Hospital Capacity Reports

Can anyone who works in hospitals give us some info on which location you work in and how close to capacity your hospital is?

Any news reports that describe hospital capacities would be welcome here too.

Let's use this thread to discuss the issues with over capacity considering that is supposed to be the most harmful concern regarding this virus.

"Overall, 18 million people live in counties that have hospitals but no ICU, about a quarter of them 60 or older, the analysis shows. Nearly 11 million more Americans reside in counties with no hospital, some 2.7 million of them seniors."
Millions Of Older Americans Live In Counties With No ICU Beds As Pandemic Intensifies | Kaiser Health News

Unlike Italy, most (not all) geriatric care facilities are at least as well suited to provide respiratory care for their residents as are many hospitals. Our society is built differently than Italy's and China's. In the US, senior citizens do not normally live in the same homes with their kids, whereas in many European communities it is normal to have 3 and sometimes 4 generations in the same home.

Most hospitals in the US have been living in luxury with most of the rooms being single bed rooms. The vast majority of the country is going to likely be OK when it comes to available bed space. The problem is going to be found in cities with large population centers. 1-The virus has spread faster due to obvious circumstance and 2-they may well face a hospital bed crunch...depending on how wicked this thing gets. But a lot of people that get this ,especially those in good shape, manage to ride it out for the most part at home.

"To my fellow NYC nurses

Please stay safe. Thank you for everything you're doing. Try wearing a surgical mask over your N95 if you can. Idk how well it'll block pathogens from getting into the N95 but it's worth a try, right?
These are incredibly scary times we're living in right now and it's only going to get worse from this point forward. Wash your hands at all costs."
To my fellow NYC nurses : nursing

"Our perspective from a small community hospital
A coworker wrote this on fb. She did a great job sharing what we are going through in these uncertain times. A view into a community hospital and us nurses.

A day in the life...

I have to badge to enter the building because the door is locked. The typically busy hallways are unusually quiet and nearly empty. Coworkers are more hesitant to hold a door open or even start casual conversation. All conversation seems to revolve around one topic. Staff that once ran to share an elevator ride, now opt to wait for the next one just to attempt social distancing within a small space. Each unit is locked and visitors are forbidden. You badge in again just to get onto your locked unit. The typical rainbow of colors and various scrub brands are now a sea of the same light blue hospital scrubs they’ve required us to change into. Gowns, gloves, masks and goggles in labeled paper bags are outside every room. The tension is palpable. This is our new reality. This is the new norm. There are more of us nurses now because there are more COVID patients. The previous 1:1 COVID patient to nurse ratio has since increased to a 2:1 in a matter of a few days. A new day means new protocols and less PPE. There are new faces as nurses are being reassigned from other units to accommodate the daily increase in numbers. There is new equipment and a constantly changing environment as we try to keep Up with the changes to help us, help them. The typically overfilled OR, PACU, and cath lab units are scarce, their staff reassigned to newly organized units in preparation for the coming weeks that will surely be worse than this one. The“PPE police” are here again to ensure we are all safe and not unintentionally contaminating ourselves or others in the administration or removal of our PPE. My patient needs me. Wash, gown, wash, gloves, mask, goggles. Enter.... I know you have trouble hearing and the machines are loud and my mask makes it muffled, but I’m here. How can I help? I care for you and you thank me. I say goodbye. Pull, roll, throw it away. Wash, Exit, wash, gloves on, goggles off and wash and wait to dry, gloves off, wash, gloves on, mask in bag, gloves off, wash, gloves on, googles into bag, wash, is that right? My hand are raw, my skin is literally splitting from the high alcohol content. And the call bell rings. Here we go again... it is getting easier... more routine. We really are doing the very best we can. There is new equipment, new protocols, and new skill sets all in the name of COVID-19. There is construction to accommodate new needs and teams of people working day and night to make it possible. We appreciate each other because we all know we are in it together. We are all choosing to fulfill our duty each and every day. And then the next patient arrives... that too is different. One “contaminated” nurse for the patient and one that stays “clean” all to prevent the spread of infection through transport. Everything has changed and it will continue to change daily.

This is Us. This is the front line. We are here when you need us.

