Oregon hospitals gear up for expected surge in patients
Health authorities are preparing Oregon's 62 hospitals for an expected surge in patients infected with the novel coronavirus, encouraging a stop to elective surgery, arranging for additional patient beds, and shifting some emergency care to medical clinics and doctors' practices.
The challenge is clear.
Oregon officials have estimated that if they can't slow the spread of COVID-19, the state could have 75,000 infected residents by the middle of May. Based on China's experience, medical experts calculate that about 80% would face mild to moderate conditions that might not need intense medical care.
But that could leave Oregon with 14,000 people with severe to critical symptoms, a number that would overwhelm the state's hospital capacity.
Oregon hospitals have about 6,600 hospital beds and, based on 2018 data, six out of 10 are occupied by patients at any one time. At that time, Oregon hospitals had 1,059 intensive care beds, with about half of those in the Portland area.
The reality of those numbers has state and hospital officials adapting their crisis plans, refined after the 2009 outbreak of H1N1, commonly known as the swine flu, according to Dr. Richard Leman, chief medical officer with the Oregon Health Authority's Health Security Preparedness and Response unit.
Leman said in a Sunday interview with the Oregon Capital Bureau — a news partner of the Tribune — that every Oregonian now has a role in containing the virus.
He said the advice isn't new, but has to be heeded. "We've just got to make this part of the culture," he said.
That includes washing hands, covering coughs and cleaning with alcohol-based sanitizers that can kill the virus. He said sick people simply have to stay home.
"That's what we can all do together," Leman said.
He said health authorities are working to "expand the capacity within hospitals, of what we can do, how many people we can take care of, how we take care of people even if they are very sick."
He said hospitals already are stopping elective surgeries in what he said was a "rather important step." The state isn't directing such a step, however.
He said, by example, that canceling a colonoscopy "frees up some personal protective equipment that we otherwise wouldn't have" and makes those performing such procedures available for other care.
Leman said some hospitals have extra beds but they are limited by regulations in how many they can use at any one time. He said Oregon is expecting a ruling that would allow hospitals to "expand the number of beds — if they have the staff."
While rural hospitals — and half of Oregon's qualify as such — are farther from support and face greater challenges to maintain staffing, the federal government has relaxed rules so they can care for more patients.
"One of the challenges we are going to see is we are an independent hospital, we are a small community-based private hospital," said Erik Thorsen, CEO of Columbia Memorial Hospital in Astoria.
He said that Columbia Memorial is the largest hospital in Clatsop County and serves about 50,000 people, with over half on Medicare or Medicaid. He said there's a large retired community and many patients suffer from heart disease or cancer.
In response to the coronavirus outbreak, he said that he's confident that the hospital is well-equipped.
He said that the hospital monitors how many people are coming into the emergency department as well as its supply of personal protective equipment to keep its staff from being exposed to the virus.
"For most of our supplies, we are in good shape," said Judy Geiger, the hospital's vice president of patient care services.
Leman said state officials "are looking very seriously" at establishing "alternate care sites" to treat those who are too sick to be at home but don't need hospital-level care. This would be for people such as those who have trouble breathing — a symptom of COVID-19 — who can be treated outside a hospital setting for that "extra bit of help" recovering.
Leman said Oregon's doctors, physician's assistants and other medical professionals will be expected to care for more people who normally would be sent to a hospital emergency room for deep cuts or broken bones.
"We're asking them to step up," Leman said. "There are a lot of well-trained people. They can do a lot."
That diversion would help spare hospitals and leave more resources for those infected with COVID-19 who need hospitalization.
"We think that's what we need to do," Leman said.
He noted that most people who are infected with the disease are expected to have mild symptoms.
"Many people do not need to see a health care provider at all," Leman said, and instead can resort to home rest and recovery.
Another challenge is getting hospitals and other medical providers the supplies they need. He said hospitals are reporting they have what they need — for the moment.
Gov. Kate Brown last week asked for immediate supplies from federal caches, but learned Friday the state was getting only a portion of what it requested. Federal officials are doling out supplies based on a state's percentage of the national population, according to an email issued Friday by a federal official with the U.S. Health and Human Services Department.
Brown, for instance, asked for 400,000 N95 respirators, which are designed to protect the wearer from airborne particles and liquid. The federal agency said it would provide 36,855. The governor requested 600,000 face and surgical masks. Oregon will get 87,795.
In one shipment on Saturday night and another Sunday morning, the state received a portion of its request, including 36,3000 N95 respirators, 87,500 masks, 12,762 gowns, 26,245 gloves and 16,700 disposable face shields.
"We are not getting the equipment we need," Brown told reporters Friday, saying her administration has reached out to federal officials daily to learn what supplies would be coming.
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