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Members of the U.S. Army Corps of Engineers are scheduled to arrive in Rhode Island on Monday to scout buildings that could be converted into medical facilities as the state braces for a potentially severe shortage of hospital beds to care for patients infected by the novel coronavirus.
The number of infected patients who would need beds in hospital intensive care units (ICUs) throughout Rhode Island and in Attleboro, MA, could range from about 9,000 people to nearly three times that number -- in an area with roughly 2,250 beds, according to several scenarios analyzed by researchers at Harvard’s Global Health Institute for the nonprofit news organization, ProPublica. (The analysis is based on hospital referrals areas.)
“Are we going to get to a place where our hospitals are overrun?’’ Governor Gina M. Raimondo said during a news conference broadcast from the State House on Sunday. “That is very likely. You’re seeing that all over the country...We’re planning for a major surge.”
As of Monday, 106 people in Rhode Island had tested positive for COVID-19, the illness caused by the coronavirus. So far, there have been no reported deaths. In Massachusetts, the number of cases over the weekend rose to 646, including five patients who have died from the virus.
Rhode Island’s health officials and hospital leaders for weeks have been preparing for a surge in COVID-19 cases, based on models that show projections similar to the Havard team’s model published by ProPublica, said Alysia Mihalakos, the state Health Department’s chief of the Center for Emergency Preparedness and Response.
In all but the best-case scenario, the Harvard team’s model projects that hospitals throughout Rhode Island would need to double or triple their ICU beds to care for the anticipated number of critically ill patients. And that’s assuming the hospitals have already emptied half of all their beds by cancelling non-urgent surgeries and discharging patients who could be cared for at home.
“It's very daunting when you look at the numbers,’’ Mihalakos said. “The bottom line is that there is no easy answer for how we manage that level of patients…”
Potential sites to accommodate additional hospital beds include the Rhode Island Convention Center, the Dunkin’ Donuts center, hotels, college dormitories and former hospitals.
Memorial Hospital in Pawtucket also is “on the table,’’ Mihalakos said, though lack of maintenance and modifications made to the interior of the shuttered hospital would “present some challenges.” Care New England closed the 294-bed hospital in 2018. A Care New England spokeswoman said in an email that Memorial “does not have equipment or staff, with staff being a key need in a healthcare facility, so would not be considered at this particular time.’’
In Westerly, R.I., two children and a doctor at Westerly Hospital have tested positive for COVID-19. The two children have since recovered, but Dr. Oliver Mayorga, chief medical officer of the 125-bed hospital, said he suspects that the number of COVID-19 cases is actually much higher. “Beds are going to be defined differently as this pandemic expands,’’ he said. “It’s no longer how many licensed beds do you have? It's if you absolutely need to, you’re gonna have to open up a tent, put cots in there and do triage for folks into different areas.” Mayorga later said in an email that “tents are purely hypothetical at this point.”
Finding space for more hospital beds is one thing; supplying those spaces with the necessary equipment and staff to care for critically ill patients is another. One item in short supply is ventilators, life-saving machines that help people breathe. The coronavirus can cause severe respiratory problems in some patients, requiring that they be placed on a ventilator.
Rhode Island currently has about 350 ventilators -- including 200 in the state’s stockpile stored in warehouses. That’s five times the average number of patients on ventilators on any given day in Rhode Island, Mihalakos said. But it may not be nearly enough if 40% of adults become infected over 12 months -- the researchers’ moderate scenario -- filling nearly 600 ICU beds.
In addition to putting out a call for more ventilators, state health officials are looking at how to modify some of their ventilators in operating rooms and other parts of the hospital system so they can be used in ICUs, Mihalakos said. Another option is building simpler ventilators that could be operated by someone other than a doctor or critical care nurse in case of staffing shortages.
“It's not the ventilators typically that are the limiting factor, (though) of course they can be,’’ Mihalakos said.“But the real limiting factor is the people to manage those ventilators.”
The state has a database of healthcare professionals and volunteers who can be enlisted to help during public health emergencies. The state network, Rhode Island Responds, includes a medical reserve corps of more than 3,000 licensed health care workers.
If that’s not enough, Mihalakos said, state health officials may have to enlist the help of untrained volunteers, including patients’ family members. “We're trying to keep people out of the hospitals so that we don't have any sort of cross infection,’’ she said. “But at some point in time, when we need more hands on deck, if there are not enough healthcare workers then we may need to rely on families to provide some of the care.’’
With reporting by Alex Nunes.