St. Louis doctors are worried that the region’s hospitals don’t have enough beds to treat the expected surge in patients with COVID-19, the disease caused by the new coronavirus.
The St. Louis metropolitan area has about 9,300 hospital beds, not including those in public hospitals, according to the St. Louis Area Business Health Coalition. Nearly one-third of those beds are available.
But that likely won't be enough to treat more than 100,000 patients who could need emergency care throughout the outbreak, Harvard University researchers said in a recent report.
By looking at the rate of infection in other parts of the country and world and comparing it with hospital data, they were able to model how overloaded hospitals may become.
“In the areas of the country where they’ve waited a week too long, the curve has exploded so quickly they’ve found themselves in really dire straits,” said Dr. Clay Dunagan, chief clinical officer at BJC HealthCare. “But I think we’re going to be able to get ahead of this.”
How strained hospitals will be depends on how long the outbreak lasts and how many people are infected at a time, the Harvard scientists said. The longer the outbreak lasts, the less strain will be put on the health care system.
In the most dire scenario, in which an outbreak lasts only a few months and 60% of people are infected, patients would need nearly three times the total number of beds.
St. Louis could be particularly short on intensive care unit beds. The region has nearly 750 ICU beds, according to data from the Missouri Department of Health and Senior Services. Hospitals only have a limited number of ventilators to use on patients who have stopped breathing.
“Those are really the first two chokepoints where, if we’re not ahead of the curve, we can see some big problems,” Dunagan said.
Many rural areas surrounding St. Louis have few, if any, ICU beds, said Karen Roth, director of research at the Business Health Coalition. Sick patients there would come to the city’s hospitals.
“Those [hospitals] are probably not going to have the capability to care for really severely ill patients whose lives are in danger, and they may need to be transferred to other, more tertiary care facilities in St. Louis,” she said.
If hospital personnel become infected with the virus, that could further reduce hospital capacity, Dunagan said.
Hospitals could increase capacity by repurposing buildings or setting up makeshift clinics in tents, said Missouri Hospital Association spokesman Dave Dillon.
Dr. Fred Echols, St. Louis health director, said Monday that he was exploring ways to increase hospital capacity with the region’s health systems but did not offer details.
Doctors said St. Louis residents can help reduce the strain on hospitals by staying home.
St. Louis and St. Louis County issued a shelter-in-place order over the weekend that requires people to stay in their homes except for essential trips. The state has not issued such an order.
Social distancing measures such as closing businesses could buy hospitals more time by extending the period over which people in the region catch the virus. Because the cases would be spread over many months, there would be more beds and equipment available to people that need them, said Keith Starke, Mercy Hospital St. Louis chief quality officer.
“If St. Louis had gone on about its business, I think we would quickly see the entire health system overwhelmed,” Starke said last week. “Once you reach the point where capacity runs out, it becomes really hard to control from that point on.”
The Missouri State Medical Association on Monday sent an open letter to Gov. Mike Parson imploring him to issue a statewide shelter-in-place order.
“We believe a ‘shelter-in-place order’ is the only way to curb the exponential spread of COVID-19 in Missouri,” wrote Dr. James DiRenna, the association's president. “If things progress as is, COVID-19 patients will deplete the state’s available hospital beds, ventilators and precious personal protection equipment.”
Doctors do not want to have to decide which patients receive lifesaving treatment, basing such decisions on a person's age and health. That's what happened in Italy, where the health care system quickly became overwhelmed by seriously ill patients. Doctors there have needed to triage patients based on their health and age to decide who receives lifesaving treatment.
“We’re seeing a really extreme situation in Italy where they’re having to triage them,” said Roth, the Business Health Coalition researcher, “which is something that is unimaginable to us. But probably it was unimaginable to them, too.”
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