Bracing for a surge: CRH urges physical distancing to avoid overwhelming hospital

An exterior view of Columbus Regional Hospital in Columbus, Ind., pictured Friday, March 6, 2020. Mike Wolanin | The Republic

As COVID-19 continues to spread across Indiana, hospitals around the state, including Columbus Regional Hospital, are bracing for a surge in patients — one that could leave hospital officials scrambling for beds and personal protective equipment already in short supply.

In Indiana, at least 209,700 COVID-19 patients older than 18 are projected to require hospitalization over the course of the pandemic, according to the Harvard Global Health Institute and the Harvard T.H. Chan School of Public Health.

There are only 17,433 hospital beds in the state. Columbus Regional Health is licensed for 225 beds.

Whether Columbus Regional Hospital, as well as other hospitals around the country, will be able to handle a surge of patients is largely dependent upon how fast the virus spreads, CRH officials said. How fast the virus spreads, they said, depends on the community’s ability to maintain social distancing.

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As of Thursday, six people had tested positive for COVID-19 in Bartholomew County, according to the Indiana State Department of Health. At least four of those cases have required hospitalization.

Those six cases, however, are likely just tip of the iceberg.

“Because there are significant testing restrictions and limitations, we know that more of the population in our area has COVID-19 than the current laboratory-confirmed numbers reflect,” Tom Sonderman, CRH vice-president and chief operations officer. “It is spread through personal contact and … (people) may not be experiencing symptoms at all, which makes it very difficult to detect, which then emphasizes how important the physical distancing is.”

For weeks, local health officials have stressed the importance of social distancing, which they have now rebranded as “physical distancing” to emphasize the need for people to maintain physical separation from others.

Physical distancing is a set of practices designed to increase the physical space between people to avoid spreading illness, according to Johns Hopkins Medicine. Health experts say staying at least 6 feet away from other people decreases the probability of catching COVID-19.

Other physical distancing practices include working from home instead of the office, using electronic devices to communicate with loved ones instead of visiting them in person and postponing large meetings.

The rationale

The main rationales behind physical distancing are to slow the spread of the virus and stretch out the time it takes COVID-19 cases to emerge – which could reduce the strain on health care systems and, ultimately, save lives, local health officials said.

Marc Lipsitch, an epidemiologist from the Harvard School of Public Health, has projected that 20% to 60% of the world’s adult population will be infected with COVID-19 over the course of the pandemic, and around 15% of those cases could require hospitalization, according to the Harvard Global Health Institute.

To put that in perspective, the latest U.S. Census Bureau estimates say there are around 63,057 adults in Bartholomew County — meaning, according to Harvard’s model, between 12,611 and 37,834 adults in Bartholomew County could get infected at some point and an estimated 1,891 to 5,675 of them could require hospitalization.

The model, however, has some limitations, including assumptions that the virus will spread equally in all communities and everyone has an equal chance of being infected.

CRH has been using national models to plan for different future scenarios based on, among other things, possible local infection rates, the potential severity of the cases and the population demographics of CRH’s 10-county service area, said CRH spokeswoman Kesley DeClue.

The modeling shows strikingly different outcomes based upon how much physical distancing is done in the community.

A worst-case scenario, where people do not practice proper physical distancing, is “frightening,” said Dr. Slade Crowder, CRH vice president of physician enterprise operations and associate chief medical officer.

Under that scenario, CRH would see a massive spike in COVID-19 patients needing to be hospitalized over the next 40 days – peaking at nearly double the hospital’s current daily capacity for hospitalizations and well beyond its intensive care unit and ventilator capacity, according to models provided by CRH.

“With no change in our behavior, (the model) would predict that we would go well above our normal capacity, the day-to-day that we can handle now,” Crowder said. “If you model in a moderate amount of physical distancing, that model predicts that we will reach right at our capacity on something like hospitalizations. And it’s important to remember that you also have to consider that we’re normally running a hospital and doing other work. We’re taking care of heart attacks. We’re taking care of appendectomies. This model is only showing you those COVID-19 patients.”

However, under a best-case scenario where local residents practice proper physical distancing, the sudden surge of patients at CRH is stretched out over a longer time period, which predicts that CRH would have sufficient beds and equipment to manage the number of daily patients.

The result is what health experts have called “flattening the curve.”

“With very successful physical distancing, you spread out that peak over a much longer duration and it becomes very manageable,” Crowder said. “The supply chain can catch up. You never have a rapid, quick onset of people. Managing two to three people on a ventilator every day is completely different than the first model, where it’s well above your capacity.”

CRH officials are continuing to urge people to comply with physical distancing guidelines “for the foreseeable weeks and months.”

“It’s absolutely important for us to be able to have the scenario play out where it shows we can handle the volume, rather than the big spike if we really dramatically relax how seriously and how much we comply with physical distancing,” Sonderman said.

“In our opinion, this is not just another two- or three-week effort,” Sonderman added. “It’s longer than that. It’s months, not weeks of the required physical distancing.”

Preparing for a surge

CRH officials said have been preparing for a potential surge in COVID-19 patients for several weeks, as hospital around the country attempt to navigate a shortage of personal protective equipment and testing supplies.

DeClue said CRH currently is “sufficiently equipped” with personal protective gear and other supplies to treat COVID-19 patients, and the hospital system has people “working around the clock” to monitor the pandemic, redirect staff, procure more supplies they believe they could need more of as the pandemic progresses, including masks, gowns and gloves.

