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For the last ten days, Dr. Calvin D. Sun has been working in emergency rooms throughout New York City and treating patients with COVID-19, the disease caused by the coronavirus. The 33-year-old physician specializes in emergency medicine, and he’s been filling in when hospitals have a shortage of doctors.
Last week, he said ERs were rationing tests. “Next week the triage might be different: We might be rationing care,” he said. “Everyone could be intubated, the hospitals might be full, the ICUs are full, we don’t have enough ventilators.”
Physicians and nurses across the country have already seen an overwhelming number of patients. More than 2,300 new cases of COVID-19 were confirmed on Wednesday alone, bringing the national total up to 10,442. And 150 people have died. With a shortage of beds, intensive care units, respirators, doctors, or nurses, the country’s hospitals will soon be overwhelmed as those patients’ symptoms worsen.
“There’s concern about what we always call the staff, the stuff, and the space,” said Richard Branson, a respiratory therapist and professor in the College of Medicine at the University of Cincinnati.
“Do you have the people to take care of the patients? The space, the intensive care unit, to take care of them? Do you have all the devices — ventilators, IV pumps — to deliver medication, monitors to monitor how the patient is doing,” he added.
“What's the point of testing if they're not going to get admitted to the hospital?”
Right now, the U.S has about 924,000 hospital beds and 98,000 beds for patients who need intensive care. Even if the U.S. manages to stem the contagious respiratory disease as intended, the country will need eight times as many intensive care beds, according to a recent study by the Imperial College of London. And if the pandemic snowballs out of control, the U.S. would need 30 times more beds.
Another study from Harvard estimates that if 40% of the country gets the novel coronavirus over the course of a year — researchers’ mid-range estimate — the country will need double the number of available hospital beds. If 60% of the country contracts COVID-19 within six months — the worst case scenario — the U.S. hospital system would be completely overwhelmed. The country would need seven times more beds.
To make up for the lack of beds, the federal government has already sent Navy hospital ships to the east and west coasts, the epicenters of the U.S. outbreak. But even those ships only have about 1,000 beds.
It’s not just beds
The country’s hospitals also don’t have enough ventilators, which help people breathe when they can’t on their own. The U.S. healthcare system has an estimated 160,000 ventilators now, with an additional 12,000 or so in secret federal stockpile. It’s not clear how many the U.S. will need to treat the influx of coronavirus cases, but hospitals don’t have enough right now.
New York State is expected to need about 25,000 more ventilators than it has on hand. In just a few weeks, doctors in New York could find themselves in a position of having to decide who gets a ventilator and who doesn’t.
“If things are going the way they are, and the system is about to collapse and we don't have enough ventilators,” Sun said, “a committee decides whether to even offer this patient a ventilator or palliative, compassionate care.”
On Wednesday, President Donald Trump invoked the Defense Production Act, which usually kicks in during wartime. He could use the federal law to force factories to produce needed supplies to fight the pandemic, like ventilators.
But even if the country had enough ventilators, operating them can be dangerous. Doctors have to get up in sick people’s faces to intubate them, and physicians and the specialists who carry out the procedure could easily fall ill. And there’s a shortage of masks: At Sloan-Kettering, a cancer hospital in New York, had only a one-week supply of masks, according to BuzzFeed News. The CDC now recommends that, if proper facemasks aren’t available, doctors might fashion their own out of a bandana.
Physicians are also stretched thin when there isn’t a pandemic, and the shortage would be even worse if they were treating the poor and uninsured. If everyone were insured and receiving care, the U.S. would need another 100,000 doctors.
Now, healthcare professionals are bracing for the worst. California has seen a nearly 30% spike in demand for temporary doctors, according to a medical staffing agency there.
“Are our hospitals staffed? No,” said Dr. Krutika Kuppalli, an infectious diseases physician and vice chair of the Infectious Diseases Society of America global health committee. “There’s a lot of demand on physicians in a regular situation. So now you have a situation where there’s so much more happening, and I don’t think hospitals are staffed for it.”
As this extremely infectious strain of coronavirus has spread, it’s already forced some nurses and doctors to quarantine and stop treating patients. The governor of Connecticut on Tuesday said that some 200 nurses at a hospital in Connecticut were furloughed after being exposed.
“If I can test those nurses, I can potentially get them back into the game a lot sooner,” Gov. Ned Lamont said on MSNBC. “We’ve got a surge in use, demand is going up and I’m losing nurses by the day who have to furlough themselves for some time.”
In New York, the epicenter of the outbreak, Sun said last week they had a shortage of tests. Now, those tests are more readily available, but he’s urging patients not to come to the ER unless they’re having severe symptoms and need treatment.
“What’s the point of testing if they’re not going to get admitted to the hospital? They’re just going to catch COVID-19 on the way home,” Sun said. He noted that they'll warn patients that their tests might not be accurate, since they could catch the coronavirus in the ER or on the subway ride home. “So we’re just giving them false reassurance and actually hurting them."
Emma Ockerman contributed to this report.
Correction 3/20: An earlier version of this story incorrectly stated the number of ventilators New York State would need. The text has been updated.
Cover image: 13 March 2020, Saxony, Dresden: An intensive care bed on an intensive care unit at the University Hospital Dresden. (Photo by: Ronald Bon'/picture-alliance/dpa/AP Images)