The issue around the world seems to be the number of hospital beds available versus current COVID19 patient loads.
https://www.washingtonpost.com/health/2020/03/13/…
https://www.cnbc.com/2020/03/16/ny-gov-cuomo-warn…
"In a report last month, the Center for Health Security at Johns Hopkins estimated the United States has a total of 160,000 ventilators available for patient care (with at least an additional 8,900 in the national stockpile).
Cuomo said he sent a letter to President Donald Trump asking him to deploy the Army Corps of Engineers to the state to “start building temporary health-care capacity.” He also criticized the federal government’s response to the pandemic, saying it has “been behind from day one on this crisis.
The United States has roughly 2.8 hospital beds per 1,000 people. South Korea, which has seen success mitigating its large outbreak, has more than 12 hospital beds per 1,000 people. China, where hospitals in Hubei were quickly overrun, has 4.3 beds per 1,000 people. Italy, a developed country with a reasonably decent health system, has seen its hospitals overwhelmed and has 3.2 beds per 1,000 people.
The United States has an estimated 924,100 hospital beds, according to a 2018 American Hospital Association survey, but many are already occupied by patients at any one time. And the United States has 46,800 to 64,000 medical intensive-care unit (ICU) beds, according to the AHA. (There are an additional 51,000 ICU beds specialized for cardiology, pediatrics, neonatal, burn patients and others.)
A moderate pandemic would mean 1 million people needing hospitalization and 200,000 needing intensive care, according to a Johns Hopkins Center for Health Security report last month. A severe pandemic would mean 9.6 million hospitalizations and 2.9 million people needing intensive care.
Now, factor in how stretched-thin U.S. hospitals already are during a normal, coronavirus-free week handling usual illnesses: patients with cancer and chronic diseases, those walking in with blunt-force trauma, suicide attempts and assaults. It’s easy to see why experts are warning that if the pandemic spreads too widely, clinicians could be forced to ration care and choose which patients to save."
It seems like a late call to the National Guard would result in deaths (if we exceed bed capacity). When should the US federal government step in and construct enough medical facilities and beds? Do you think the US needs extra beds?
If we hit a saturation point, it will turn into unavoidable deaths for many.
Italy:
https://www.timesofisrael.com/northern-italy-warn…
What do you think should happen?
Didn't China build like 16 temporary centers to deal with their outbreak? Why can't the US do the exact same thing if it comes down to it?
because the US actually has human right laws
Not sure why this is getting downvoted. China's "temporary centers" were essentially human corrals where infected were left to die with no treatment.
Funny, until you consider widespread use of prison labor, up to and including fighting fires.
To be serious though, there’s a benefit for having a centralised decision making and executive process that can mobilise resources without delay. ACoE has been working overtime to negotiate and sign individual contracts last two weeks: the most progress they’ve made is repurposing an already built stadium in NYC by filling it with hospital beds, fake flowers and Wayfair lamps.
I'm going to jump out on a limb and throw my hat in the ring on this one...
First, a disclaimer: I've got 10 years of CF experience in healthcare delivery and am currently the Director of Finance for the Surgery division of a healthcare provider in the Boston area. I've spent nearly my entire career on the business side of the delivery of healthcare (plus five or six years or so as a paramedic)
The US healthcare system is a really weird cottage industry. For perspective, a fantastically run Hospital/Health System turns a 3% margin every year (yes...low single digits is considered awesome). Part of this is due to the reimbursement system in this country, part is due to the salary rates paid to healthcare providers, part is due to the US leading the way in terms of new innovations, and (a very small) part due to drug costs.
The fact of the matter is that the US healthcare system is relatively well-equipped to handle the annual epidemic of flu cases. But that annual epidemic typically leaves many Hospitals -- the high-quality, well-run ones -- at near full capacity. The remainder will make all of their money during this four month period. This ability to receive care close to home, even if only of passable quality, is what pushes communities to ensure a Hospital is open locally. Additionally, these facilities provide relatively high paying jobs in the community.
