By Paul J. Gough – Reporter, Pittsburgh Business Times
In one of her first appearances as Allegheny County Health Department director — in a video Sunday night with Allegheny County Executive Rich Fitzgerald — Dr. Debra Bogen painted a bleak picture of what could happen here in the too-near future: Tens of thousands of southwestern Pennsylvania residents infected with COVID-19, requiring intensive care and ventilators in a health care system that won’t be able to handle it.
And, Bogen said, if drastic social changes aren’t made immediately to reduce the spread of COVID-19, then what happened in Wuhan, China, and northern Italy could happen here.
“When we apply these numbers to the 3 million people who live in southwestern Pennsylvania, we estimate that tens of thousands will need intensive care and breathing support to survive and recover,” she said. “Our world-class hospitals can only handle a small portion of this number at any one time. This is a very grave situation. … The best hope we have for averting this catastrophic outcome to take aggressive action to dramatically slow down the spread of the virus in our community.”
Measures to do just that have been implemented in Pittsburgh, in Allegheny County, in Pennsylvania and at the federal level. And officials say while there’s no real hope of containing the virus that has killed thousands of people worldwide and infected countless more, there is hope that the worst-case scenario for the American people can be avoided by these measures.
Bogen predicted between 40 percent and 60 percent of the population will get the virus in the next 18 months, and that for many people it will be either mild or moderate. But for those who are highest risk, it will be life-threatening.
“I don’t think we’re going to be able to say that we’re going to keep everyone from potentially being infected,” said Dr. Brian Parker, Chief Quality Officer of Pittsburgh-based Allegheny Health Network. “We just want to slow down the pace.”
By social isolation and distancing, it could “flatten the curve,” reducing the spread of the virus to the point where the number of cases doesn’t overwhelm the health system. That’s because hospitals are normally pretty busy, and now, still in the midst of influenza season, even more so.
“Our hospitals across the nation operate pretty close to a 90 percent occupancy rate on a regular basis,” said Scott Newton, a 30-year health care provider and Executive Director of Clinical Operations at Pittsburgh-based TeleTracking Technologies Inc., who was involved with pandemic planning in Maryland.
“Patient access, capacity and throughput is a struggle on a daily basis, and when we look at major surge events like COVID-19, we need to think about how do we operate differently.”
It’s a justified concern. There are 3,858 licensed intensive care and critical care unit beds in Pennsylvania, according to data from the Pennsylvania Department of Health. There are thousands of overall licensed beds in the Pittsburgh region. The largest, UPMC Presbyterian Shadyside Hospital, has 1,542 licensed hospital beds. The second largest, Allegheny General Hospital, has 552. But they’re also among the highest-occupancy in the region as well; AGH with a 95.1 percent occupancy rate in 2018 and UPMC Presbyterian with an 81.8 percent rate.
UPMC and AHN, along with municipal and county officials, have been looking at the pandemic problem for years. They’ve been focused on an ever-increasing basis on the new novel coronavirus, which became known as COVID-19, ever since reports started emerging out of Wuhan.
Dr. Don Yealy, emergency department chief of UPMC, said UPMC had 3,000 hospital beds in the Pittsburgh region alone that could be brought to bear in a crisis. He said that could be increased by 30 percent to 40 percent under efforts that have been underway.
“We began preparing in the first week of January, fearing this might actually be necessary,” Yealy said. “That’s the easy expansion. I suspect we have even more capacity on top of that in total beds.”
That could include unused buildings in floors in existing hospital space or, as Pittsburgh Mayor Bill Peduto suggested, unused municipal buildings or even hotels. City officials are already looking at cots, water supplies, heat and electric.
Highmark Health and AHN have geared up for a 60-day period, starting with Allegheny County’s first COVID-19 cases reported March 14, that will include an increasing number of positive tests, quarantined people and critically ill patients that could stress the region’s health care system if measures aren’t taken now.
