The Case for Designated COVID-19 Hospitals
Achintya Moulick
Marie Duffy
Tucker Woods
Maxwell Kilcoyne
Chi Chi Do-Nguyen
Randy Stevens
10.25373/ctsnet.12627497.v1
https://ctsnet.figshare.com/articles/media/The_Case_for_Designated_COVID-19_Hospitals/12627497
<p><b>BACKROUND</b></p>
<p>COVID-19
is a zoonotic virus originating from the Hubei province of China. COVID-19’s
typical presentation of fever and cough can rapidly escalate to acute
respiratory distress syndrome (ARDS) and sepsis (1). The initial outbreak rapidly
spread into what is now a global pandemic, infecting over 750,000 people and
leading to over 37,000 deaths (2, 3). The massive influx of COVID-19 patients quickly
overwhelmed healthcare systems throughout the world including Italy, South
Korea, and Iran (4, 5).<sup> </sup>The global impact of COVID-19 has been
profound, and the public threat COVID-19 represents to the United States (U.S.)
is the most serious since the H1N1 influenza outbreak in 1918 (6).<b></b></p>
<p>COVID-19
has an estimated R<sub>0</sub> of 2.24 - 3.58, leading to a doubling rate every
6.4 days and has thus far demonstrated global exponential growth. With the optimal
antiviral therapy still unknown and vaccines still in the early stages of
development, the most effective action to combat this pandemic is to limit the human-to-human
transmission (3, 7).<sup> </sup>Without large-scale measures to decrease
transmission, projections estimate that 81% of the U.S. would become infected
(8). The impact of public health interventions, such as social distancing, will
reduce this number to 20-50% of the U.S. becoming infected. What is especially
important is it will lead to a more gradual increase in case volume with a less
dramatic but prolonged peak of the pandemic (Figure 1). As described below, this becomes incredibly important
for the ability of the U.S. healthcare system to cope (9, 10).<b></b></p>
<p> </p>
<p><b></b><b></b></p>
<p><b> </b></p>
<p> </p>
<p><b> </b></p>
<p><b>Figure 1.</b> The projected
critical care beds needed (per 100,000) in the upcoming months based on the
levels of community measures put in place (8).<sup></sup></p>
<p> </p>
<p> </p>
<p><b>THE
PROBLEM</b></p>
<p>The
U.S. has 925,000 staffed hospital beds with 75,000 - 90,000 of those being critical
care beds (11).<sup> </sup>The number of full-featured ventilators in the
United States is approximately 62,000, with an additional 98,000 ventilators that
are not full-featured but can provide basic ventilatory support in emergent
cases (12).<sup> </sup>Approximately 4-5% of the U.S. population will require
hospitalization, with 30% of these patients requiring critical care admission
(13).<sup> </sup>This equates to 13.1 - 16.4 million patients being admitted
and 3.93 – 4.92 million ICU admissions. Even with these infections spreading
across 3-6 months, the need for hospital beds may be at least eight times the
actual hospital capacity. An additional consideration is that patients admitted
to the hospital with COVID-19 infection have an average hospital stay of 10.4
days (8).<sup> </sup>This issue is compounded by the exposure physicians and
other healthcare staff are experiencing, which may lead to up to 20% of
healthcare staff being unable to work for periods of time from being ill or
self-isolated from high-risk exposure (13). </p>
<p>An
example that provides a more tangible set of numbers: Philadelphia is a
relatively hospital-rich metropolitan area compared to most cities in the
United States. The greater Philadelphia area is home to about 4.1 million
residents with 10,228 staffed hospital beds, 941 ICU beds, and 150 ventilators
(14-17).<sup> </sup>This would equate to a projected 164,000 – 205,000 patients
requiring hospital admission and 49,200 - 61,500 requiring ICU admission. Most
models suggest a majority of these infections will occur within a 3-month surge.
If the lower end of the COVID-19 case projection (164,000) in the greater
Philadelphia area were spread evenly across 12 weeks, then that would lead to
roughly 13,700 cases weekly. With an average hospital stay of 10.4 days, this would
overwhelm the hospitals within a week with patients that require admission
continuing to come in at the same pace for 11 more weeks. </p>
<p>Manpower
and supply shortages also remain a major limitation in the U.S. healthcare
system’s ability to handle the pandemic. These include the previously mentioned
undersupply of ventilators, personnel shortages secondary to exposure and/or
contracting COVID-19, lack of personal protective equipment (PPE), and supply
chain roadblocks. To make matters worse, hoarding of PPE by the general public and
unequal distribution of supplies have created a serious nationwide shortage.
This has forced some medical professionals to use PPE that is below clinical
standards, putting themselves and patients at risk (18). </p>
<p> </p>
<p>The
presence of COVID-19 positive patients in every hospital has also led to a
massive strain on the healthcare infrastructure. Healthcare personnel that have
the skills and training needed to treat COVID-19 patients are not optimally
utilized. They are decentralized working under various healthcare systems where
standardization of protocols for prevention, containment, and treatment of the
disease will most likely change in each institution, making it difficult to
establish best practices and advance our understanding of COVID-19 management. </p><p>Read more at: <a href="https://www.ctsnet.org/article/case-designated-covid-19-hospitals">https://www.ctsnet.org/article/case-designated-covid-19-hospitals</a></p>
2020-07-09 15:13:40
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