Protecting Against a Surge in Demand on Medical Resources

By March 27, 2020 Commentary

We have extensive, but not unlimited, health resources in the United States.  There has been a substantial push in the last decade in particular, to reduce hospital use and that has inevitably resulted in a reduction in the number of hospitals and hospital beds.  Seriously ill coronavirus patients often need hospitalization, and even time in an intensive care unit, which may often include mechanical ventilation to aid in breathing.  The United States actually has the highest number of ICU beds per capita in the world, largely because we tend to utilize much more aggressive end of life care than other countries and we have higher rates of significant trauma cases from events like car accidents and shootings.  We have 100,000 beds in ICUs.  That is a lot of ICU beds.  Obviously some of those beds are being used for patients treated for conditions other than coronavirus illness.  But the bigger problem is that the beds are scattered across the country and aren’t necessarily where there may be large numbers of coronavirus cases.

Right now, we don’t appear to have an actual shortage of ICU beds or ventilators.  Ventilators are obviously easier to move from one location to another and a larger supply can be produced somewhat quickly.  It is not possible to move an entire ICU unit.  It is possible to convert hospital units to additional ICU capacity, but that takes a fair amount of work.  And it is possible to be creative about using other methods of adding hospital beds–using hospital ships and repurposing large public building to be temporary hospitals, for example.  Having sufficient qualified medical personnel is also important.  Health workers have an enhanced likelihood of getting coronavirus infection, due to proximity to already infected patients.  Even if they become sick, the workers would need to quarantine to avoid becoming an infection source themselves. So being short-staffed is possible.  We can add medical personnel for coronavirus treatment by using people who otherwise would be working in less urgent departments and by inducing retired personnel to come back.

In general, I have a fairly good level of confidence that the system will have sufficient capacity to ensure appropriate treatment for patients, but it is a reason to engage in strong mitigation measures.  No one wants to see any patient die or have a bad outcome because adequate health resources were not available.

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