Victoria hospitals are bracing for an increase in patients should the new coronavirus infect a significant number of local residents.
Hospitals in New Orleans, New York, Washington state and elsewhere already are facing an influx of COVID-19 patients and are grappling with a shortage of beds and equipment. Most of Texas isn’t facing as high rates of infection as those communities, but that could change depending on the effectiveness of local and statewide steps to slow the spread.
Both Citizens Medical Center and DeTar Healthcare System, which operate the three largest hospitals in the region, are looking for ways to care for an increased number of patients. Officials with both hospitals said they could adapt to allow two patients to a room, if necessary, a step made available through an executive order from Gov. Greg Abbott.
“We are closely attentive to the governor’s executive order which permits hospitals to place two patients per room, but remain hopeful that won’t be necessary,” said Dr. Daniel Cano, the chief medical officer for Citizens. “The hospital is always committed to meeting the needs of the region, and I am working on identifying rooms where double occupancy may be possible.”
Judith Barefield, DeTar’s director of marketing, said, “Our hospitals are working to identify areas within our hospitals and affiliated clinic spaces that could be used for additional bed capacity as part of our pandemic response plan, including pre-op and anesthesia care units and surgery centers. All of our rooms are single occupancy and could be converted to double-occupancy, if needed.”
Citizens has 18 dedicated adult beds in the intensive care unit, and DeTar has 30 ICU beds, officials said. All other hospitals in the region have less than 10 ICU beds, if they have any at all.
A model released by the Harvard Global Health Institute forecasted that Victoria hospitals do not have enough intensive care unit beds to care for the most critically ill COVID-19 patients if the infection spreads.
The new data show most hospitals in the U.S. do not have enough beds to treat the many COVID-19 patients who will need care, even under the best of circumstances.
“Almost every community is going to need more beds under very generous assumptions, but many communities will need far more beds,” said Dr. Ashish Jha, director of the Harvard Global Health Institute and the leader of a team of researchers who published the data March 17.
The model looks at nine possible outcomes for regional health care capacity by looking at what would happen if 20%, 40% or 60% of the adult population were infected over six, 12 or 18 months. Epidemiologists using data from China and Italy have estimated between 20% and 70% of the adult population in the U.S. could be infected with the new virus. That does not mean everyone infected will get sick, or even that they will show symptoms. The model also estimates 20% of infected patients will need hospital care.
In the researchers’ moderate scenario, where 40% of the adult population is infected over 12 months, the Victoria region, which includes six local hospital systems, would need 71 intensive care beds. There are 55 available now.
Dr. Paul Bunnell, an internal medicine physician and the hospitalist at Memorial Medical Center in Port Lavaca, said the shortage of ICU beds was his most pressing concern should critically ill patients need care at his hospital. Memorial Medical Center has six beds in its intensive care unit.
The ICU provides constant monitoring for a hospital’s sickest patients and also has a lower ratio of nurses to patients. Typically, a nurse in the ICU would care for no more than two patients, Bunnell said.
“The greatest fear would be Victoria’s ICUs are full because of referrals from those communities that encircle Victoria, including us, our two ventilators are being used by patients and then we have difficulty getting transfers up to Houston,” Bunnell said. “It could be very devastating.”
The researchers’ projections do show a bright spot in the overall number of beds available in the Crossroads — Victoria’s hospitals have an adequate amount of total beds (regular beds and beds in the ICU) should the virus infect about 40% of adults over the year.
The data from Harvard, which was translated into a searchable tool by the news organization ProPublica, has some important caveats. First, the model assumes steady infection rates over either six, 12 or 18 months, but that’s not actually how the virus spreads. Based on data from China and Italy, the U.S. can expect to see a peak of infections in the coming days or weeks. Jha and his colleagues said that flattening that data over time would serve as a rough proxy for how effectively the country is able to “flatten the curve.”
“That’s the key concept, basically buying time for physicians to increase that bed capacity by canceling elective surgeries, decreasing elective admissions, moving to virtual visits, all efforts to increase bed supply,” said Dr. Thomas Tsai, assistant professor in Harvard’s Department of Health Policy and Management. “It takes time to do that.”
The data also assumes patients who require hospitalization will stay for 12 days, based on patients’ experience in Italy and China.
In addition, the model uses what’s known as “hospital referral regions” to create the projections. But hospitals like Memorial Medical Center in Port Lavaca and Lavaca Medical Center in Hallettsville are a part of Houston’s hospital referral region, and thus not included in the projections for the Victoria region.
Most hospitals in the Crossroads already had moved to cancel elective surgeries before Gov. Greg Abbott mandated the move statewide in an executive order.
This decision, leaders with local hospitals said, will allow for more hospital beds to be available should COVID-19 patients begin needing them. The Harvard researchers agreed that canceling non-essential procedures would be one of the most effective ways to free space for potential COVID-19 patients.
“One way to think about flattening the curve is it basically decreases the risk of overwhelming the U.S. healthcare system,” Tsai said in a phone call with reporters. “It’s not just to decrease transmission in the community, but also increasing the likelihood of receiving effective care and minimizing the risk of needing to ration care.”