional beds at Freeman East (Oak Hill) used for rehab and psychiatric patients.
Freeman Health System said in a statement this week that it has a minimum of 60 beds that can be used for COVID-19 patients, and that it is actively expanding capacity now.
“We want to assure you that we are accessing the appropriate supplies and creating a plan, should there be a surge of patients,” Paula Baker, Freeman president and CEO, said Thursday. “Currently, our hospital is not at capacity, and we are preparing unused areas in our facilities to make even more space available for patients. This equates to adding bed space for inpatients here at Freeman Hospital West, and we are also refurbishing parts of Freeman East in order to admit patients there, should the need arise.”
In its statement this week, Freeman also noted, “As Freeman demonstrated during the 2011 tornado, we are prepared for a surge of patients should (that) occur.”
Freeman also said it has 27 ventilators and is working with suppliers to get more, noting that not every patient who has COVID-19 will need a ventilator, even if they are admitted.
The hospital said it also has implemented measures to conserve personal protective equipment and is working with its vendors and administrators have “managed to provide adequate supplies and are utilizing some of our disaster stockpile and replenishing it as trucks with allocated shipments arrive. We have requested masks from the national stockpile as well. As long as allocations continue, we will not have a shortage.”
On Thursday, Missouri received a delivery of thousands of pieces of personal protective equipment from the federal Strategic National Stockpile.
Some hospitals have said they are reluctant to provide details such as how many ventilators they have or the maximum number of COVID-19 cases they could handle, citing security concerns.
Asked about its ventilator status as well as the number of beds that it could make available in Joplin, Mercy Hospital Joplin did not provide a number but said in a statement: “The number of available beds regularly fluctuates, and whether it’s COVID-19 or a surge of another type of patient, Mercy is prepared and has the flexibility to place patients in the most appropriate setting in order to provide ICU care to those best suited for that level of care, in the ICU or other spaces as needed.”
“There is a scale that we don’t have the resources, and that’s always true, but we don’t know exactly what that is,” Dillon said. “We’re focusing all our front-side resources on the idea of reducing this problem to where the unthinkable is not the eventuality.”
Dillon emphasized what state officials have been saying, that the best steps people can take right now are to wash their hands, isolate when sick, make sure commonly touched surfaces are clean and keep social distance by avoiding contact with large groups of people.
The kind of planning that hospitals have been doing is something they’ve been practicing consistently since Sept. 11, 2001, called “all-hazard” planning. Whether the crisis is a tornado or a pandemic, the tools for responding are similar, Dillon said. The Ebola virus has made infectious diseases a focus of that planning for the past several years, Gatz told lawmakers.
What hospitals and the state association are doing now behind the scenes is identifying obstacles to treatment. That includes rules that set boundaries for care in a typical setting but could block hospitals and health care providers from doing what they need to do to respond to COVID-19, Dillon said.
One of those rules is a requirement that anyone who comes to an emergency room for treatment has to be treated in the emergency room. Possible COVID-19 patients would ideally call first so they could be put through a separate site for testing, keeping them from exposing other emergency room patients to the virus.
Ideally, people would be tested in a physician’s office, urgent care or a site set up specifically for testing for COVID-19 — such as the drive-thru testing sites opening around the United States. Joplin is planning to have a site set up this week. But the emergency room is where a lot of people access care, and if a patient steps into one, they can’t currently be redirected, Dillon said.
Trump’s disaster declaration also gave the Centers for Medicare and Medicaid Services the authority to waive that and some other regulations, as it’s done during natural disasters and pandemics such as the swine flu outbreak of 2009.
Florida was the first state to have that waiver approved this week, and CMS said it expects more states to follow. The agency also issued a blanket waiver to temporarily lift some regulations on all health care providers right after Trump declared a national emergency.
But on Thursday, several governors spoke with Trump and expressed concern with their ability to deal with the virus. In their teleconference with Trump and Vice President Mike Pence, the governors pressed for more supplies — masks and other protective equipment for medical professionals, test kits and lifesaving supplies such as ventilators.
Last month, a report from the Center for Health Security at Johns Hopkins, estimated hospitals across the country had 160,000 ventilators, with thousands more in reserve at the federal Centers for Disease Control and Prevention.
Nationwide, hospitals are rushing to rent more ventilators from medical equipment suppliers. And manufacturers are ramping up production. But whether they can turn out enough of the machines at a time when other countries around the world are clamoring for them is unclear.
“The real issue is how to rapidly increase ventilator production when your need exceeds the supply,” Dr. Lewis Kaplan, president of the critical care society, said last week. “For that, I don’t have a very good answer.”
In the most severe cases, the coronavirus damages healthy tissue in the lungs, making it hard for them to deliver oxygen to the blood. Pneumonia can develop, along with a more severe and potentially deadly condition called acute respiratory distress syndrome, which can damage other organs.
Ventilators feed oxygen into the lungs of patients with severe respiratory problems through a tube inserted down the throat. The machines are also used routinely to help other hospital patients breathe, namely those undergoing surgery while under general anesthesia.
“If everyone in the country wants to order some, that will get rapidly depleted in a heartbeat,” Kaplan said.
On Tuesday, U.S. Defense Secretary Mark Esper said the Pentagon will provide 2,000 specialized ventilators to federal heath authorities to help handle the outbreak. He said the machines are designed for use by troops, and the military will need to train civilians how to use them.
The Society of Critical Care Medicine’s estimate of the number of ventilators nationwide includes those in the U.S. government’s Strategic National Stockpile, which keeps medical supplies on hand for states to use in emergencies. The stockpile has nearly 13,000 ventilators, Dr. Anthony Fauci, the Trump administration’s infectious-disease expert, said recently.
Whether that is enough depends on how well the nation can contain the virus, he said.
For most people, the coronavirus causes only mild or moderate symptoms, such as fever and cough. Most patients recover in a matters of weeks, as seen in mainland China.
But evidence from China also suggests that some COVID-19 patients who develop severe breathing problems will need to be on ventilators for weeks, if not longer, said Dr. Jacqueline Kruser, an intensive care physician and professor at Northwestern University’s medical school.
Philips Healthcare of the Netherlands; General Electric Co., which manufactures ventilators in Wisconsin and sells them globally; and Vyaire Medical Inc. of Mettawa, Illinois, all said they are stepping up production.
Vyaire is adding a second shift at its Palm Springs, California, factory and hiring more workers, spokesman Cheston Turbyfill said. As a global supplier, it has previously shipped ventilators to China and now is getting requests from Italy.
“We’re prioritizing by where the hot spots are,” he said.
One major rental company, US Med-Equip, reported that U.S. hospitals have rented 60% more ventilators, monitors and other equipment over the past few weeks than at any time last year. It said it has 6,500 ventilators available for rent and expects 1,200 more to arrive within the next few weeks at its Houston headquarters.
“Our team is working around the clock to provide patient-ready equipment so medical staff can focus on their lifesaving work,” CEO Gurmit Singh Bhatia said in a statement.
The Associated Press contributed to this report.