Coronavirus pandemic: How our preparation in the US now could shape our future

The World Health Organization declared last week that COVID-19 is a pandemic. At this time, experts do not know how wide the disease will spread, though prior estimates predicted that the worst-case scenario could be 60% of the world population being infected.

However, it should be noted that “being infected” is not the same as “being critically ill.” About 80% of patients will have only mild symptoms, with upper respiratory symptoms or mild pneumonia, according to estimates from the European Centre for Disease Prevention and Control.

Most of these cases can be handled by basic measures at home, including eating, staying hydrated, resting, and giving your body time to fight off the virus.

But the remaining 20% who do develop more severe illness will likely need to be hospitalized.

And with infections in the country quickly increasing, is the U.S. healthcare system prepared to handle this influx of patients?

Some experts have warned that if the United States experiences a sudden rush of patients, the healthcare system will be overwhelmed – akin to the way Italy’s resource-strapped doctors are now forced to make tough decisions about which patients to treat.

That’s why experts are emphasizing the importance of “flattening the curve,” which means taking measures now to prevent the disease burden from reaching a critical mass to overload a health system, through interventions suggested by the CDC, such as appropriate handwashing, covering coughs and sneezes, social isolation and quarantine.

Assuming we flatten the curve successfully, the United States will have sufficient resources and “surge capacity” ) to withstand public health threats.

By the numbers

Hospital Beds: A survey conducted in 2018 by the American Hospital Association suggests that there are currently 6,146 hospitals in the nation, with a total of 924,107 beds.

Higher acuity hospital beds: The estimated number of ICU beds in the nation is 46,500, though the number of beds that can be converted to ICU beds is approximately an additional 46,500.

Ventilators: A 2010 study estimated that there were approximately 62,000 full-feature ventilators at the time, with an additional 99,000 non-full-feature ventilators. These statistics are a decade old, and it is unclear what the current numbers are.

Of note, in the case of emergencies, hospitals can call upon the Strategic National Stockpile, which is a national supply of life-saving medicines and medical supplies (https://www.phe.gov/about/sns/Pages/default.aspx), though for national security concerns, the quantity cannot be released to the public.

Staffing

Patients falling into the 20% of cases classified as a severe disease may require hospitalization or in critically ill cases, require ICU level care.

2018 data from the U.S. Bureau of Labor Statistics estimate that there are more than 3 million nurses. While this is appropriate from a hospital standpoint, ICUs require higher intensity care with specialized staff.

Data published in the last three years estimates there are 134,000 respiratory therapists in the nation and over 510,000 critical care nurses available for ICU care.

Where does this leave us

These numbers are informative, but ultimately geographic distribution also matters. A fully free and available respiratory therapist in Idaho would not be able to manage a ventilator in New York. The ability to ship and transport equipment efficiently is unclear. Therefore flattening the curve in geographic hotspots for COVID-19 will greatly help flatten the curve on a national and international level, allowing us to better control the pandemic without exceeding surge capacity of local hospitals.

For the general public, the question remains, “What does this mean for my family and me?”

Dr. Ford Vox, a physician at Shepherd Center, says, “U.S. doctors are not legally equipped to make the kind of rationing decisions that are reportedly underway in Italy. Triaging is very tough for us. This is a consumer-first medical culture and the patient in front of you right now is the most important patient in the world. ...When two people need the same resource to survive, in American medicine, the default position is first-come, first-served.”

As long as everyone does their individual responsibility to flatten the curve successfully, this pandemic’s severity can be mitigated.

Vinayak Kumar, MD, MBA is an Internal Medicine Resident at Mayo Clinic and is a contributor to the ABC NEWS Medical Unit. -