Triangle Hospitals Prepping For Spike In COVID-19 Patients

Mar 15, 2020

A worker unloads boxes of protective gloves and gowns from a truck at UNC Hospital. The supplies will be taken to storage shelves in the bowels of the hospital, in preparation for a possible spike in coronavirus patients.
Credit Jay Price / WUNC

It's an odd moment for the people who work in North Carolina healthcare. They read the reports of what is happening in Italy, South Korea and China, where hospitals in the worst-hit areas have been swamped with patients and in some cases reportedly overwhelmed.

Testing for the virus in the United States, meanwhile, has lagged. And that means there isn't an accurate picture of how much and how quickly the virus is spreading.

So they're preparing as quickly as they can, and for the worst.

"We're, of course, hoping that we're over-preparing, and that this won't turn into the kind of disease that's being seen in China or is now being seen in northern Italy," said Dr. Joseph Rogers, Chief Medical Officer for the Duke Health System.

"But we have teams of people who are working 14 and 16 hours a day trying to think about all of the potential eventualities of a serious pandemic locally."

There are about 925,000 staffed hospital beds in the nation — most of them occupied. And only about a tenth of them are the intensive care beds that the most seriously-ill patients would use.

Under some worst-case estimates, millions of COVID-19 patients could need hospitalization. Not all at once, but potentially enough to overwhelm hospitals if the peak of the outbreak can't be flattened by the public health measures like social distancing and increased hygiene practices now being advocated by government officials.

The state's big hospital systems are figuring out how to open up beds, especially at the major hospitals by doing things like shifting patients who don't need elaborate care to smaller facilities.

Rogers says the major hospital systems in the Triangle — Duke, UNC and WakeMed — have been talking regularly to ensure they're on the same page with planning.

"So today as we're talking about what we're doing as a larger healthcare delivery system in the Triangle, it's really mostly around planning and making sure that we're thinking about things that each of the other entities are considering," he said. "We've not gotten to the point of saying, gosh, if our hospitals become full, are you available to take extra patients, but I think the thing that's important for the residents of this area is to know that the health systems are talking at least a couple of times a week with very high-level administration to make sure that we have a coordinated response."

All the systems are pondering ways to hold down the number of COVID-19 patients coming to their main hospitals, and created enough capacity to handle the number who would in worst-case scenarios.

UNC has already set up diagnosis sites for potential cases that don't seem life threatening, rather than have them come directly to the hospital. Duke is planning that, too, and has begun talking about off-site triage units.

Executives with both systems said the options under consideration include halting elective surgeries to reduce the number of incoming patients.

And Rogers said Duke is already beginning to block off rooms in the main university hospital it can use as isolation units, and planning the possibility it could have to find space in places not normally used for patients.

"You could imagine that we might be providing care to patients in different kinds of care locations across the Triangle," he said. "If we got to that point, there may be ways that we can repurpose some of our areas inside a hospital and use them as patient care areas, but those are all things that we're starting to think about in case this really develops into a crisis.

Part of the planning also has to include scenarios where different percentages of the health care systems' staff get sick, reducing the capacity to treat patients.

Christian Lawson leads emergency management planning for UNC Health Care. He paused briefly between meetings to talk in a busy hallway.

UNC and Duke have more than 2,000 beds between them. But they're mainly full.

"We're anywhere from 93 to 97% capacity week to week, meaning there's very little wiggle room and availability of beds," Lawson said. "So this can and will likely strain our capacity."

He said the contingency plans the systems are having to build are complicated.

"So what would our staffing plans look like? What would our provider staffing plans look like? Would we be canceling elective surgeries? There's a whole variety of variables that we would be considering to ensure that we can stay open and maintain what we need to maintain in order to care for patients that need care," Lawson said.

And then there are worries about stocks of the vital equipment like ventilators to help the worst-hit patients breathe and of the supplies that hospitals would need in a major outbreak.

"We believe that at least right now, the thing that we're most concerned about is personal protective equipment for our teams, as a way to keep them safe and to try to mitigate the spread through the community," said Rogers, the Duke executive.

Duke has enough now, and for the foreseeable future, he said, but the question is how bad will things get, not just locally but across the country.

"As you can imagine there's an incredible pressure on that supply chain, and so we believe that we have enough for the disease as we understand it today, and likely in the next several weeks, but as this disease begins to spread across the country, the pressure on that supply chain is going to grow," Rogers said. "And I think it's possible that we could face as a country, some shortages in personal protective equipment. The gowns, gloves, booties, but the thing that most people are concerned about are the N95 masks that are so prevalently discussed in the press, and every health system across the country is trying to make sure that they have sufficient amounts of those supplies to protect their workers."

In northern Italy, the scenes at hospitals are being compared with those during World War II, with hospitals and healthcare workers on or past the edge of being overwhelmed, cancelling surgeries, and getting sick themselves, further reducing the capacity of the system to with the crisis. Hospitals setting up tents to try to create enough space to treat all the patients, doctors recruited from other specialties and being yanked out of the last years of residency and put on the front lines.

Those charged with planning for healthcare here see those scenes, and try to learn what they can about COVID-19, the illness caused by the virus, and how to handle a major outbreak, Lawson said, echoing Rogers' comments about planning for the worst.

"If it gets as bad as northern Italy, what's most important is as a health care provider and a health care system, our mission is to take care of patients," Lawson said. "And so we need to be prepared for anything and everything. So in this instance, we are planning for the worst, and hoping for the best."

"We are planning our staffing contingency plans of what it would look like if we were down 10 percent, 20 percent, even 50 percent of our staff, and many of us that have been doing this for a long time, have never had to plan in such ways," Lawson said. "But from we've what we've seen in China, what we've seen in Italy, we might have to do that and we are learning daily on how they would have done it differently, how they could have positioned them themselves in a more prepared way. And we're applying those to our plans on a daily - sometimes hourly -  basis."