But for the love of human kind... will you please stay home so this stops? Stay home so we can return to work and go to school and have visitors at hospitals again. Can you stay home now so we can stay alive and keep our loved ones alive and have them attend our next holiday celebration? Can you stay home so Disney reopens and planes can fly and travel is allowed and parks are filled again and outing are actually outside and not virtual.? Can you stay home now so we can live the way we are used to living? Please can you just stay home?

With love, maybe a little tough love, Me, RN"
Our perspective from a small community hospital : nursing

"An Ochsner nurse says she has spent years working in the ICU, but nothing prepared her for the waves of coronavirus patients she’s been seeing. In less than a week, her unit went from having a handful to having only coronavirus patients.

“The first night I worked where the entire unit was COVID patients, I got into my car and started bawling,” she said. “When I tell you it's like a war zone up there, that's kind of putting it easy.”

There are so many patients and so few nurses that the recommended ratio of one nurse for every patient on a paralytic drug has already fallen by the wayside, she said. The hospital network is putting scores more nurses without ICU experience on a crash course to learn how to treat coronavirus"

Here are the stories of 9 Louisiana health care workers on the front lines of coronavirus | Coronavirus | nola.com

"Elmhurst Hospital, which is part of the city's municipal hospital system, is already running at more than 125-percent capacity compared to its typical 80-percent capacity rate, according to a source who was briefed by a top Health + Hospitals official on the situation.

Twelve coronavirus patients died overnight Monday at Elmhurst Hospital, according to the source, who asked to remain anonymous to speak candidly about a private conversation."
Coronavirus Cases Already Overwhelming Elmhurst Hospital: Source | New York City, NY Patch

Pozessed said:

"Elmhurst Hospital, which is part of the city's municipal hospital system, is already running at more than 125-percent capacity compared to its typical 80-percent capacity rate, according to a source who was briefed by a top Health + Hospitals official on the situation.

Twelve coronavirus patients died overnight Monday at Elmhurst Hospital, according to the source, who asked to remain anonymous to speak candidly about a private conversation."
Coronavirus Cases Already Overwhelming Elmhurst Hospital: Source | New York City, NY Patch

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One thing to contemplate through these stories...if a hospital is already overwhelmed with these cases....if they happen to need emergency services....for their stroke or heart attack or whatever life threatening issue is.....do you think your care will be impacted? Also...do you think it will impact you as a "clean patient" that the staff does not have enough personal protective equipment (especially masks - which reusing and using same masks between patients is now common in many facilities)?

year2late said:

One thing to contemplate through these stories...if a hospital is already overwhelmed with these cases....if they happen to need emergency services....for their stroke or heart attack or whatever life threatening issue is.....do you think your care will be impacted? Also...do you think it will impact you as a "clean patient" that the staff does not have enough personal protective equipment (especially masks - which reusing and using same masks between patients is now common in many facilities)?

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For sure it will have an impact. There will be a low mortality rate for covid patients and a higher mortality rate for things that are harder to treat than covid

I think it's important to add that I am seeing more stories of hospitals being underwhelmed as opposed to overwhelmed. But many of these stories are claiming that their hospital is eerily quiet and it seems like the calm before the storm.

Beaumont Hospital near capacity for patients, facing limitations on staff, equipment

Two weeks following Michigan's first confirmed case of coronavirus and one of the state's biggest hospital systems is already nearing its limit.

Almost 450 COVID-19 patients have been admitted across the eight Beaumont hospitals, while 212 more people admitted to the hospitals have test results pending.

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Atlanta mayor says ICU units at capacity

Atlanta Mayor Keisha Lance Bottoms (D) said Tuesday that the city's intensive care units (ICUs) are at capacity and warned that hospitals in the area could soon be maximized amid the coronavirus pandemic.

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Pozessed said:

For sure it will have an impact. There will be a low mortality rate for covid patients and a higher mortality rate for things that are harder to treat than covid

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Here's a useful analysis I posted in another thread, but appropriate here: American Hospital Capacity And Projected Need for COVID-19 Patient Care (Health Affairs Blog). "In the United States, the disease is expected to infect 20-60 percent of the population before the pandemic finishes its course."

The analysis (and charts) are particularly useful because they started with existing capacity and usage, gave a wide range of potential outcomes from mild to widespread, and broke down capacity by regions.

Pozessed said:

I think it's important to add that I am seeing more stories of hospitals being underwhelmed as opposed to overwhelmed. But many of these stories are claiming that their hospital is eerily quiet and it seems like the calm before the storm.

