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COVID-19 expected to stress Oregon hospital system; some worry it will be overwhelmed.

PMG FILE PHOTO - Oregon hospitals have the lowest number of beds per capita in the country, and some are calling on state to take action to prepare for a flood of COVID-19 patients.As Oregonians prepare for a surge of hospitalizations from the COVID-19 pandemic, one data point does not bode well: the state's hospital beds per capita ranks as the lowest number in the country.

Oregon has 1.6 beds per 1,000 population, according to the Kaiser Family Foundation. Ahead of it: 49 other states. South Dakota leads with 4.8 beds per thousand: triple the rate of Oregon.

The figure was shared with Oregon reporters by Jacob Fenton, a local investigative data journalist.

In all, the state had 6,601 staffed hospital beds in 2018, the most recent year tracked, according to Apprise Health Insights. But the state is bracing for as many as 75,000 coronavirus cases by mid-May, under a worst-case scenario, officials say. About a sixth of those will require hospitalization, judging by reports from China and Italy.

That flood of patients will compete with all the other ill patients who already are filling most of Oregon's beds. And the implication is obvious: existing capacity risks being overwhelmed.

Sharon Meieran, an emergency room doctor who has been vocal about the need for Oregon to prepare, said Thursday that the state's tight resources call for urgency.

"If our systems are overwhelmed, then more people will die," said Meieran, who sits on the Multnomah County board of commissioners.

Reason for low number unclear

The reasons for Oregon's low hospital bed rate are many. Western states tend to be lower, which some attribute to climate and lifestyle. Some reform advocates take pride in a related figure — Oregon's relatively low health care expenditures — and point to Oregon's "certificate of need" system that limits the number of acute care beds to deter health care waste.

Others attribute Oregon's low expenditures to provider culture, leading to a low Medicare reimbursement rate for the state.

Whatever the reason for Oregon's low bed rate, the lean health care infrastructure that some Oregon reform advocates have touted in the past now could be a hindrance in the time of coronavirus.

Andy Van Pelt, executive vice-president of the Oregon Association of Hospitals and Health Systems, said Oregon's low number of beds reflects years of efforts to use hospital beds less.

But now, "we're in a moment where inpatient capacity is going to be stretched. And this will be a case study down the line in emergency preparedness and community resource for situations like this."COURTESY PHOTO - Andy Van Pelt, executive vice president of the Oregon Association of Hospitals and Health Systems, says hospitals will be 'stretched' by the coronavirus pandemic.

However, Van Pelt said the Trump declaration of emergency on Friday will do a lot to help. It will waive regulations and let hospitals adapt and "flex our space" to increase beds temporarily, he said — even expanding into other buildings. The declaration also will lift emergency room strictures requiring all entering patients be stabilized there, allowing hospitals to treat offsite, and better triage and prioritize care, Van Pelt said.

Nursing home safety valve not there

One of the aspects of the Trump declaration — easing the way for hospitals to move the least sick, or non-acute patients to other facilities, may also be more difficult to capitalize on for Oregon.

The number of long-term care beds at nursing homes in this state has historically been one of the lowest in the country.

Maxine Dexter, a lung and critical care doctor running for a seat in the Oregon House, is one of the physicians who have been urging the state to respond more aggressively the COVID-19 situation. She argues that the scant resources call for greater government role, such as stronger government control of hospital and health care resources. She contends that the United States is following in the footsteps of Italy, where much of the country has been placed on lockdown. A March 13 study of Italian hospitals' experience with the coronavirus outbreak, published in the Journal of the American Medical Association, found that the system there has been overwhelmed.

"In practice, the health care system cannot sustain an uncontrolled outbreak, and stronger containment measures are now the only realistic option to avoid the total collapse" of the hospital intensive care system," the authors wrote.

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