This article was first published on Pittsburgh Business Times
The surge of Covid-19 patients in southwestern Pennsylvania, driven by record-high caseloads, is eating up available intensive care beds, with less than 10% in Allegheny County remaining as of now and a comparable number in the surrounding counties. Independent estimates say Allegheny County could run out of ICU beds by Thanksgiving or early December, although the region’s health care leaders say that may not happen.
That’s setting up a potential health crisis that had been feared and planned for in the first wave of the novel coronavirus but, fortunately, hadn’t happened then or in the second increase in cases over the summer. But now there’s a looming strain on Pennsylvania’s health care capacity. State officials fear all ICU beds will be filled statewide by December; independent experts say that limit could be reached in Allegheny much sooner.
Allegheny County is among 14 counties in Pennsylvania at over 90% ICU capacity, according to state data. Five of those, including Warren, are at 100% capacity for adult ICU beds. Allegheny County’s 92.4% is its highest rate ever during the pandemic. In fact, the six highest reported adult ICE bed occupancy rates for Allegheny County have occurred in the last six days.
“The next two to three weeks will be, in my professional opinion, where we could reach (ICU) capacity quickly and sustain it,” said Scott Newton, an emergency medical services expert and executive director of clinical operations at Pittsburgh-based TeleTracking. “That’s a concerning piece, that it will be sustained.” It's also backed by a projection from a Carnegie Mellon University professor, who warned of dwindling ICU beds on Tuesday.
UPMC and Allegheny Health Network executives say they remain able to provide care for anyone who has a medical need at their hospitals despite the increase in hospitalizations and ICU beds. They say their internal projections do not have the region going beyond ICU and ventilator capacity even with the increasing number of cases.
"While there may be more demand for ICU beds and ventilators, it does not look like it will outstrip the supply here in western Pennsylvania and in our system," said Dr. Don Yealy, senior medical director and chair of the Department of Emergency Medicine at UPMC and the University of Pittsburgh.
Yealy said that the numbers would have to not only increase, but to get to a level of magnitude higher before there was a concern. He said that UPMC and other health systems have a number of actions they can take to increase capacity.
UPMC has 193 inpatients with Covid-19 across southwestern Pennsylvania but also said it’s able to meet the demands.
"UPMC is able to provide care to any patient with a medical need. We have robust plans in place to scale up our capacity and manage the health care needs of our communities, including transferring patients and sharing resources across our 40-hospital academic medical center,” UPMC told the Business Times.
Dr. Donald Whiting, AHN’s chief medical officer and president of the Allegheny Clinic, said that AHN and Highmark Health projections as well as the current belief of the region’s chief medical officers is that there will be enough capacity to meet the Covid and health care needs. But, Whiting said, it depended on people following physical distancing, masking and hygiene rules as well as avoiding traditional Thanksgiving gatherings and limiting interactions.
Thanksgiving – and the SARS-CoV-2 virus’ ability to spread through the population during the holiday gatherings – remains the big unknown. The region’s chief medical officers and Allegheny Health Department Director Dr. Debra Bogen, as well as Pennsylvania Health Secretary Dr. Rachel Levine, have appealed to Pennsylvania residents to stay with their immediate family.
Whiting said that if people are able to follow those guidelines, then hospitals will be able to meet the needs. The hospital systems have been planning for this for a long time, he said, and were ready to implement surge plans for hospital beds, facilities and staffing back then. They can do that as needs arise.
“We’re prepared. There’s capacity in the region. We are really thinking of every scenario and in our own enterprise, with Highmark and AHN, we’re bringing all resources to bear, and in the region, with all the other providers,” Whiting said.
In response to a question Wednesday afternoon by the Pittsburgh Business Times, Bogen said that the county has lots of hospitals and they have good plans to expand services and capacity as needed.
"I never want to find out if we have enough ICU beds. I want to never have to tell you that we are short on medical staff to staff our hospitals," Bogen said. "And if we don't act now and we don't take this seriously, we can be there in a couple of weeks or months."
TeleTracking’s Newton said the overall trends are that about 25% of Covid-19 patients admitted to the hospital require some level of ICU care and about 90% of the people who are in the ICU are over age 50.
“There’s increasing demand and we’ve got increased length of stay with that demand, so that puts us in the position to occupy all of our ICU beds and occupy for a longer time,” Newton said.
Allegheny County is one of the oldest counties by median age in the country, which Newton said puts the region’s residents at greater risk for hospitalization and ICU admission.
Carnegie Mellon University Professor David Andersen on Tuesday warned on Twitter about the declining number of ICU beds and how they could run out in Allegheny County between Thanksgiving and the end of November. He said the latest data shows that Covid hospitalizations have increased in the county but that number of total beds rose slightly overnight. He said that it could be that hospitals are redesignating medical/surgical beds to ICU beds.
“The data for today looks like today ICU occupancy in the county remained flat since yesterday,” Andersen told the Business Times.
But knowing that the total number of cases are only part of the picture and the hospitalizations lag by two weeks or so and the ICU admissions sometimes two days after that, indicate that the increases aren’t over yet. Before Oct. 21, Allegheny County had only been below 100 available adult ICU beds once during the pandemic, on July 28 at 97. Now, it has been below 100 for eight straight days. There were 90 available Allegheny County adult ICU beds on Nov. 12. The drop from 89 on Sunday to 67 on Monday to 59 on Tuesday demonstrates the precipitous decline in available ICU beds for adults.
The region’s hospitals and health care systems have been planning for a long time, well before the first case was confirmed March 14 locally, for the potential for a crushing surge. Initial estimates, voiced by county officials, were that if a New York City-style devastation would occur, that tens of thousands of critically ill patients would seek care. While that didn’t happen in the Pittsburgh region in the spring nor in the summer surge, local officials and medical leaders kept at the ready the plans to drastically increase capacity in anticipation of a fall/winter surge that would dwarf the previous limits.
Medical leaders have been talking through those plans and getting ready ever since, as cases rose, first outside Pennsylvania and then in the commonwealth and in parts of western Pennsylvania. Last week, there had been strains to hospitals outside of the immediate Pittsburgh region — including Altoona, Somerset and Bedford – but that UPMC, the medical provider there, had been shifting resources around to meet the needs.
That’s still happening but other areas are also becoming hotspots, and Dr. Rachel Levine, secretary of the Pennsylvania Department of Health, directed hospital leaders statewide to be ready for mutual aid and shifting of patients and resources as ICU beds and other capabilities become filled up.
In southwestern Pennsylvania, the region’s hospital systems early in the crisis began to hold weekly conference calls to share information and best practices. Several hospital leaders and Bogen have credited these meetings — along with the regular conversations by chief nursing officers and other executives — with helping Allegheny County with coordination and understanding of the evolving pandemic. That was in evidence just last Thursday, when top medical leaders from AHN, UPMC, St. Clair Hospital and Heritage Valley Health System appeared with Bogen at a news conference to discuss the looming crisis.
Excela Health, based in Westmoreland County that saw a spike in Covid cases several weeks ago, has the second-highest number of available ICU beds (27) and airborne isolation beds (43) in the five-county region, according to the state’s dashboard.
“Excela communicates regularly and collaborates closely with our regional colleagues. We keep one another apprised of our individual capacities and we work together to ensure that all patients receive appropriate care. The available resources to meet the need are fluid based on demand on any given day,” Excela Health Chief Medical Officer Dr. Carol Fox told the Business Times in an email Wednesday.