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Hopefully we have taken enough measures to slow the spread to those most likely to overwhelm hospital services.

In response to epidemic it is hard to say if you did too much. It is easy to say when you have done too little.

We just have to wait and see if it is the calm before the storm. Hopefully we are doing enough.

"Out of Spain’s 40,000 confirmed coronavirus cases, 5,400 — nearly 14 percent — are medical professionals, the health ministry said on Tuesday. No other country has reported health care staff accounting for a double-digit percentage of total infections.

But the problem is widespread throughout Europe. In Italy, France and Spain, more than 30 health care professionals have died of the coronavirus, and thousands of others have had to self-isolate.

In Brescia province, the center of Italy’s outbreak, 10 to 15 percent of doctors and nurses have been infected and put out of commission, according to a doctor there."
Coronavirus in Europe: Thousands of Health Workers Out of Action - The New York Times

I saw yesterday, trying to refind it, that mandatory shut down measures have had an immediate impact on the spread of the virus and death tolls. This is demonstrable by looking at the infection charts (curves) for various countries and when mitigation measures were imposed.

Not the same story, but similar data: From New York City to St. Augustine, fever charting shows social distancing may be 'breaking the chain' of coronavirus infections (USA Today).

“"We are collapsing. We need more workers,” said Lidia Perera, a nurse who works with Núñez at Madrid’s Hospital de la Paz, which has 1,000 beds.

This week, 11 of the hospital’s 14 floors are devoted to caring for those suffering from COVID-19, and there is still not enough room: The patients with less serious cases of the disease are being put in the hospital’s gym or in a large tent outside."
'''We are collapsing''': Virus pummels medics in Spain and Italy - ABC News

Pozessed said:

I think it's important to add that I am seeing more stories of hospitals being underwhelmed as opposed to overwhelmed. But many of these stories are claiming that their hospital is eerily quiet and it seems like the calm before the storm.

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That is what my hospital is like. The calm before the storm, people keep saying that. Along with it’s not if but when. Lots of preparation happening with protocols being put in place and units being reorganized. We have door screeners for visitors, the Ed and by the employee garage. The last time I worked we had 6 suspected cases in the new Covid unit. I’m in Northern lower Michigan, it’s getting bad downstate and creeping up towards us.

From the Health Affairs article I posted earlier:

Finally, we observed large variations in availability of both regular and ICU beds across communities (see exhibits 1 and 2). Some rural communities have adequate numbers of regular beds but often large shortfalls of ICU beds, whereas many more-populous communities have inadequate number of total beds but smaller shortfalls of ICU beds. Our findings clearly illustrate the public health imperative to both flatten the curve of transmission and recruit additional capacity of both regular and ICU beds.

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So, there are four parts to the policy process:
1) flatten the curve (social distancing, testing, contact tracing)
2) add bed capacity
3) add personnel capacity
4) add equipment capacity

But, another element that has to be addressed is flexibility - getting resources where they are needed.ICU Bed Capacity Varies Widely Nationwide. See How Your Area Stacks Up (npr).

An NPR analysis of data from the Dartmouth Institute for Health Policy and Clinical Practice looked at how the nation's 100,000 ICU beds are distributed across the more than 300 markets that make up the country's hospital system.

In some areas, like several in Florida, there are more than 60 intensive care beds for every 100,000 residents. In others, like Las Vegas and Nashville, Tenn., there are fewer than 20. ICU beds are especially important now because they are the hospital units typically equipped to treat patients with respiratory problems that require ventilators.
....
A report from the Society of Critical Care Medicine found that more than nine out of 10 intensive care beds nationally are in metropolitan areas with a population of more than 50,000. Only 1 percent of America's ICU beds are in rural areas.

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What the article does not point out, but I have noted elsewhere, is that ICU usage was at 65% nationwide prior to the start of the epidemic. That means that nationally there are only about 35,000 ICU spaces available. Once we exceed that in particular areas, rationing will become reality.
A Hard Look at the Remaining Hospital Capacity across America (National Review.)

Julianna123 said:

That is what my hospital is like. The calm before the storm, people keep saying that. Along with it’s not if but when. Lots of preparation happening with protocols being put in place and units being reorganized. We have door screeners for visitors, the Ed and by the employee garage. The last time I worked we had 6 suspected cases in the new Covid unit. I’m in Northern lower Michigan, it’s getting bad downstate and creeping up towards us.

