When will the U.S. healthcare system be overwhelmed?

As the coronavirus spreads across the globe, the hot new lingo these days is “social distancing”: the practice of keeping a physical distance between yourself and others to minimize the risks of contracting COVID-19.

Social distancing will slow down the spread of the highly contagious virus, which will then help the U.S. medical system avoid being overwhelmed. In other words, it would help “flatten the curve,” another newly discovered phrase that has entered our daily vocabulary. That way, the people who are sick and in need of ventilators, intensive care unit treatment, and hospital beds can get the help they need when they need it while others who could have potentially caught coronavirus in crowds will be safe at home.

But even with social distancing, the U.S. medical system is at great risk of being overwhelmed. The reason why this is so dangerous is simple: If the medical system gets overwhelmed, more people die. It’s happened already in Italy and in China. It certainly could happen in America, as well. 

Hospitals don’t have enough beds 

Here’s one way to know if the medical system has been overwhelmed. The Harvard Global Health Institute (HGHI) posits this: If 40% of adults are infected during the next 12 months, 40% of the hospital markets in the U.S. would not have enough room for all the coronavirus patients, even if every bed they had was dedicated to COVID-19 sufferers. Forty percent of American adults is about 99 million people. According to the model built by Harvard epidemiology professor Marc Lipsitch, an estimated 20% of people with coronavirus would need to be hospitalized, and that means nearly 20 million beds would be required.

According to a 2018 survey by the American Hospital Association, there are about 924,000 medically staffed beds in the U.S.

A CDC report from March 18 paints a slightly rosier picture. Analyzing 4,226 patients from 49 states, Washington D.C., and three U.S. territories between Feb. 12-March 16, a total of 508 (or 12%) of the patients were known to be hospitalized with the virus. That means the U.S. would need 11.9 million beds in this model.

In the most extreme example in HGHI’s model, if 60% of adults were infected within the next six months, hospitals nationwide would need seven times more hospital beds than it can currently provide. Even in a best-case scenario, which HGHI said would be 20% of adults infected within the next 18 months, hospital beds in the U.S. would be 95% full.

There are even more worrisome stats. According to a federal government report, the country could need as many as 3 million ICU beds for coronavirus patients. A recent analysis by Johns Hopkins said there were less than 100,000 ICU beds in the U.S. In a separate study by Johns Hopkins Center for Health Security, a moderate pandemic in the U.S. means 1 million people would need to be hospitalized with 200,000 of those needing ICU help. A pandemic that’s considered severe would raise those numbers to 9.6 million needing hospitalization and 2.9 million in the ICU.

“Even spread out over several months,” Johns Hopkins wrote, “the mismatch between demand and resources is clear.”

In that newest CDC report, 121 of the 4,226 patients studied had to be admitted to the ICU. That’s 2.8%, and based on the model that 99 million U.S. residents would be infected, that’s a total of nearly 2.8 million people who would need intensive care. That’s a little better than 3 million, but not much—especially considering there were 74,000 ICU beds in 2018 (though it’s possible other beds not necessarily earmarked for the ICU could be used).

In a New York Times story on March 25, it was reported that all of the 1,800 ICU beds in New York City were expected to be full by March 27. By March 30, reports were filtering out that hospitals in America’s biggest city were being overwhelmed. Detroit was also experiencing the same trend.

The U.S. has about 2.8 hospital beds per 1,000 inhabitants, fairly similar to the numbers in China (4.3) and Italy (3.2). Both of those countries have been overwhelmed. Meanwhile, South Korea has had much more success containing the pandemic, and that country has about 12 beds per 1,000 people. There are plenty of other factors why Korea has kept its coronavirus numbers low, but plentiful hospital beds can be considered one reason why.

But the number of beds in the U.S. isn’t static. It is possible to create more room. Older hospitals have reopened, and new temporary hospitals are being rapidly built.

The New York Times reported that some hospital executives believe they could increase their bed capacity between 20-70% if needed. Hospitals, after all, have been canceling elective surgeries and sending home patients that aren’t necessarily critical. But Dr. Ashish Jha, the director of the HGHI, said, “Vast communities in America are not prepared to take care of the COVID-19 patients showing up.”

It’s not just beds, though.

Sources: Harvard Global Health Institute, Harvard School of Public Health, New York Times, Washington Post, ProPublica, CNBC, CDC, American Hospital Association, Wall Street Journal

Face masks and ventilators for coronavirus are in short supply

Already, doctors and nurses are worried about this possibility. As the New York Times notes, the medical providers are pleading for more face masks and saying they’re being asked to fight a battle without the proper equipment. Though U.S. Surgeon General Jerome Adams has asked the public to stop buying masks for themselves, the country’s supply is still running low—to the point where individuals are sewing masks for others.

