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From the archives 2020

Demand for ICU beds in Pa. will greatly surpass availability if coronavirus hits hard

by Nathaniel Lash of the Philadelphia Inquirer and Brett Sholtis of WITF |

Medical workers collect samples from individuals who signed up for "drive-through testing" for the coronavirus at a Penn Medicine site in West Philadelphia on Tuesday.
TIM TAI / Staff Photographer

This story was produced as part of a joint effort among Spotlight PA, LNP Media Group, PennLive, PA Post, and WITF to cover how Pennsylvania state government is responding to the coronavirus. Sign up for Spotlight PA’s newsletter.

YORK, Pa. — Mayor Michael Helfrich spent much of Wednesday fielding calls from an office setup in his kitchen. York County had just confirmed its first cases of the coronavirus, and people had a lot of questions.

“It’s hard to compare it to anything else,” Helfrich said. “Even though we’re in the early stages, I think some of us, luckily, can see the potential dangers.”

Already in York and the surrounding region, there are few beds in intensive-care units and they’re often occupied. If COVID-19 spreads quickly, as it did in Italy, researchers estimate the need for beds here will be 26 times greater than the existing capacity in ICUs — more than anywhere else in the nation.

Those predictions come from a team at the Harvard Global Health Institute, which projects that if the outbreak peaks quickly over six months, Pennsylvania’s ICU units will need 2.5 to 7 times the number of beds they can likely make available. Just how great the need will be depends on how much of the population the virus ends up infecting.

The predictions are even more dire outside of the state’s major cities, where greater shares of elderly residents and fewer hospital beds spell trouble for the looming outbreak.

The projected shortfall in the York region is not entirely a surprise to Helfrich, who, with county officials, has set up an emergency response plan. He declined to provide details, but said it involves locating hospital resources like beds and ventilators and being ready to move them to where they are most needed.

“We’re acting the best as we can on our own, not knowing what the next decision from the state or federal government is going to be,” Helfrich said.

In an optimistic scenario, where the virus spreads slowly over the course of a year and only 20% of the population is infected, only Pittsburgh and Wilkes-Barre are projected to have the capacity for the number of patients who will need treatment in an ICU.

Predictions for the total share of the population that could be infected in an unmitigated scenario have reached as high as 80%. If the virus ends up infecting over 40% of the population, there’s no scenario where Pennsylvania’s existing systems will be able to treat all patients at the outbreak’s peak.

It’s unknown how many Pennsylvanians who get the virus will need an ICU bed, but current national and international estimates put the number at 3% to 10%. Health Secretary Rachel Levine said Thursday a 10% estimate is “about right” for Pennsylvania so far.

Levine told reporters the Health Department has cut regulations, making it easier for hospitals to add beds. She added the state is working with health systems to prepare for the surge in patients.

However, key questions remain unanswered.

Department spokesperson Nate Wardle said there are “nearly 3,400 intensive and critical care beds and 71 pediatric intensive care beds” in Pennsylvania. But he didn’t say how many beds health systems have committed to adding to prepare for the surge, or how they would do it. (Levine said hospitals have been directed to implement updated emergency plans that account for COVID-19 by Friday.)

Wardle said the Health Department has ventilators — a key piece of ICU equipment — on hand, but wouldn’t say how many or when the state would deploy them.

Across the state, health systems have muzzled their employees. Doctors who normally would be permitted to speak about their departments are being denied permission to talk. Reports about conditions at ICUs come by anonymous text or posted online, often along with desperate calls for more supplies.

WellSpan and UPMC Pinnacle would not answer questions but provided e-mailed statements saying they’re working with state and local officials.

Mark Ross, vice president of emergency management at the Hospital and Healthsystem Association of Pennsylvania — which represents those hospitals and works closely with the state Health Department — said facilities have what they need and are prepared to meet the increased demand for ICU services.

“We are using our surge plan and we are responding to the numbers we’re seeing,” Ross said. “We’re responding to those predictions.”

Thomas Tsai, a surgeon and researcher with the Harvard group, said the projections emphasize the need for the public to “flatten the curve” and delay the peak to buy the health-care system time to increase its capacity.

On Thursday, Gov. Tom Wolf ordered all businesses that aren’t “life-sustaining” to close. “To protect the health and safety of all Pennsylvanians, we need to take more aggressive mitigation actions,” Wolf said in a statement.

“We need social action to buy time,” Tsai said. “If we can flatten the curve from six to 18 months, we buy time for the second part of this: for hospitals to react to create more inpatient bed capacity and intensive care capacity.”

If mitigation efforts are successful in Pennsylvania, researchers posited that the virus would spread more slowly over the course of 18 months. In that best-case scenario, where the York region’s hospitals are also able to free up about half of their occupied ICU beds for COVID-19 patients, the area would still need 1.5 times its ICU capacity.

In Philadelphia, where projections show the system can bear the burden of patients in an 18-month scenario, hospitals are canceling elective surgeries to free up more space for coronavirus patients, according to city Health Commissioner Thomas Farley.

“The hospitals are anticipating a surge and trying to drive down other patients so they can make more beds available,” Farley said.

But in Philadelphia, too, officials were tight-lipped on the city’s actual maximum capacity.

“That question is difficult to answer because every day it changes. Every day the hospital population is different,” Mayor Jim Kenney said Tuesday.

The need for expanded ICU beds has been put on stark display in countries like Italy, where the virus has been spreading for 11 days longer than in the U.S.

In the Lombardy region, the epicenter of the pandemic in Italy, the share of patients with the virus admitted into hospitals has fluctuated, but is not trending downward. However, fewer patients were admitted to ICUs. As fewer patients were admitted to intensive-care units, the share of patients dying from COVID-19 began to rise.

Data published by the Italian government show how in the first two weeks of the pandemic, deceased patients made up less than 5% of positive cases in the region. But as more cases streamed in, deaths rose, making up over 10% of the patients who had tested positive for the virus in Lombardy by Tuesday.

As the ICUs in Lombardy have filled with patients, doctors have had to prioritize access to beds and ventilators to younger patients who are more likely to survive.

In Italy overall, the share of patients testing positive for the coronavirus who are in an ICU has averaged about 9%. The models used by the Harvard researchers estimate that 5% of confirmed cases will need treatment in an ICU.

“In practice, the health care system cannot sustain an uncontrolled outbreak, and stronger containment measures are now the only realistic option to avoid the total collapse of the ICU system,” wrote a group of Milan-based doctors on Friday.

Inquirer staff writer Laura McCrystal contributed to this article.

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