BOSTON — The nation’s hospitals would be overwhelmed if people don’t practice social distancing to help “flatten the curve” on the spread the new coronavirus, according to a leading doctor of emergency medicine.
Dr. Ali Raja, vice chair of emergency medicine at Massachusetts General Hospital in Boston, applauded moves by Massachusetts and other states to close schools and encourage people to limit contact with each other. Those measures, Raja said, should slow the rate of infection and keep the workload for hospitals “manageable.”
But if those measures fail, Raja said, the nation faces formidable obstacles in fighting the disease.
The Unite States has 924,100 hospital beds, or 2.8 beds per 1,000 people. That’s fewer than any of the countries that have already experienced widespread outbreaks, including South Korea (12 beds per 1,000 people), China (4.3 beds) and Italy (3.2 beds). The American Hospital Association estimated in a 2018 survey that there are between 46,800 and 64,000 intensive-care beds in the U.S.
Last month, Johns Hopkins Center for Health Security released a report saying a moderate pandemic would result in 1 million people being hospitalized and 200,000 needing intensive care. A severe pandemic would result in 9.6 million hospitalizations and 2.9 million intensive care patients, the report said.
Raja said hospitals also are concerned about their supply of ventilators, a critical piece of equipment to treat the most severe cases of coronavirus.
Nationally, there are 160,000 ventilators, and at least another 8,900 in the national stockpile. In a 2005 federal government study, researchers estimated the country would need 64,000 ventilators for a moderate pandemic, like the influenza outbreak in 1957, and 740,000 for a severe pandemic like the 1918 Spanish flu outbreak.
“The fact of the matter is if we don’t flatten the curve, we run the risk of overwhelming our hospitals, even those like Mass General that have 1,000 beds,” Raja said. “We’re simply not built for the hundreds or thousands of new patients we’d see each week.”
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Raja said he spoke with emergency room doctors in hospitals across the country. They reported a shortage of basic medical supplies, including masks and gowns. At Mass General, Raja said, doctors are already reusing masks.
“Even at Mass General, where we have a solid supply chain, we’re concerned,” Raja said. “We’re hoping that by taking steps, like reusing masks, our supplies won’t run short.”
Because the initial symptoms of coronavirus are similar to the flu, many patients may prematurely seek care in the emergency room, burdening the hospital system. Raja said anyone who can no longer manage their symptoms at home and are having trouble staying hydrated and nourished because of nausea and vomiting should call a doctor.
“And if they can’t get a hold of their doctor, they should come in to the emergency room to get evaluated,” he said.
Younger, healthy people who get symptoms of an upper respiratory infection, however, should stay home and focus on staying hydrated. Older patients, as well as patients with a preexisting heart or respiratory illness, should seek care sooner.
“They should absolutely check in with their doctors, but they shouldn’t come to the hospital because we’re not going to be able to do anything for them right now,” Raja said.
On Monday, the Massachusetts Health & Hospital Association warned that the state’s decision to close all schools for three weeks will make it difficult for health care workers with children to get to work. Raja echoed those concerns.
“It’s not just the doctors and nurses, but the administrative and support staff,” he said. “Environmental services, for example, becomes exceptionally important in a situation like this because they’re the ones who have to go in and clean a room where someone with coronavirus has been treated.”
Raja said so far Mass General has been able to maintain staffing levels.
“But it’s likely to become an issue as the schools stay closed longer,” Raja said. “While the decision to close schools is great for helping people to social distance, I’m really worried about the impact that’s going to have on the staff at Mass General.”