Homemade face masks might not be the answer, though. An N95 face mask is thicker than a normal mask and it creates a tight seal to your face—that helps keep 95% of the airborne particles away from you. A mask sewn out of cotton by a well-meaning amateur simply wouldn’t have those capabilities. It’s probably better than nothing, but it won’t necessarily keep you safe against COVID-19.

According to the Department of Health and Human Service, the federal government’s stockpile of medical equipment included 12 million N95 masks and 30 million surgical masks. But in a pandemic, it’s estimated that 3.5 billion masks would be needed over the next year. That means the stockpile had about 1% of the numbers of masks it might need. The HHS said in early March that it had ordered 500 million N95 masks to be produced in the next 18 months.

Ventilators, which help patients breathe, also are in short supply.

“The number of ventilators we need is so astronomical. It’s not like they have them sitting in the warehouse … there is no stockpile available,” New York Gov. Andrew Cuomo said on March 26, via Reuters.

A 2005 federal government report that was created in the event of a pandemic claimed that the country’s medical system would need mechanical ventilators for 740,000 patients. A recent estimate by the American Hospital Association said the U.S. could need up to 960,000 ventilators for COVID-19. The current estimate for the number of ventilators that are actually available in the U.S.? More like 160,000 with the possibility of another 9,000 more (though other studies believe there are less than 100,000 total).

It won’t be easy to mass-produce ventilators. One ventilator company told Wired it normally sells 50 ventilators per month. Now, it can’t keep up with the thousands that have been ordered.

“Making ventilators is not a trivial process,” Eric Gjrede, the chief executive of Airon Corporation, said.

Other companies can produce hundreds of ventilators per month. But they’ll have to really ramp up production. As Technology Review notes, “Medical device manufacturing is highly regulated, depends on proprietary global supply chains, and requires significant expertise to ramp up and run. It’s absolutely critical, of course, that the machines function safely. So the suggestion of some politicians that UK car makers or other major manufacturers could swing into action and save the day is almost certainly over-optimistic.”

Experts say that patients in large metropolitan areas can perhaps be moved to more rural areas, and it’s possible that hospital equipment can be shared more often than normal or repurposed for other needs, but that likely wouldn’t affect the system on a large scale.

Sources: New York Times, Johns Hopkins, Forbes, CNET, U.S. Department of Health and Human Services, Vox, Wired, Technology Review, Reuters

Italy, China were overwhelmed

The world grew scarier on March 12 when news reports revealed that Italy’s healthcare system was buckling under the weight of coronavirus. The New York Times reported then that less than three weeks into the coronavirus epidemic, the system was creaking and groaning as doctors were forced to choose which patients would receive care and which would receive a death sentence instead.

The current mortality rate in Italy is about 11%, compared to the global rate of about 4.5%. Though it’s been theorized that Italy’s aging population has been one reason for the high mortality rate, PBS reported that 1/3 of the ICU patients in the region of Lombardy were between the ages of 50-64, “meaning the virus isn’t just striking the very old, but also Italians still in their working prime.”

In March, the country received an influx of 11 tons of ventilators, protective masks, and other much-needed medical supplies, but Italy is still teetering.

In Wuhan, China, doctors had to make tough decisions in March when 1,000 people needed ventilators but only 600 were accessible. Meanwhile, a number of Chinese doctors, working non-stop and in contact with so many coronavirus patients, have contracted COVID-19 and died.

By early March, more than 3,300 of the 78,800 cases in mainland China—abut 4.2%—were healthcare workers, and at least eight workers, including a 29-year-old and a 34-year-old, had died.

In Italy, at least 2,600 healthcare workers had contracted the virus, about 8.3% of all cases, as of March 19. By March 27, at least 51 Italian doctors had died. In France, meanwhile, the president of the French Hospital Federation stated that Paris hospitals were nearing their saturation point, and in Spain, the country’s 4,400 ICU beds are filled with even more patients needing intensive care help.

China managed to build two hospitals with a combined 2,300 beds in 10 days for coronavirus patients, and that country has slowed the virus’ spread. But the chances of the U.S. medical system bulging at the seams the same way as Italy are high—and it already appears to be happening in New York.

“The capacity in northern Italy hospitals is a preview of a movie that is about to play in the United States,” Marty Makary, a surgeon and health policy expert, told USA Today on March 18.

Sources: New York Times, Washington Post, Business Insider, USA Today, CNBC, Johns Hopkins, PBS, Daily Beast, Daily Mail, Al Jazeera, Bloomberg