Hospitals bracing for surge of patients

Nurses with Christiana Care, Delaware’s largest health care system, administer a free test for the coronavirus (COVID-19) to a man at the Riverfront complex in downtown Wilmington on March 13. Special to the Delaware State News/Butch Comegys

DOVER — So far, Delaware seems to have been spared the worst of the coronavirus, with 45 cases as of Saturday evening. Just five people here have been hospitalized from the coronavirus, according to the Division of Public Health’s official count.

But health experts warn that number will climb, perhaps exponentially, a risk that poses a serious threat to Delaware. Like the rest of the country, the First State’s health care system will be overwhelmed if cases do indeed skyrocket.

Data released by Harvard Global Health Institute last week indicates Delaware would not have enough hospital beds under most circumstances. While Delaware does not have health care “deserts” like some states, particularly the more rural ones, a large-scale outbreak could still be devastating.

In the “moderate” scenario, with 40 percent of adults in the Wilmington region (which includes Kent County) contracting the virus in a 12-month period, the area would need 1,766 beds — almost three times the number that would be available, per the data. After all, other ailments don’t stop just because of the coronavirus, meaning medical practitioners would be dealing with a mix of people fighting the virus and issues ranging from broken limbs to cancer to migraines.

To put it another way, if no beds were added, almost every existing one would have to be used to help coronavirus patients in this scenario.

For Sussex County, which is grouped with the Salisbury, Maryland, area in the data, 1,070 beds would be needed given the same spread. Unfortunately, the region has only 598 beds total, according to the findings — and that’s without even taking into account that many of those would already be used for other medical issues.

In fact, the area would need to increase its capacity about 570 percent in this scenario.

Intensive care units would be hit especially hard in both areas.

The findings assume patients spend an average of 12 days in the hospital, based on data from China. Using the estimate of 40 percent catching the virus within 12 months, the Wilmington region would have about 53,000 patients, with the Salisbury area having around 32,000. About 8 or 9 percent of patients would need to be hospitalized, Harvard estimated.

A more serious spread would obviously have an even greater impact. The worst-case scenario examined by Harvard would require the Wilmington area to have 5,299 beds, with 3,204 needed in the Salisbury region.

The dataset credits the state with 1,864 hospital beds and 249 ICU beds, although the only Delaware city listed is Wilmington.

According to the Delaware Healthcare Association, there are 2,544 licensed beds in Delaware hospitals, with 395 ICU beds. It’s next to impossible to tell how many are occupied at any given time.

Local preparations

Wayne Smith, the president of the association, said in a statement hospitals are working with each other and all levels of government to prepare.

“Delaware hospitals have plans in place in case of an event, like COVID-19, to provide more than 1,000 additional temporary beds to treat a surge in patients. Should additional resources be needed, planning is also underway to procure beds and locations to meet an increased demand,” Mr. Smith said.

“We will do everything possible along with our state partners to treat every Delawarean who needs health care services resulting from a COVID-19 infection. We are also working with state officials to make sure additional staff is available to meet patient needs.

“This preparation is critical, and Delaware residents have a vital role to play. By practicing social distancing, diligently hand washing, and not utilizing the Emergency Department unless there is a true emergency, such as significant difficulty breathing, Delawareans can help preserve precious hospital resources for those that truly need them.”

New York Gov. Andrew Cuomo said last week the White House should order the U.S. Army Corps of Engineers to construct temporary medical facilities, calling it “only a matter of time before” ICUs are at capacity.

In Italy, hospitals have been overwhelmed, forcing health care workers to decide what patients to prioritize. Experts have said the country, which has universal health care, was in many ways better prepared for the epidemic than the United States.

A spokeswoman for the state said the Delaware Emergency Management Agency “is currently working with our state and federal partners and stakeholders to identify locations where patients could be housed if needed and determining what those triggers may be” if a surge does arise.

Rick Hong, the medical director for the Division of Public Health, said the state has been readying for a large-scale outbreak since the 2009 H1N1 spread.

Delaware is trying to increase staffing levels at hospitals, such as by making changes to the licensing process if necessary, although providers are handling the day-to-day and developing their own plans, he said.

Delaware’s small size means the state has only one health agency, the Department of Health and Social Services (of which DPH is a subset), which helps it better coordinate with doctors, hospitals, urgent care and the like, Dr. Hong said.

DPH has its own backup plan for staffing and has already brought in more people to its laboratory in Smyrna, where the agency tests samples collected by doctors for coronavirus.

The state is mobilizing many resources to fight the epidemic, from creating a special hotline to pulling in spokespeople from other departments to help answer questions about the virus.

The biggest thing individuals can do to prevent a surge is to avoid catching and spreading the disease in the first place — hence the social distancing that has kept many indoors for the past week-plus.

“It’s really the entire community and the entire state that’s battling this disease, so the public has the ability to make this better,” Dr. Hong said.

Gary Siegelman, the chief medical officer at Bayhealth, said the health care system has been encouraging people to delay surgeries if possible, freeing up resources for coronavirus patients. Simply reducing the number of surgeries taking place by pushing back elective procedures gives the hospital both more people and more beds to deal with the epidemic should it worsen significantly.

Bayhealth can also take steps to keep all coronavirus patients in one place, such as on the same floor, and can adjust air pressure to reduce the risk of infection, Dr. Siegelman said.

Still, a bed shortage could happen, as could staffers becoming sick from the virus, he acknowledged: “At any hospital you can lose a number of health care workers, and that can be even more serious than a bed shortage at times.”

