What small hospitals will face if coronavirus continues to spread and overwhelm the system.
Coronavirus and the illness it causes, COVID-19, are moving across the land. While the medical aspects are concerning, the disruptions the infection may cause to the health-care system will be equally challenging.
During a normal influenza and pneumonia season, hospitals are often overwhelmed. Emergency departments’ inpatient units and intensive care units are often at capacity. It seems inevitable that coronavirus will only add increased strain to facilities already under duress.
Small, rural or suburban hospitals have limited capacities. They depend on the ability to transfer very sick or complicated patients to other “higher levels of care.” Large hospitals, however, are not infinite. They cannot admit everyone. This is a tough balancing act in a normal year. It is of greater concern now.
This is made more complex by the recommendation that people who have significant exposures to coronavirus be quarantined for two weeks. Realistically, large numbers of physicians, nurses and other health-care professionals will be exposed to coronavirus.
Are doctors protected?
It’s nice to think that medical personnel, at least, are protected. News footage of patients in large hospitals being treated for COVID-19 often shows staff in elaborate protective gear. But few facilities have such equipment, and if they do, they don’t have much. In addition, the suits themselves are difficult to wear and work in for long periods of time.
If the virus continues to spread (as experts suspect it will), healthcare workers will likely have simple masks and gloves, scrubs and sometimes protective gowns and be encouraged to wash their hands frequently and well. That’s it. Exposure will be certain, infection very possible.
Sending exposed physicians, nurses, medics and others back home could result in a steady depletion of staff from hospitals until the hard-stop is met and there are simply no health-care professionals who are not either ill or in isolation from exposure.
In addition, will those in quarantine have salaries paid? Perhaps those working in hospitals.
But what of the volunteer firefighters or medics who show up to help and are advised to go into quarantine? Who will pay their bills when they are forced to stay home, but not given any supplemental income?
I fear, at some point, that health-care staff who have the disease will simply continue to work with mild symptoms as they do all too often with other illnesses.
Hospitals were busy before coronavirus
The answers are elusive. For all our concerns about its medical consequences, coronavirus will not reduce the rate of traumatic injuries, different (less newsworthy) infections, heart attack, stroke, high blood pressure, poisonings, suicide attempts, and all the other maladies that normally afflict the species. How can we make hospitals sustainable, if only for a while?
For one thing, we can encourage the public not to come to the hospital simply out of curiosity; that is, not just to find out if those cold symptoms are, or are not, coronavirus. There won’t be enough tests for everyone, and someone who comes in with a cold might leave carrying coronavirus.
We can ask urgent cares and primary-care offices, employee health and school clinics, tele-health services and phone-triage lines to avoid sending people to the hospital just for testing, unless they are genuinely ill and potentially in danger.
We can also ask employers to avoid the tendency to tell employees to “go to the ER and get a work excuse,” a thing that simply exposes individuals to potential infection and unnecessary cost. Ditto for schools and school excuses.
And hospitals should consider triage and treatment outside, under tents or shelters, to avoid concentrating viral particles in enclosed areas, with people who have problems unrelated to COVID-19.
Finally, state and federal legislators will have to address this, for now and for future events. We need a medical supply chain not dependent on China. We need education and funding for rapid development and production of vaccines. A kind of antiviral Apollo project!
All hospitals need to purposefully stockpile protective equipment. We have to stop pretending that small hospitals aren’t an essential part of our health-care system. They must remain open as public health assets in times of crisis as well as providing day-to-day care.
Finally, we need to develop mechanisms to ease the financial burden of those who become ill responding to epidemics and other public health crises. Worry is paralyzing, and it will not help the situation.
America will get through this. We’re at our best in crisis.
But planning? That’s how lives are saved.
Dr. Edwin Leap is an emergency physician who lives in Tamassee, South Carolina, with his wife and children. Follow his blog at edwinleap.com. This column first appeared in the Greenville News.