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As a subscriber you can listen to articles at work, in the car, or while you work out. Subscribe NowThe full force of Indiana’s outbreak of COVID-19 is still weeks away, and is not likely to peak until in mid- or late April, Indiana’s top health official said Friday, pointing out that hospitals in the state are doing everything possible to gear up for the worst of the outbreak.
“I still think we are in a little bit of the calm before the storm,” said Dr. Kris Box, the state’s health commissioner.
But state officials again refused to say how many ventilators or intensive-care unit beds hospitals have, citing confidentiality agreements with hospitals and vendors. Box said hospitals will expand ICU areas or find ventilators on their own or with state assistance.
Gov. Eric Holcomb agreed that the number of infected Hoosiers will continue to increase for at least several more weeks, with numbers growing substantially larger each day, due to more people getting sick and more getting tested.
“We don’t see the peak yet,” he said.
Like Box, he declined to provide any numbers of ventilators or ICU beds, even on a regional or statewide basis. That’s even as some neighboring states, including Ohio, are updating the public daily on those figures. Many states are expecting a ventilator shortage as the number of cases grows, but Indiana officials have not commented on that.
Holcomb only said that Indiana hospital have enough ventilators and ICU beds to deal with the patient volumes they have right now. He said he would keep the public informed about specific steps the state might take when Indiana gets closer to the peak of COVID-19 cases.
Meanwhile, hospital systems in central Indiana told IBJ they currently have enough ventilators, ICU beds and other supplies, such as gowns, masks and respirators. Yet they are bracing for what they predict will be a crunch in the weeks ahead.
“When we count the numbers that we’re going to need, it’s going to be tough,” said Dr. Chris Weaver, an emergency physician and senior vice president of Indiana University Health. He said IU Health doesn’t expect the outbreak to be winding down and “behind us safely” for at least 90 days from the first case, which was reported March 6.
Some hospital systems, including Franciscan Health and Community Health, have called for donations of equipment to help keep doctors and nurses safe.
“Some of these items that are critical to our ability to provide care are in short supply across the country, including ventilators, masks, gowns, gloves and other personal protective equipment,” Community Health said in a statement.
Franciscan Health initially said on Thursday it was experiencing “a severe shortage” of personal protective equipment, but later said that supplies were adequate and that it was accepting donations “as backups” if its supplies run out.
Some hospitals say that Holcomb’s stay-at-home order is likely to slow the virus from spreading, helping to keep them from being overwhelmed with infected patients. The order runs through April 7, but Holcomb said he is keeping flexible on that date, depending on how the patient load grows over time.
Hancock Health, for one, told IBJ that it is counting on the stay-at-home order continuing through April 7, if not longer.
“Should this order end prematurely, the influx of patients will cripple hospitals’ infrastructure and rapidly exhaust their supplies, and Hancock Health will not be spared,” the health system said in an email. “We are doing everything we can to prepare and plan.”
Hospitals are also taking steps to reconfigure patient areas. IU Health’s Methodist Hospital, the state’s largest hospital, said it has converted part of its emergency room into a “negative pressure room,” where contaminated air can not escape into surrounding areas.
The hospital has built eight rooms with negative pressure for patients with flu-like symptoms who might test positive for COVID-19. It has also built a separate entrance on its emergency room for patients with those symptoms, and erected barricade walls to separate public hallways.
The goal is to segregate patients who might have COVID-19 from a patient who might be going to the emergency room with a sprained ankle, said Dr. Steven Roumpf, medical director of emergency medicine at Methodist Hospital.
Johnson Memorial Health in Franklin was just about to open a new emergency department and outpatient services building in late April, but has been able to move up the date by several weeks, and now plans to use it as an isolation area for COVID-19 patients, outfitted with 22 beds, spokesman Jeff Dutton said.
“This will allow us to keep our existing [emergency department] open and keep COVID patients away from the main hospital and in a safe isolation area in the new building,” he said.
Most if not all Indiana hospitals have postponed non-urgent, elective surgery to free up beds and staff.
Ascension St. Vincent said it is arranging expedited shipments of supplies directly from manufacturers, and taking advantage of its national presence to find and buy supplies. The Indiana system is part of St. Louis-based Ascension, the nation’s largest chain of Catholic hospitals.
Meanwhile, the Indiana Department of Corrections is making masks, face shields and gowns to help supply local hospitals. On Friday, the department was in full production of gowns, about 200 a day. On Monday, it expects to reach full production for masks, also about 200 a day.
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The confidentiality agreements are with individual hospitals and/or vendors. Such agreements do not prohibit the state from providing the aggregate totals that exist statewide. One therefore can only assume that the real numbers are so low they would prompt an outcry if disclosed, and in turn reflect badly on the hospitals and Indiana policymakers.
We just found out the previously used model of predicting were very wrong. These are though useful for make ready for some larger events. These incorrect numbers were probably based on no social distancing, etc. So with these measures in place we could see less symptomatic infections coming and less need for hospitalization.
I tend to write down little factoids in the margins of pages of notes I take – not just about SARS-CoV-2/COVID-19, but in general.
I’ve got the number 64,941 written down as the number of dedicated ICU beds in the US prior to when all of this started. There are obviously going to be more beds now that many hospitals have committed portions of, if not entire, floors to attempt to be better prepared.
Prior to the construction of new hospitals on the fly, the number of beds in the US was 29/10,000 people.(Italy has/had 34/10,000).
Recent OR (Operations Research) numbers for hospital usage by SARS-CoV-2/COVID-19 are 5% will need to be hospitalized, 2% will need ICU access, and 1% will require a ventilator.
Even if that number of ICU beds are tripled (194,823) and in use concurrently, you can extrapolate there would be 9,741,150 people sick at the same time.
The above is exactly why the “state officials again refused to say how many ventilators or intensive-care unit beds hospitals have” Every news organization would be coming up with their own dramatic numbers as to how things were going to get dramatically worse and continue to stir the panic. (I mean why not create another run on toilet paper!) As Doug stated above, prediction models were in need of change. And, all models will need to be changed once the information is disseminated from the Canadian anesthesiologist who developed a method where one ventilator could be used for nine patients. Also, with the change in one vent, anesthesia machines can be converted into a ventilator, are any of these possibilities in anybody’s numbers? My guess would be no.
Just as important as the number of ICU beds and ventilators is the availability of the newer treatments in clinical trials for the SARS-CoV-2 virus causing COVID-19 for the more severe cases. What is plan to get these to the ICU’s for treatment. Are the different health care systems prepared for the clinical trials or compassionate use basis as a means of acquiring these treatments?. Specifically, is paperwork in place and IRB’s are primed to conduct clinical trials for experimental treatments such as remdesivir (Gliead) and Actemra/RoActemra (anti-IL 6) (Roche)?