'U.S. Hospitals Prepare for Coronavirus, With the Worst Still to Come' diff viewer (2/3)

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U.S. Hospitals Prepare for Coronavirus, With the Worst Still to Come	U.S. Hospitals Prepare for Coronavirus, With the Worst Still to Come
2020-06-01 14:34:36 UTC	2020-06-03 02:56:47 UTC (1 day later)
WASHINGTON — One Seattle-area hospital has already seen patient care delayed by the stringent infection-control practices that the government recommended for suspected coronavirus cases. Another in Chicago switched Thursday morning into “surge” mode, setting up triage tents in its ambulance bay and dedicating an entire floor to coronavirus patients. At least one is already receiving emergency supplies from the federal government’s stockpile.	WASHINGTON — One Seattle-area hospital has already seen patient care delayed by the stringent infection-control practices that the government recommended for suspected coronavirus cases. Another in Chicago switched Thursday morning into “surge” mode, setting up triage tents in its ambulance bay and dedicating an entire floor to coronavirus patients. At least one is already receiving emergency supplies from the federal government’s stockpile.
With the bow wave of coronavirus infections still to come, hospitals across the country are trying to prepare for a flood of critically ill patients who will strain their capacities like nothing they have seen in at least a generation. Even with some time to prepare, administrators fear they will not be ready.	With the bow wave of coronavirus infections still to come, hospitals across the country are trying to prepare for a flood of critically ill patients who will strain their capacities like nothing they have seen in at least a generation. Even with some time to prepare, administrators fear they will not be ready.
Staffing shortages could hinder care if doctors and nurses become infected. There may not be enough ventilators or bed space for a crush of seriously ill patients.	Staffing shortages could hinder care if doctors and nurses become infected. There may not be enough ventilators or bed space for a crush of seriously ill patients.
“Our hospitals are already stretched to capacity,” said C. Ryan Keay, the medical director of the emergency department at Providence Regional Medical Center in Everett, Wash., near Seattle, which is dealing with the largest outbreak in the country. “We’re a hospital that is always full, so it doesn’t take much to tip us over the edge.”	“Our hospitals are already stretched to capacity,” said C. Ryan Keay, the medical director of the emergency department at Providence Regional Medical Center in Everett, Wash., near Seattle, which is dealing with the largest outbreak in the country. “We’re a hospital that is always full, so it doesn’t take much to tip us over the edge.”
The novel coronavirus could result in 10 million to 34 million hospital visits, based on statistics from other countries, according to the Harvard Global Health Institute. About one-fifth of those patients will require intensive care. With 2.8 hospital beds per 1,000 people, the United States has fewer than Italy’s 3.2 beds per 1,000, China’s 4.3 and South Korea’s 12.3.	The novel coronavirus could result in 10 million to 34 million hospital visits, based on statistics from other countries, according to the Harvard Global Health Institute. About one-fifth of those patients will require intensive care. With 2.8 hospital beds per 1,000 people, the United States has fewer than Italy’s 3.2 beds per 1,000, China’s 4.3 and South Korea’s 12.3.
The estimated 45,000 intensive care unit beds in the United States would be swamped by even a moderate outbreak of about 200,000 in need of I.C.U. admission.	The estimated 45,000 intensive care unit beds in the United States would be swamped by even a moderate outbreak of about 200,000 in need of I.C.U. admission.
“I am very, very worried,” said Ashish K. Jha, who directs the Harvard Institute.	“I am very, very worried,” said Ashish K. Jha, who directs the Harvard Institute.
The strain is already playing out in unexpected ways. Since admitting the first known case in the United States, Dr. Keay’s hospital has followed Centers for Disease Control and Prevention protocols for sanitizing facilities used by multiple patients with suspected coronavirus infection, which resulted in slower treatment.	The strain is already playing out in unexpected ways. Since admitting the first known case in the United States, Dr. Keay’s hospital has followed Centers for Disease Control and Prevention protocols for sanitizing facilities used by multiple patients with suspected coronavirus infection, which resulted in slower treatment.
“If somebody had to go in for a chest X-ray, as most of these patients do, the X-ray room would need to be down for 30 minutes afterward to reverse the airflow and sanitize,” Dr. Keay said. “If you have lots of patients, that becomes a huge issue and delay.”	“If somebody had to go in for a chest X-ray, as most of these patients do, the X-ray room would need to be down for 30 minutes afterward to reverse the airflow and sanitize,” Dr. Keay said. “If you have lots of patients, that becomes a huge issue and delay.”
Another unanticipated development: More moderate forms of breathing support, such as nebulizers and Bipap machines, should spare ventilators for the worse cases, but those technologies cannot be used on coronavirus patients because they risk releasing particles into the air.	Another unanticipated development: More moderate forms of breathing support, such as nebulizers and Bipap machines, should spare ventilators for the worse cases, but those technologies cannot be used on coronavirus patients because they risk releasing particles into the air.
Hospitals can take steps to increase their capacity, for instance by canceling some elective procedures or repurposing facilities meant to care for psychiatric patients. The most critical action, however, is outside hospitals’ control: slowing the spread of the virus through hygiene and social distancing, so cases spread out and the health system can treat patients who need care.	Hospitals can take steps to increase their capacity, for instance by canceling some elective procedures or repurposing facilities meant to care for psychiatric patients. The most critical action, however, is outside hospitals’ control: slowing the spread of the virus through hygiene and social distancing, so cases spread out and the health system can treat patients who need care.
