Hospital capacity debate out in open in New York

Day after day, as New York has become the epicenter of the coronavirus outbreak in the United States, Gov. Andrew Cuomo has gone before television cameras to lay out the situation facing his state.

His press conferences are carried live on cable news, and have become must-watch TV for the coronavirus obsessed. A slide presentation with facts and figures about hospitalizations and equipment needs appears next to his image.

And in blunt, but simple terms, the governor lays out the math: 53,000 hospital beds and 3,000 intensive care units currently in New York state. A surge peak expected in 14 to 21 days when as many as 140,000 patients will need a bed, including 40,000 that will require an ICU bed with a ventilator.

"That's a challenge," Cuomo said Wednesday, describing how he has asked hospitals to find ways to increase their capacities by 50 percent.

In Massachusetts, anticipating and planning for the surge is still a work in progress. Gov. Charlie Baker also has daily press conferences, but they do not include much discussion of how many beds will be needed to meet patient demand, or where the state plans to find those beds.

The state has not yet released its projections for how bad the spread of the virus could be at its peak, or when that peak is expected to arrive.

Baker has established a command center headed by Health and Human Services Secretary Marylou Sudders to coordinate the state's coronavirus response, and officials at the command center told the News Service they are "planning for medical surge" and engaging with health care facilities in that planning, but declined to provide specific projections for hospital capacity.

The Department of Public Health has reported just 103 hospitalizations with COVID-19 illness so far, though hospitals have described admitting a far greater number of patients exhibiting symptoms.

Massachusetts Health and Hospital Association President Steve Walsh, who is in contact with the command center, said that over the past week hospitals have been doing what they can to "move patients through the continuum" and discharge them to their homes, if possible, to clear space for coronavirus patients.

Walsh said the administration and the command center also have been working closely with hospitals to prepare, including the identification of possible locations for hospital overflow should that be needed. He deferred to the command center team to provide the latest estimates for case volume and bed capacity.

Cuomo declared a state of emergency in New York three days before Baker on March 7, when New York had 89 cases. Today, that state has more than 30,800 cases, and is testing more individuals than anywhere else in the country.

Baker and health officials early in the crisis described hospitals as being at about 74 percent capacity, but where that stands now system-wide is not publicly known.

A January report published by the Center for Health Information and Analysis identified 14,596 acute care hospital beds in Massachusetts spread across the academic medical centers, teaching hospitals, community hospitals and specialty hospitals.

At the current hospitalization rate of 8 percent, all of those beds would be filled with COVID-19 patients by the time Massachusetts clocks case number 182,450. The state is currently reporting 1,838 confirmed cases, but as testing has increased the number of cases has also started to grow exponentially.

The governor has taken steps to reduce hospital occupancy by canceling elective surgeries, and to prepare for an influx of patients by allowing licensed physicians who had retired in good standing in the last year to be reactivated, expanding telehealth opportunities and permitting licensed providers in other states to quickly get emergency licenses to practice in Massachusetts.

Baker has also initiated discussions with the Army Corps of Engineers and others about converting or retrofitting structures, like closed hospitals or shelters, to boost capacity.

A command center spokesman said the governor may enlist the National Guard to support that effort, and said that colleges, recently closed nursing facilities,and other large venues could be used.

New York's numbers, Cuomo said, are based on modeling done by Cornell University, his Department of Public Health and McKinsey consultants. And while it's not perfect - hospitalization has actually outpaced the modeling - Cuomo said it's all he has.

"It's the only data we have to plan," Cuomo said.

In California, Gov. Gavin Newsom said this week that his state was now projecting a need for 50,000 hospital beds to meet coronavirus demand, an increase of 20,000 beds over the forecast he made a week earlier.

Massachusetts Nurses Association President Donna Kelly-Williams said Massachusetts should follow the lead of New York, where the New York National Guard and Army Corps of Engineers are working to turn the Jacob K. Javits Center on the west side of Manhattan into a 2,000-bed hospital.

"There are spaces available at the Baystate Expo, DCU Center in Worcester, Union Hospital in Lynn, Quincy Medical Center, North Adams Hospital and many other places. We must act now to increase capacity," Kelly-Williams said in a letter to Baker Tuesday.

Boston Mayor Mary Walsh, in his press conference Wednesday, said the city a week and a half ago gave state officials a list of sites that could be used for for health care workers or patient overflow, and that the city would use some of those spaces for its homeless population.

"What Gov. Cuomo did in New York by using the convention center, I think that should be an option," Walsh said. "I think there's a lot of opportunities for us here in the city of Boston. I know there's conversation happening right now."

"Unfortunately we're going to have to build it," Walsh said. "Hopefully we'll never have to use it."

Like Cuomo, Walsh said he was trying to "get as much information out to people and overload them with information to let them know the importance of it."

"Anyone that quite doesn't understand it I'd suggest you turn on the national news and you listen to what Gov. Cuomo's saying in New York," Walsh said. "He's basically telling us a roadmap to prevent what New York is going through."


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