Contrast this with most states' desire to limit health care costs. This has led to many states creating State Health Facilities Plans that limit the number of inpatient beds that can be placed in any one location. We have to go to the State and work through a fairly arduous process to get approval to open a bed/OR/Emergency Department and the like. In Massachusetts, it's also fairly costly as there are required Community Health Initiative payments on top of project costs (5%) that can become rather large numbers when you consider the cost to build a new Hospital bed in this market is approximately $2 million in CapEx. (and yes, it really does cost about $2 million to build out all of the facility infrastructure, space, medical gasses, required sterile processing, and equipment for one Hospital bed space).
This, combined with the razor thin margins, is why most Hospitals only build to the 80-90% level of surge capacity needed. Building capacity to serve the current pandemic that occurs once-twice a generation is simply unaffordable.
This creates a number of externalities -- the one that is most clear in this pandemic is staffing. States also have requirements on the various clinical activities students must participate in before being licensed to provide healthcare. Given the general lack of "growth capacity" in the healthcare system, we can only replace Nurses and Physicians at close to a 1:1 rate. There aren't enough other clinical opportunities that are appropriately managed by seasoned providers to train additional students. Couple this with the desire of most schools to work with only those "prestigious" Health Systems and the problem further compounds.
Building temporary facilities could easily be performed by the ACoE -- but they'd be just that; temporary. A bigger question becomes who will we find to staff these temporary facilities. We're already in the midst of a Nurse and Physician shortage. A large chunk of our current Physician population (the Surgeons) don't actually train to handle infectious disease outbreaks like this -- they literally spend one month of their five-year residency handling medical patients. Some Surgeons will admit that they are less qualified than paramedics and EMTs to treat patients during a communicable disease outbreak.
While we can draw similarities between beds per 1,000 and outcomes -- this isn't the real issue we need to focus on. We can put patients in tents outside and convert the Hospital Dining Rooms to makeshift wards with cots. That's easy. It's finding sufficiently trained staff to care for these patients.
As a fairly junior analyst for the strategy team for a health system, this feels spot on. We are flying by the seat of our pants and pushing our project pipeline back so members of my team can provide analytical support for our hospitals and for surge capacity initiatives.
Whenever we all get through this, I'm curious as to how this will affect things like CON laws, and medical education, and non-healthcare companies stepping into healthcare further (along with affecting the debate about universal healthcare, of course)
This is 100% spot on. I've seen this from the opposite side of the table (dealing with Hospitals) and I can tell you that there is so much here that is absolutely true. I will add this to what you've said about Physicians being traid to handle Infectious Diseases - when was the last time a truly infectious disease was regularly seen in a hospital like the Coronavirus? I'm not talking about the occasional breakout of MRSA here - I'm talking about something on the level of TB. It's just not part of the curriculum these days.
Also, spot on when it comes to the replacement rate. Getting the right training to properly replace an aging physican or nursing population is hard, especially when it comes to folks wanting to be in either the most prestigous programs/health systems in their state, or are looking for low volume high prestige medical paths (think your Cardiothoracic/Neuro/Ortho/Derm and Plastics/Anesthesiologists). I mean, this does make for a great opportunity to train the next generation of nurses and doctors, but what happens when this is over?
My SO works in one of the major Boston hospitals and I'll just add that the nursing staff are dropping like flies due to the COVID rule-out, and it's compounding the problem badly. I really appreciate your well thought out response, helps to contextualize the problem.
+1 on staffing issue; our medical group (national single-specialty) has constantly found servicing our current volumes one of the largest issues (as if there already aren't enough in healthcare)
Curious if there are opinions on how to incentivize more Primary Care physicians as a preferred specialty during in medical school/residency. I'm acutely aware the borrowing cost to graduate med school is, put lightly, absurd and will of course push a number of students to pursue the more highly-compensated specialties.
Are the final rules from CMS 2020 fee schedule a step in the right direction (ie: increase in E&M reimbursement)? Is the reduction in payments from other specialties to pay for this (budget neutrality) going too far? Will the private payor market follow? So many questions and variables... absolutely underscoring your point, "This is a really weird cottage industry".