Most hospitals maintain disaster preparedness plans for multiple situations, such as mass casualties and novel infectious diseases. Those contingency plans are typically for a surge in capacity of up to 20 percent, hospital executives said. Some experts believe that hospitals could increase their capacity by resorting to more extreme measures, such as sending patients home earlier than planned or renting space at nearby facilities to set up makeshift hospital rooms.	Most hospitals maintain disaster preparedness plans for multiple situations, such as mass casualties and novel infectious diseases. Those contingency plans are typically for a surge in capacity of up to 20 percent, hospital executives said. Some experts believe that hospitals could increase their capacity by resorting to more extreme measures, such as sending patients home earlier than planned or renting space at nearby facilities to set up makeshift hospital rooms.
The American Hospital Association has lobbied the Trump administration for flexibility to further stretch capacity by allowing physicians to practice in states where they are not licensed and waiving requirements that Medicare enrollees stay at a hospital for three days before moving to a long-term care facility.	The American Hospital Association has lobbied the Trump administration for flexibility to further stretch capacity by allowing physicians to practice in states where they are not licensed and waiving requirements that Medicare enrollees stay at a hospital for three days before moving to a long-term care facility.
“This is an unusual case where we have a new disease, no immunity and no vaccine,” said Nancy Ann Foster, the American Hospital Association’s vice president for patient safety. “As we watch it in other countries, we realize it has the potential to spread quite easily.”	“This is an unusual case where we have a new disease, no immunity and no vaccine,” said Nancy Ann Foster, the American Hospital Association’s vice president for patient safety. “As we watch it in other countries, we realize it has the potential to spread quite easily.”
Rush University Medical Center, the largest hospital in Chicago, put its surge protocols into effect Thursday morning for the first time in its 183-year history. The hospital has treated four confirmed cases of coronavirus and expects an onslaught in the coming weeks.	Rush University Medical Center, the largest hospital in Chicago, put its surge protocols into effect Thursday morning for the first time in its 183-year history. The hospital has treated four confirmed cases of coronavirus and expects an onslaught in the coming weeks.
“We made the decision to surge because of the concern we’re seeing nationally and internationally,” said Omar B. Lateef, the hospital’s chief executive. “The W.H.O. is making statements about the risks of inaction, so we felt a responsibility to do something.”	“We made the decision to surge because of the concern we’re seeing nationally and internationally,” said Omar B. Lateef, the hospital’s chief executive. “The W.H.O. is making statements about the risks of inaction, so we felt a responsibility to do something.”
Rush officials estimate that new triage tents outside — with chairs spaced 6 feet apart, the distance the World Health Organization recommends for separating infected individuals — and additional beds inside will increase the hospital’s emergency department capacity by 40 percent.	Rush officials estimate that new triage tents outside — with chairs spaced 6 feet apart, the distance the World Health Organization recommends for separating infected individuals — and additional beds inside will increase the hospital’s emergency department capacity by 40 percent.
“We have to accept that this is a tremendous challenge for the health care system,” Dr. Lateef said. “If we allow uncontrolled spread, we will be overwhelmed. But if we practice mitigation, then hospitals can handle it.”	“We have to accept that this is a tremendous challenge for the health care system,” Dr. Lateef said. “If we allow uncontrolled spread, we will be overwhelmed. But if we practice mitigation, then hospitals can handle it.”
The federal government and states maintain stockpiles of emergency supplies that hospitals can tap into when patient volume surges. The Trump administration has already fulfilled one request from Washington State for additional N95 respirator masks, which health care providers use to protect themselves from the virus, a Department of Health and Human Services spokeswoman confirmed.	The federal government and states maintain stockpiles of emergency supplies that hospitals can tap into when patient volume surges. The Trump administration has already fulfilled one request from Washington State for additional N95 respirator masks, which health care providers use to protect themselves from the virus, a Department of Health and Human Services spokeswoman confirmed.
The stockpile also includes ventilators, a supply that could become crucial in fighting the severe respiratory infections that can result from the virus.	The stockpile also includes ventilators, a supply that could become crucial in fighting the severe respiratory infections that can result from the virus.
~~Updated June 1, 2020~~	Updated June 2, 2020
	Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.	Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.	States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.	Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.	Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)	If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.	More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.
Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.	Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.	The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.	If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.	If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.
One study, published in 2010, estimated that American hospitals had stockpiled 160,000 ventilators. If the coronavirus pandemic follows the pattern of the 1918 flu, American patients would need more than 740,000. The experiences in Italy and Iran have heightened fears of a shortage in the United States.	One study, published in 2010, estimated that American hospitals had stockpiled 160,000 ventilators. If the coronavirus pandemic follows the pattern of the 1918 flu, American patients would need more than 740,000. The experiences in Italy and Iran have heightened fears of a shortage in the United States.
“The biggest, most dreadful thing we might face is rationing or triaging who gets ventilators,” said Gabe Kelen, the director of the Office of Critical Event Preparedness at Johns Hopkins University. “I really hope we never have to make these kinds of life-and-death decisions.”	“The biggest, most dreadful thing we might face is rationing or triaging who gets ventilators,” said Gabe Kelen, the director of the Office of Critical Event Preparedness at Johns Hopkins University. “I really hope we never have to make these kinds of life-and-death decisions.”
Johns Hopkins University, which has five hospitals in the Baltimore area and has treated coronavirus cases, could surge its capacity by as much as 50 percent if it went into what Dr. Kelen described as crisis mode. That would mean housing some patients in hallways and canceling elective procedures.	Johns Hopkins University, which has five hospitals in the Baltimore area and has treated coronavirus cases, could surge its capacity by as much as 50 percent if it went into what Dr. Kelen described as crisis mode. That would mean housing some patients in hallways and canceling elective procedures.
Johns Hopkins ordered extra ventilators weeks ago, as staff began to see the virus spreading across the world. But Dr. Kelen still worries about access to protective gear for his staff.	Johns Hopkins ordered extra ventilators weeks ago, as staff began to see the virus spreading across the world. But Dr. Kelen still worries about access to protective gear for his staff.