At the moment, though, Bayhealth is doing well, and it has specialized staffers it can add if need be, Dr. Siegelman noted.

The hospital has developed a “command center,” and leadership communicates regularly to help prepare for the worst. Its electronic health record system enables it to identify patients who may be at a higher risk for COVID-19, such as individuals who recently traveled to China or have a fever and coughing.

“We’re treating this as a public health emergency,” he said.

Providers are stepping up use of telemedicine, based in part on loosened guidelines Gov. John Carney put in place last week, and Beebe, ChristianaCare and Bayhealth have held large-scale drive-through testing events.

Bayhealth plans to have more events in the future.

Hospitals are working to ensure they have enough supplies, although a shortage is quite possible if the virus does spread.

The state has some extra respirators, masks, gowns and face shields it can give to health care providers if their stock is low and unable to be refilled.

Per the Delaware Healthcare Association, which represents hospitals around the state, all ICU rooms contain ventilators. Many around the country have raised concerns about a shortage of such equipment.

Beebe Healthcare Chief Quality and Safety Officer Marcy Jack said in a statement the organization regularly works on its emergency plans.

“We also have protocols that existed prior to the outbreak of COVID-19 in how to manage a sudden surge of patients who present to the hospital,” she said. “We have performed simulations and drills for these types of events to ensure we are prepared. Beebe is confident that we have the necessary equipment and environment that aligns with the CDC and WHO guidelines to safely treat patients and prevent the spread of an infectious disease, while Beebe’s protocols and personal protective equipment keep our team members safe.

“Additionally, Beebe has deployed teams consisting of clinicians who are specially trained in the management of COVID-19 to work one on one with employees within units of the Margaret H. Rollins Campus as well as outpatient locations. This enhanced preparation ensures that employees are trained and ready to care for patients in our community.”

“Beebe has been working on creative solutions to care for patients on an outpatient basis, one example being last Saturday’s mobile screening event. Beebe is in the process of working up additional outpatient plans that we believe will result in fewer patients presenting to the Margaret H. Rollins Campus, unless they require emergency care.”

According to NurseFly, a health care staffing company, Delaware has seen an increase of more than 300 percent in terms of the demand for traveling nurses who specialize in fields related to COVID-19 this month.

The state on Friday unveiled a plan to test individuals with COVID-19 symptoms at no cost to patients. Starting Monday, there will be seven standing health facility sites for people to be tested on a doctor’s order.

ChristianaCare will operate one site in Newark and one in Wilmington, with Saint Francis Healthcare running another site in Wilmington. In Dover, Bayhealth will handle the procedures. Beebe Healthcare will have testing sites in Millsboro and Frankford, while Nanticoke will operate one in Seaford.

Individuals who do not have a primary health care provider can call the state’s special hotline at 1-866-408-1899 or call centers run by Christiana Care, Beebe or Bayhealth.

Visitor restrictions have been put in place at Delaware hospitals as part of the effort to prevent the spread of the virus.

Both Bayhealth’s Kent and Sussex campuses will not take any visitors, with exceptions on a case-by-case basis for laboring mothers, neonatal intensive care patients, pediatric patients, end-of-life patients and individuals undergoing urgent procedures or surgeries, the health care system said Thursday. Bayhealth Medical Group practices, Bayhealth Emergency Center in Smyrna, Bayhealth Cancer Centers and Bayhealth Outpatient Centers will only allow visitors if the patient requires assistance.

Beebe Healthcare on Friday announced it would bar visitors from the Margaret H. Rollins Lewes Campus and outpatient locations, with some special exceptions.

One visitor is allowed for pediatric patients, those in palliative care or hospice, specialty physician outpatient visits, labor and delivery and patients having surgical procedures. That visitor will be screened upon arrival to the hospital and will not be able to enter if deemed potentially infectious.

Children 16 and under will not be allowed to visit.

Peninsula Regional Health System has suspended all inpatient visitation beginning at both Peninsula Regional Medical Center in Salisbury and Nanticoke Memorial Hospital in Seaford. Exceptions will be considered for specific situations, including end of life.
ChristianaCare is not allowing visitors to hospitals, outpatient services and the Helen F. Graham Cancer Center & Research Institute, although patients in palliative care or hospice and laboring mothers are allowed one guest each.

Additionally, one support person is permitted for patients in the emergency department or outpatient services, and a single visitor is allowed for NICU and pediatric patients.

All visitors to the hospital will be screened for coronavirus risk before they are allowed to enter. Hospital visitors must be age 16 or older, and ChristianaCare recommends older individuals or people who are especially vulnerable to illness refrain from coming.

Individuals with loved ones in a hospital are urged to consider alternative ways of communicating, such as video and phone chats.

“We’d love to say it’s just for a few days, but this may be a way we need to adapt to living our lives for a while,” DPH Director Karyl Rattay said Wednesday. “It’s really important that we do everything we can to listen to what is advised. We’ve got to heed this call to action.”

Delawareans with general questions about COVID-19 or their exposure risk can call DPH at 1-866-408-1899 (711 for individuals who are hearing impaired) from 8:30 a.m. to 8 p.m. Monday through Friday and 10 a.m. to 4 p.m. Saturday and Sunday or email DPHCall@delaware.gov.

For more information, visit de.gov/coronavirus.


Helpful Coronavirus links

Delaware Division of Health Coronavirus Page
CDC: About the Coronavirus Disease 2019
CDC: What to do if You Are Sick
Johns Hopkins Coronavirus Resource Center
AP News Coronavirus Coverage
Reopening Delaware: Resources for Businesses
Delaware Phase 2 guidance

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