“As far as ventilators go, we could have more than 50 in use, if needed,” DeClue said. “Again, that is nowhere near normal capacity or need. That would be for the worst-case surge scenario.”

Internally, CRH has been taking steps to conserve supplies by encouraging employees to only change out masks if they get exposed to a contaminated area or if they get soiled and limit number of times they go in and out of a patient’s room to limit the number of gowns used, Crowder said.

CRH is advising people to call the COVID-19 Triage Resource Call Center, which handles calls from residents with questions and concerns about exposure or symptoms associated with COVID-19 and advise people on a course of action and whether they should be tested for the virus.

The hospital system has also canceled or postponed all non-urgent, elective surgeries “to free up more hospital beds, preserve staff and equipment” and has offered telemedicine appointments to some patients to screen for symptoms, Crowder said.

“Most people with (COVID-19), it will run its course and they don’t need to be seen,” Crowder said. “…I think a lot of people have a fear and want to be tested, but testing brings you into the health system and exposes yourself, maybe because you didn’t have the disease, and it exposes others. Most people do not need to be tested. Only very high-risk people should be tested.”

CRH, in a worst-case scenario, is able to reconfigure the layout of the hospital to incorporate more ICU beds, if necessary, DeClue said.

CRH also has already started coordinating with other hospitals in the region to share resources if a hospital were to reach its capacity, Crowder said.

“We’re doing everything we can to prepare and build our readiness, our reserves, whether that be equipment, staffing, technology, facility resources,” DeClue said. “…We know that the reality out there on the national level is that some of those efforts may not be enough if we don’t get the community to play a huge part in this and take ownership of what they can do.”

“This is a national issue and every hospital is facing the same issues that we are here and we’re all looking for the same resources,” DeClue said.

Feeling the strain

Hospitals around the United States are starting feel the type of strain felt by hospitals in Italy and China due to influx of COVID-19 patients, The Associated Press reports.

Some U.S. hospitals are setting up triage tents, calling doctors out of retirement, guarding their supplies of face masks as they brace for an onslaught of patients, according to wire reports.

Depending on how bad the crisis gets, the sick in some parts of the country could find themselves waiting on stretchers in emergency room hallways for hospital beds to open up, or could be required to share rooms, according to wire reports.

Some doctors fear hospitals could become so overwhelmed that they could be forced to ration medical care.

On Tuesday, Illinois Gov. J.B. Pritzker said the state would have to double the number of available hospital beds in the next two weeks to treat COVID-19 patients if the coronavirus is not contained.

Illinois would need almost 38,000 additional hospital beds, including more than 9,000 in intensive-care units, by April 6, in a worst-case scenario, and nearly 5,000 ventilators would be in demand — more than double what’s available in the state, according to wire reports.

New York Gov. Andrew Cuomo has predicted that the state could be as close as two weeks away from a crisis that sees 40,000 people in intensive care, according to The Associated Press. Such a surge would overwhelm hospitals, which now have just 3,000 intensive care unit beds statewide.

Last week, seven members of Wisconsin’s congressional delegation said the state was running “critically low” on needed medical equipment to combat the spread of the virus and asked the federal government for immediate help.

Health care workers from Oklahoma City to Minneapolis sought donations of protective equipment, according to wire reports. Staff at a Detroit hospital have been creating homemade face masks for workers.

CRH is currently seeking protective suits, gloves (especially medium) and N95 masks as health officials prepare for the surge, according to the Columbus Area Chamber of Commerce’s website.

In Bartholomew County, several local employers have donated personal protective equipment to CRH, like gloves and masks, including Cummins, NTN Driveshaft, Decatur Mold, Lowe’s, Sherwin Williams and Menards, DeClue said.

“We have also had many homemade masks made that are being kept as reserve,” she said, adding that the hospital system is “so appreciative” of the donations of personal protective equipment, food and discounts at local businesses.

Only time will tell how many patients in Bartholomew County will need to be hospitalized, but local health officials agree that the next two weeks are crucial for flattening the curve.

“We know we haven’t seen the peak yet here in Bartholomew County and our service area,” DeClue said. “What happens over the course of the next several weeks is going to be critical as to how those supplies are affected.”

“Our community has the power to affect the outcome for every single one of us.”

The Associated Press contributed to this report.

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Federal officials are scrambling to broaden testing for the coronavirus after one of the government’s top health officials called the initial testing effort “a failing” and health care professionals, politicians and patients across the country complained about lack of access to testing, according to The Associated Press.

CRH officials acknowledged last week that there is a “shortage of testing supplies” and said relatively healthy people with a low fever and cough and are not that sick would likely be advised to stay at home and not seek medical attention.

However, people with symptoms such as shortness of breath or risk factors such as being older than 60 and/or having a compromised immune system should seek medical care and let their physician decide if a test will help direct their care.

Anyone with concerns are urged to call the health system’s Triage Resource Call Center, a phone resource line launched by CRH last week to handle calls from residents with questions and concerns about exposure or symptoms associated with COVID-19.

The phone line is open daily from 7 a.m. to 8 p.m. and is staffed by registered nurses who will offer screening questions and potentially recommend a course of action for patients, said CRH spokeswoman Kelsey DeClue.

The phone resource line can be contacted at 812-379-4449.

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