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EDITORIAL

Hospitals on the front lines as pandemic takes hold

When the going gets tough with this coronavirus, Boston’s world-class health care system will be tested.

Even Boston's best hospitals will be tested by the coronavirus pandemic. Their best practices should be stepped up now.
Even Boston's best hospitals will be tested by the coronavirus pandemic. Their best practices should be stepped up now.Erin Clark/Globe Staff

We know one thing for sure about the strange new world of the coronavirus into which the nation has now been plunged: It will get worse before it gets better. Health care experts are agreed on that point.

So the issue becomes how best to manage the inevitable — the patients who will need care in this city that has proudly claimed to be a health care mecca, a place with the resources, the brain power, and the capacity to work wonders.

And working wonders is exactly what it will take to handle the inevitable crush of patients — those in need of testing and those who will be in need of hospital care.

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What Massachusetts doesn’t want to become is Italy, where hospitals are now so overwhelmed that they have gone on something approaching a wartime footing, rationing care and space. The death rate from Covid-19 in Italy is at least 5 percent (some estimates put it as high as 6 or 7 percent); 50 percent of those testing positive require hospitalization and 10 percent end up in intensive care units. (The World Health Organization estimates a global average death rate of 3.4 percent for this coronavirus pandemic, but Dr. Anthony Fauci of the National Institutes of Health last week estimated a death rate more like 1 percent for the United States.)

So when health care professionals talk about using “social distancing” to “flatten the curve” of new infections, what they mean is that, with some real luck, new infections will be spread out over a longer period of time, and the number of cases lower at the peak of the epidemic, so as not to overwhelm the health care system — and maybe even give researchers time to come up with new treatments.

The numbers alone are sobering. Dr. Ashish Jha, director of the Harvard Global Health Institute, said in an interview with WBUR that epidemiologists estimate that between 40 and 70 percent of adults will get the infection. Even taking that lowest number, that means some 2 million adults here in Massachusetts could get infected. Using China’s data, that would mean 400,000 hospitalizations.

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“At any given time in Massachusetts, we think there are 3,000 to 4,000 hospital beds open at most,” he said. “And so if you start doing the numbers, you very quickly realize we do not have anywhere near capacity to take care of tens of thousands of people who might need hospitalization.”

A lean health care system — where unused beds and underutilized facilities are discouraged — has been the public policy goal for several decades. But how will it respond in a crisis? How can it create “surge capacity”?

In this instance, at least the private sector is light years ahead of the public sector in its ability to respond to the current crisis. With the White House having taken far too long to finally declare a state of emergency, on Friday, and the Baker administration more reactive than proactive, it certainly helps that the hospital industry here has taken the lead.

Massachusetts General Hospital has literally written the book on dealing with pandemics — its experience in dealing with the 2002–03 SARS outbreak and its role as one of 10 medical centers equipped to deal with Ebola infections provided ample experience. Their handbook, now widely distributed and available on the Massachusetts Hospital Association website, offers chapter and verse on how institutions can cope in the weeks and months ahead.

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But according to the MHA, there are some 14,596 staffed beds in Massachusetts’ acute care hospitals and only about 1,112 in various ICU units (not counting specialized pediatric and burn units).

“The bottom line here is to free up hospital beds, and that should have been done yesterday,” said Eugene Litvak, president of the Institute for Healthcare Optimization, which has long specialized in managing patient flow. “If we did that, we would be in much better shape now.”

And while some in the industry fear the state is already about six weeks too late, there are some well-established protocols for dealing with the crisis.

▪ Hospital beds can be “repurposed” — transitioned to different levels of care. A post-op recovery room can become an all-purpose ICU.

▪ Community hospitals and health care facilities can be used for patients requiring lower levels of care. Clinics usually used for day surgery or outpatient care can be used as well for those not in need of critical care.

▪ The state should consider whether previously shuttered facilities need to be prepared for emergency use.

▪ Elective surgeries are already being canceled or postponed. Or as one doctor put it, “You don’t want someone getting a hip replacement requiring days and days of care and nursing staff” in the middle of a pandemic.

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On the latter issue, what many of the region’s top teaching hospitals had already decided was crucial became official Baker administration policy by Sunday night.

“What this data shows us is without very aggressive action, we are in pretty serious trouble in terms of hospital capacity in Eastern Massachusetts,” Jha told the Globe.

Making those decisions sooner rather than later — and making them with more aggressive leadership from the governor’s office — will better prepare this community for the inevitable trauma ahead.

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