PROVIDENCE, R.I. -- As the spread of coronavirus increases in Rhode Island, state health officials have made recommendations to all acute-care hospitals to help decide how they will ration medical equipment and treatment if they are overwhelmed by patients with COVID-19.
The crisis standards of care will make sure Rhode Island is ready “if we get to a place where we have to make difficult decisions for health supplies and hospital beds," Governor Gina M. Raimondo said during a news conference Friday at the State House.
Neither the governor nor Health Department Director Nicole Alexander-Scott elaborated about what those standards look like or how care will be triaged. The Health Department and bioethicists from Brown University reviewed the hospitals’ draft documents on Monday. The hospitals are required to submit their plans to the Health Department by April 23.
To aid the hospitals in developing guidelines, the Rhode Island Health Department shared comparative standards developed by other states, including Washington state and Massachusetts, Alexander-Scott said.
The guidelines from the Bay State, which were released last week, ask hospitals to ration ventilators by assigning patients a score that gives preference to healthier patients who have a greater chance of surviving their illness, and living longer overall. There is more preference for medical personnel who are vital to treating others, and to women further along in pregnancy, and people who are young.
An email from the Health Department to the hospitals released Friday evening laid out several components that all of the plans must address for the process for allocating resources.
In deciding who receives scarce lifesaving resources, Health’s recommendations said the plans should “specifically recommend against using assessments of pre-existing quality-of-life, underlying life expectancy, and ‘social value’ in ranking a particular patient’s priority score for the critically scarce resource, considering these fundamentally discriminatory.”
Social value shouldn’t be a criteria, unless the patient -- a health care worker or “protector of societal order” -- is also in critically short supply, the Health Department recommended.
Although the hospitalizations and fatalities continue to rise, Raimondo said that the state model projected there would enough hospital beds for the sick when the surge hit, possibly in two weeks. The state is still trying to have enough medical staff and personal protective equipment on hand, she said.
Rhode Island’s death toll from coronavirus reached 118 cases Friday, with a total of 4,177 Rhode Islanders testing positive for the respiratory illness since the first case was detected on March 1.
Another 13 people died and 366 more tested positive for COVID-19, the illness caused by coronavirus, according to new data from the state Department of Health on Friday. They include 10 people who lived in congregant care settings, and the ages range from a person in their 50s to over 100.
Raimondo said Thursday that the state’s own models show that, with continued social-distancing and stay-at-home restrictions, the surge will occur around May 3 and require 2,250 hospital beds.
However, the worst case scenario shows the surge arriving sooner, on April 27, and nearly doubling the hospitalizations to 4,300 beds, she said.
The death toll would be 2,120 by October, with the current best-case scenario -- or 4,015 deaths, at the worst, she said.
Raimondo said the hospitals are ready and have worked collaboratively to handle a surge, if and when it comes. The state has approved hospital plans to increase capacity by more than 250 percent, she said.
Within a few weeks, there will be more than 1,200 new hospital beds ready at the field hospitals at the former Citizen Bank complex in Cranston and the Rhode Island Convention Center, Raimondo said.
So far, 3,300 health care workers have signed up to help with the surge, and Raimondo is asking for more to sign up at RIResponds.org.
The numbers that Raimondo and health officials are watching most are those who are hospitalized. As of noon Friday, there were 252 hospitalized, with 62 in the ICU and 43 on ventilators.
Most of the deaths so far have been residents of nursing homes, places where infection can quickly spread among a vulnerable and frail population.
Health officials tried early on to reduce the risk to nursing home patients, by prohibiting visitors and isolating residents as soon as they appeared to have symptoms, Alexander-Scott said. She said that Rhode Island now has a fast-lane to test health care workers at nursing homes through the new rapid testing site run by CVS at Twin River.
Another 960 health care workers have been licensed to assist at nursing homes, she said. The state moved nursing students into the work force quicker and accelerated training programs for nurse assistants, she said.
The state is looking to have strike teams to enhance the work, by speeding up help for nursing homes, with on-site testing at nursing homes with outbreaks and focus on infection-control measures, including PPE, she said. Staff and assistants will be tested every seven to 10 days for coronavirus, she said.
In the congregant care setting, they can use testing more strategically, and repeat the tests on a regular basis to continue assessing the risks, she said. The state wants to address shortages in staffing at nursing homes, Alexander-Scott.
Rhode Island officials are still struggling to get enough personal protective equipment for health care workers. Raimondo said the state is seeking to have a 30-day supply on hand. “We’re not out of the woods yet," she said. “We’re competing with other states and the federal government.”
She said Rhode Island has now received 1.2 million surgical masks, 1.5 million gloves, 10,000 face shields and placed orders for more than 1 million N95 masks, more than 10 million surgical masks, 1 million N95s, along with gloves, gowns and face shields. It’s unclear when those orders will arrive.
Still, Raimondo sought to deliver a message of hope. This ordeal won’t last forever, she said. While life won’t return to normal for at least a year, until there is a vaccine, this will pass, she said.
“What gives me hope are the everyday expressions of kindness, bravery and strength that we see every day,” Raimondo said.
“We’re going to get through it," she added. "It won’t be without a great deal of suffering and hardship, but we will be resilient on the other side.”
Amanda Milkovits can be reached at firstname.lastname@example.org