I do not have anything intelligent to say about this topic. With that said, you get a SB for the research done to create the topic.
My father is a CEO of a top healthcare system... things are not under any circumstance under control in hospitals... they are looking for funding fast and in need of it.. quickly running out of beds, masks, and tests, people are being sent home and out of jobs left and right and community spread of this disease is abundant. Its real shit right now.
This is pretty alarming. Also, username checks out
hence the shift to post-acute / outpaitent services. Great posts above
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this is a thread about the Coronavirus not treadmill 5ks
For me, no lesson from this situation has been clearer than this: the harder you shut things down, the quicker its over.
Next time we see a pandemic of this kind approaching the US, the president will order a hard core lockdown with the confidence that it will probably only last a few weeks because the exponential spread will be stopped early.
We already missed our chance to do the most intense shutdown, but no reason why we can't start now. No doubt our actions in the last few days will reduce the problem.
So that's all a long way of saying, bring in the national guard or whoever else can get the beds and respirators ready to go because this will all be over a lot sooner if we do that.
This is the essence of the problem. The fear is aggressive action will spook the markets but downplaying the crisis can cause more damage overtime. This is why it helps to have leaders who can think critically, act decisively and aren’t influenced by parochial political interests. Hong Kong has done fairly well because of mask culture. Mask wearing should have been enforced by law. The costs to stockpile and distribute emergency time masks is, compared to other national security projects, very very small, and the relevance very high. The Taliban didnt suddenly start peace negotiations because of the new hypersonic missile.
Seems like it's better to mobilize and build out extra capacity than vice versa. Should have shut borders, schools etc down much much sooner...
It appears I'm stuck in the US for a while now too lol. Not a huge deal but still frustrating. Haven't been home in a while now.
Several posters have mentioned the National Guard ... in fact, the U.S. military, active and reserve, cannot deliver coronavirus treatments and have already publicly begged off doing it.
The hospital ships Mercy and Comfort which are being mobilized, will not be used to treat coronavirus patients, as they aren't equipped, nor are the personnel trained, to do it. Instead they will take patients with other problems out of the hospitals, to free up hospital resources.
The DoD has said the hospital systems on military bases are too small to contribute meaningfully to coronavirus treatment.
The National Guard will be mobilized and can serve some valuable support functions. However, the Guard members who are EMTs, doctors, nurses etc. in civilian life will probably be excused from duty to do their civilian jobs. The rest of the Guard will probably be deployed to guard hospitals and shoot anyone who tries to rush the entrances. I'm not being alarmist about that last prediction. The governor of California said yesterday that martial law is a possibility.
According to analyses I read yesterday, the ventilator shortage, which is the key bottleneck, is unsolvable in the time available.
Things are going to get really ugly when very sick people start going to the hospital and are either refused entry or put on a cot in the hallway to die.
I hate to sound like Eeyore, but it's what I see based on the best available information, As for my own situation, I have COPD, heart disease, diabetes and Type A blood, so my chances aren't good if I get really sick. Today and tomorrow, I'm executing my will and buying a gun (before the gun stores close) to have an easy way out if it becomes necessary.
Um, no. Italy might as well be a third world country when it comes to healthcare. It is also home to one of the oldest populations, surpassed only by Japan (one of the healthiest nations), I believe, with said population harboring a notable love of cigarettes and cramped living. Italy is a terrible example for the US to use as reference
Good points.
I just quoted the article text. Berkeley Lovelace Jr. wrote the text.
https://www.cnbc.com/berkeley-lovelace-jr/
Lol. Italy is so dysfunctional and corrupt it’s a joke how people outside think it’s technocratic. My friend had to get 2 doctors notes for a gym membership in Milan. Christmas cards were arriving in....March. The media is worse than OAN.
The lack of leadership is astounding.
NYC Mayor Bill de Blasio just said he needs 3x the hospital beds they currently have by May.
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