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Amid dire predictions of virus spread, hospitals prepare to be inundated

‘We are nowhere near ready,’ says public health expert

A restricted access sign was outside the entrance to the Tufts Medical Center Friday.
A restricted access sign was outside the entrance to the Tufts Medical Center Friday.Craig F. Walker/Globe Staff/The Boston Globe

Massachusetts’s biggest hospitals are preparing for a potential crush of coronavirus patients amid predictions that rapid spread of the disease could overwhelm the health care system.

Researchers have been racing to develop models that predict the possible impact on US hospitals, and some of those forecasts are alarming — especially if intensifying efforts to contain the virus aren’t successful.

In the absence of mass closures and other interventions, more than 225,000 Massachusetts residents may eventually need a hospital bed — and about one-fifth of those patients, or 45,000, might need to be treated in an intensive care unit, said Dr. Ashish Jha, director of the Harvard Global Health Institute at the Harvard T.H. Chan School of Public Health. Yet, according to Jha’s calculations, the state has an average of 3,600 hospital beds and about 400 ICU beds available at any given time.

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These calculations are based on 20 percent of residents getting infected with the disease known as Covid-19; if it’s closer to 60 percent, the need for hospital beds will be far higher.

Based on the experience of other countries, about one-fifth of those infected could be sick enough to require inpatient hospital care with treatment such as intravenous fluids or ventilator support, Jha said.

Importantly, the projections don’t account for social distancing measures, now rolling out, that could slow the spread of the virus and allow hospitals to keep up with patient numbers. Or for steps that some hospitals are already taking to cancel elective surgeries to preserve space for coronavirus patients.

Hospitals are also closely monitoring potential problems, such as shortages of face masks and other protective gear for health care workers, and some are limiting who can enter patients’ rooms as a way to preserve equipment.

Governor Charlie Baker and state officials said during a press conference Saturday that a new coronavirus command center would track hospital capacity and make decisions about which hospitals would get protective gear shipped from a national stockpile.

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Protecting workers is crucial — if large numbers of doctors and nurses fall ill or need to be quarantined, hospitals won’t be able to keep up with the demand from patients.

So far, just a small number of Massachusetts patients with coronavirus have been sick enough to be admitted, but patients are already swarming emergency departments and jamming phone lines at some big hospitals, looking to be tested.

For now, hospitals have been able to respond — but they are grappling with a situation that is changing daily, if not hourly.

“All of the hospitals are preparing for when they will be inundated,” said Dr. Kevin Tabb, chief executive of Beth Israel Lahey Health.

“Our health care system is going to be really challenged,” he said. “We will almost certainly be required to go beyond what we think of as near-maximum capacity."

Many hospitals — including Massachusetts General and Brigham and Women’s — are canceling elective surgeries to free up space for coronavirus patients, and to reduce potential transmission of the virus. Others are cordoning off special area for coronavirus patients, and making space to screen and admit patients en masse.

Hospitals are limiting outside visitors to curb the spread of infection, and they’re urging people with mild respiratory symptoms to stay home and rest, so staff can tend to patients who most need care.

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Doctors and hospital officials are also pleading with the public to avoid gatherings and crowds and wash their hands well, because such steps could moderate the spread of the virus and slow the rate of new patients showing up at their doors.

Most people who contract the coronavirus have mild symptoms, but the experience in China, where the global pandemic began, shows that 5 percent of infected patients needed critical care in hospitals — including ventilators to help them breathe. Hospitals have a limited number of ventilators, in their intensive care and operating rooms.

Jha said the disease might play out differently in the United States than it has elsewhere. This country has a strong primary care system that might enable more people to recover at home, and it has a younger, healthier population than Italy, for example, where hospitals have been unable to keep up with demand.

Still, Jha said, “the numbers are so staggering we have to do a lot better. We need to be thinking pretty quickly about which elective surgeries we want to start canceling and how we communicate that to people. We are nowhere near ready and able to take care of people who get infected with coronavirus in the next year.’’

Another Harvard team compared the experiences of two Chinese cities as examples of what the United States may face. In Wuhan, which did not implement strict disease control measures until weeks after the outbreak, hospitals were inundated with sick patients. Over a seven-week period in January and February, hospitals cared for an average of 637 ICU patients and 3,454 serious inpatients each day. During the epidemic’s peak, 19,425 patients were hospitalized.