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Keep yourself safe. We need you.

Pozessed said:

I think it's important to add that I am seeing more stories of hospitals being underwhelmed as opposed to overwhelmed. But many of these stories are claiming that their hospital is eerily quiet and it seems like the calm before the storm.

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I’m curious to know why you think hospitals in areas that are not peaking yet, also having no hospital loading, is important.

isn’t that both normal and not indicative of nothing but where the virus is current hammering?

Reporting of 1800 under 40, many with no health issues, all in ICU. That’s in one city in Italy. That would overload most areas.just with young patients.

Mayor of Atlanta Georgia Tuesday March-24-2020
""The feedback I received in talking with an emergency room doctor, this is just information he's provided to me, that while there are still beds available in our hospitals, that our ICU units across the city are at capacity," Mayor Lance Bottoms told CBS46 News. "This is why we have gone a step further in asking people to please, stay at home.""
Atlanta mayor says ICU units are at "full capacity" | News | cbs46.com

Pozessed said:

I think it's important to add that I am seeing more stories of hospitals being underwhelmed as opposed to overwhelmed. But many of these stories are claiming that their hospital is eerily quiet and it seems like the calm before the storm.

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So what are the actual numbers. I'm not seeing any reports of the numbers of patients compared to number of beds, nor how long they are hospitalized.

United States Resource Availability for COVID-19 (The Society of Critical Care Medicine)

This is another good background resource. In years past I was peripherally part of the State Emergency Management system, so I am familiar with some of the concepts addressed here in dealing with local disaster managment (e.g., earthquake, volcano, mass-casualty events). The AHA survey referenced indicates that approximately 65% of ICU capacity is in use at any particular point in time.

For planning purposes, approximately 5% of the identified COVID-19 cases will require Intensive Care (Care for Critically Ill Patients With COVID-19 (JAMA)). "The median duration between onset of symptoms and ICU admission has been 9 to 10 days, suggesting a gradual deterioration in the majority of cases.4 The most documented reason for requiring intensive care has been respiratory support, of which two-thirds of patients have met criteria for acute respiratory distress syndrome (ARDS).2"

Given those parameters, it can be assumed that 3150 ICU beds will be required within the next 9 days.

This is from a friends Facebook post:

STAY HOME !!!
This is from a nurse in Detroit:

Last night was horrible at work. These people coming to the ER sick AF. I've never seen anything like it. My boss was crying and took us all down to the chapel to pray. Nurses are breaking down now. We leave work crying including myself last night and we all know this is only the beginning. I ask myself how are we going to survive this? The virus takes over your whole body. Your lungs become tight, swelling everywhere, sweating, gasping for air, your heart swollen and working in overdrive. And these people come into the hospital not knowing if they will come back out alive. Some die alone (because of no visitors) We had only 4 ventilators left in the whole hospital last night. Royal Oak is out. It is almost time to start cutting out the most sickest and forcing the docs to make to most hardest decision to just let them die. My pt last night deteriorated over 5 hours. He was a 1 to 1 pt. If I wasn't standing right there with him he would've died. Family was sitting in the car for 5 hours waiting to hear how he was doing. I'm scared I will carry this home. We don’t kiss anymore, I can’t hug my family when I need a hug most. I am scared. God bless you And keep praying for you and us all. And most importantly PLEASE stay home. I Love you all. This is in God’s hands now.

"With more than 3,200 COVID-19 patients in hospitals across New York and around 600 new patients in a 24 hour period between Monday and Tuesday, healthcare workers on the front lines describe increasingly dire conditions inside hospitals, with limited access to protective gear, life-saving measures prioritized for younger, healthier patients, and early signs the virus may be spreading within hospitals themselves.

“It’s like a cesspool...It’s now spreading throughout the hospital,” he said. “I am sure I am going to get infected. My concern is that we are both getting infected and spreading it to other patients.”
Healthcare workers aren’t being tested for the virus proactively", he said, and they were dissuaded against using face masks as a precaution for patients who don’t have COVID-19."
"It's Spreading Throughout The Hospital": NYC Healthcare Workers Describe Dire Conditions As Coronavirus Patients Flood Wards - Gothamist