Coronavirus could overwhelm hospitals in small cities and rural areas, data shows - Was... - 0 views
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f a health official wanted to know how many intensive-care beds there are in the United States, Jeremy Kahn would be the person to ask. The ICU physician and researcher at the University of Pittsburgh earns a living studying critical-care resources in U.S. hospitals.
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Yet even Kahn can’t give a definitive answer. His best estimate is based on Medicare data gathered three years ago
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“People are sort of in disbelief that even I don’t know how many ICU beds exist in each hospital in the United States,” he said, noting that reporting varies hospital to hospital, state to state. “And I’m sort of like, ‘Yep, the research community has been dealing with this problem for years.’ ”
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But the pandemic has revealed a dearth of reliable data about the key parts of the nation’s health-care system now under assault. That leaves decision-makers operating in the dark
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Given the limitations, The Washington Post assembled data to analyze the availability of the critical-care resources needed to treat severely ill patients who require extended hospitalization. The Post conducted a stress test of sorts on available resources, which revealed a patchwork of possible preparedness shortcomings in cities and towns where the full force of the virus has yet to hit and where people may not be following isolation and social distancing orders.
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More than half of the nation’s population lives in areas that are less prepared than New York City, where in early April officials scrambled to add more ICU beds and find extra ventilators amid a surge of covid-19 patients.
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To compare available resources across the country, The Post examined a year-long scenario in which the coronavirus would sicken 20 percent of U.S. adults, and about 20 percent of those infected would require hospitalization
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Under that scenario, about 11 million adults would need hospitalization for nearly two weeks, and almost 2.5 million would require intensive care.
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This level of hospitalization is considered by Harvard researchers to be a conservative outcome for the pandemic, while others have described it as severe.
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about 76 million people, or 30 percent of the nation’s adult population, live in areas where the number of available ICU beds would not be enough to satisfy the demand of virus patients. The scenario for ventilator availability is even more dire: Nearly half of the adult population lives in regions where the demand would exceed the supply.
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We need to know where our weapons are. We need to coordinate all of that,” said Retsef Levi, a Massachusetts Institute of Technology professor leading a health-care data initiative called the COVID-19 Policy Alliance. “This is a war.”
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Kahn likened the task of evaluating the current readiness of the U.S. health-care system to peering into a dark room.
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By The Post’s analysis, the general Seattle region would need all of its available ICU beds — plus a 15 percent increase — to handle an outbreak in which 20 percent of the population is infected with the coronavirus and 20 percent of those people need hospitalization. But the demand for ICU beds could be lower because the curve of infections in Washington appears to be flattening, according to officials.
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Bergamo, as the ground zero of the Italian outbreak, was beset by ICU bed and ventilator shortages. “We think Italy may be the most comparable area to the United States, at this point, for a variety of reasons,” Vice President Pence said April 1 in a CNN interview.
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The MIT research group, the COVID-19 Policy Alliance, has mapped high-risk areas in the United States where sudden spikes could inundate hospitals as the surge in northern Italy did.
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In their U.S. analysis, MIT researchers considered several risk factors, including elderly population, high blood pressure and obesity.
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The takeaway, the researchers said, is that across the nation, “micro-geographies” of individual Zip codes or small towns have the potential to generate surges of covid-19 patients that could overwhelm even the most-prepared hospitals.
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Levi said nursing home populations should be prioritized for virus testing across the country, because outbreaks in such close quarters can rapidly sicken dozens of people, who then flood into area hospitals.
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“We’re outside of it, and we’re all looking through different keyholes and seeing different aspects of it,” he said. “But there’s no way to just open the door and turn on the lights, because of how fragmented the data are. And that is a really, really depressing thing at all times, let alone during a pandemic, that we don’t have an ability to look at these things.”
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The Society of Critical Care Medicine estimates that there are nearly 29,000 critical-care specialized physicians like Johnson who are trained to work in ICUs in the United States. Yet about half of all acute-care hospitals have no specialists dedicated to their ICUs. Because of the demands of treating covid-19 patients, the lack of dedicated physicians “will be strongly felt” through a lack of high-quality care, the society said in a statement.
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The society also projects that the nurses, respiratory therapists and physician assistants specially qualified to work with ICU patients may be in short supply as patient demand increases and the ranks of medical workers are thinned by illness and quarantine.
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what has the hospital been doing as a prevention epicenter in the four years between the Ebola epidemic and the emergence of the coronavirus pandemic?
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“Drilling and preparing for it,” said Jorge Salinas, an infectious-disease physician working on the effort. “You may be preparing and training for 10 years and nothing happens. But if you don’t do that, when these pandemics do occur, you will not be prepared.”
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Salinas said the pandemic has exposed the long-standing flaws in the nation’s “individualistic” health-care system, where hospitals look out for themselves. Electronic health-monitoring systems vary hospital to hospital. Supply tallies are kept in-house and generally not shared. To counter this in Iowa, he said, all hospitals have begun sharing daily information with state officials.