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But in Guangzhou, where strict disease control measures were implemented within a week of the first case, hospitals treated just 9 ICU patients and 20 inpatients each day.

Massachusetts General Hospital would not release the number of patients who have tested positive for Covid-19 or who are awaiting test results, because it said the health department has asked hospitals not to release specific information.

Officials at Beth Israel Lahey Health also didn’t provide their patient numbers.

“We are seeing significant numbers of patients present to our ambulatory and emergency department with fever and cough and various degrees of exposure” to someone with the virus, said Dr. Paul Biddinger, chief of emergency preparedness at Mass. General. “The numbers overall are indeed rising” and now reach “several dozen a day.”

Mass. General has been developing internal models of how many patients it might have to admit during the pandemic.

“Some of the modeling does suggest the number of patients with critical care needs could exceed our intensive care capacity,’’ Biddinger said. “We can’t say for certain whether that will or will not happen.’’

Mass. General, the largest hospital in New England, has 150 ICU beds, but that number could be doubled by expanding into surgical recovery areas, Biddinger said. Even though those patients would not be in single rooms, special filters can be placed in ventilator masks to keep patients from emitting infectious particles into the air.

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The hospital also has a plan for allocating scarce resources, such as ventilators. The group that developed the plan includes an ethicist, and the overall principle is to use the equipment in a way that saves the most lives, Biddinger said.

Mass. General has been canceling routine doctors’ appointments, such as annual physicals for healthy patients. It is doing the same for older patients whose immune systems are compromised and do not have an urgent need to see a doctor.

The experience from Washington state, which saw a spike in coronavirus cases before other parts of the United States, offers some small reassurance — at least so far.

The Washington State Hospital Association said it did not have an exact count of hospitalized patients, but said that most patients have had mild cases of illness and are recovering at home. “While our hospitals are busy, they have not needed to take measures to increase their capacity,’’ said spokesman Tim Pfarr. “Hospital operations are largely continuing as normal for now, though we have heard some hospitals are now looking into canceling some elective surgeries.’’

In Boston, Tufts Medical Center this week decided to cancel non-urgent appointments and procedures to make room for patients who most urgently need care, and as a precaution to reduce spread of the contagious coronavirus.

When patients with respiratory symptoms show up in the emergency department, they are quickly separated from other patients and, ideally, taken to a private exam room, said Dr. Shira Doron, hospital epidemiologist.

As of Friday, Tufts had not yet admitted any coronavirus patients. But doctors are planning for a possible surge. “We’ve played out scenarios of what it would be like if it happened tomorrow, or in four days, or in 14 days,” Doron said.

At UMass Memorial Medical Center in Worcester, one patient so far has tested positive for the coronavirus and is now in home quarantine, officials said. When they suspect a patient may have the coronavirus, doctors and nurses wear protective gear — masks, eye shields, gloves, and gowns — until they can rule out the novel virus as the cause of respiratory symptoms, hospital officials said.

UMass Memorial has begun setting up tents: one to hold a potential surge of patients who show up to the emergency department, and another for those seeking tests. And if the number of seriously ill patients exceeds the number of intensive care beds at UMass Memorial, hospital officials may convert other areas, such as recovery rooms, into a makeshift ICU.

“We have to think about the worst-case scenario in Italy, [where] hospitals are over their capacity,” said Dr. Michael Gustafson, the hospital president.

Boston Medical Center is canceling elective surgeries and has set up tents in case it’s flooded with patients who need to be screened for the virus.

In Springfield, Baystate Medical Center has prepared a two-bed containment area for patients who are severely ill from the coronavirus, as well as a 12-bed unit for less critical patients.

“We are reserving those for if and when we get a confirmed case of coronavirus,” said Dr. Andrew Artenstein, chief physician executive at the hospital’s parent company, Baystate Health.

“We will have to be flexible and nimble,” said Artenstein, an expert in infectious diseases. “I don’t think any of us know where the situation is going, but we have to be ready.”

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Liz Kowalczyk can be reached at lizbeth.kowalczyk@globe.com. Priyanka Dayal McCluskey can be reached at priyanka.mccluskey@globe.com. Follow her on Twitter @priyanka_dayal.