AHN and Highmark Health implemented its pandemic response policy in early February, enhanced screening procedures to check for COVID-19 symptoms and restricted visitors from its facilities. It has also been testing for COVID-19 patients through health departments and now commercial labs for three weeks and is working with vendors to get more capability.
“AHN continues to explore development of in-house testing, but has moved forward swiftly to provide testing to the community through the most expeditious means possible,” said Highmark Health CEO David Holmberg.
AHN had the first publicly known experiences with confirmed COVID-19 patients, two Pittsburgh residents in their 60s and 70s who were treated at West Penn Hospital in Pittsburgh, and then an adult in his or her 60s who was hospitalized at AHN Jefferson Hospital in Jefferson Hills. It has also set up tents near all of its emergency rooms for triage, just one visible sign among many AHN and other health systems are taking. And AHN also is planning to roll out a mobile care unit that can move from place to place, as needed, much like a MASH unit in the Korean War.
And it wouldn’t be just for patients in Allegheny County or Pittsburgh. Pittsburgh’s strengths in health care already draw people from throughout western Pennsylvania, and an existing Region 13 emergency response system would coordinate the flow of patients in and out of Pittsburgh.
‘We have to avoid what happened in Italy’
Holmberg said in an interview that it’s critical social distancing be followed and that every individual be a partner.
“What we have to avoid is what happened in Italy. In Italy, you have an overwhelming stressing of the health care capabilities,” Holmberg said. “By stretching this out, by reducing the (social) contact and slowing down the transmission of the virus, what we’re able to do is have a more orderly process here and enable us to stay within the capabilities of the U.S. health system. … I think we have some advantages here, particularly in this region, where you have some strong resources like Allegheny Health Network and others, but what’s most important is that people take this seriously.”
Holmberg said the Allegheny County Health Department’s estimate that tens of thousands of patients may require hospital care is based on modeling they’ve done.
“We should take it seriously. If we’re wrong, it turns out to be nothing, then hallelujah,” Holmberg said. “But the early days of this would certainly suggest that the responsible thing to do is to start creating social distancing.”
Highmark has said that it expects cases to plateau around 60 days. This projection is based on the results of aggressive measures in Wuhan. Around the 60-day mark there, the number of cases began to decline.
“We believe we are prepared for 60 days. That’s the mindset we have put in place,” Parker said.
‘Planning for the physical needs’
UPMC has taken many proactive steps as well to prepare for what’s coming, said Dr. Joe Suyama, chief of emergency medicine services at UPMC Magee-Womens Hospital and associate professor of emergency medicine at the University of Pittsburgh.
“We feel of any institution we have a good understanding of what we have and what we could have (in capacity) in a surge,” Suyama said on March 13.
He said that UPMC health care professionals are learning about what is needed based on experiences from providers nationally and internationally.
“It’s not theoretical. We are truly planning for the physical needs, the beds we will need,” Suyama said. “These are all things that we practiced and planned. … It’s not a matter of if (now), it’s when.”
And UPMC is taking the lead in other, critical parts as well. UPMC on March 17 began rolling out its own test to detect the novel coronavirus SARS-CoV-2, the virus that causes COVID-19, and opened the appointment-only collection site on the South Side of Pittsburgh at the former South Side hospital.
“We expect to initially test over 20 patients a day, quickly ramping up to 100 by the end of the week,” said Dr. Alan Wells, medical director of UPMC Clinical Laboratories. The initial specimen collection in Pittsburgh will be joined by sites in Harrisburg, Erie, Williamsport and Altoona.
AHN also is preparing for a rapid increase in testing and said this will include drive-through testing.
“AHN continues to explore development of in-house testing, but has moved forward swiftly to provide testing to the community through the most expeditious means possible,” Holmberg said.
In West Virgina, Dr. Stephen Hoffman, a pulmonary specialist and vice president of clinical programs at WVU Medicine, and Dr. Judie Charlton, chief medical officer, said they have been tweaking a pandemic response plan to optimize it.
Hoffman said the key is to make sure you slow down the pace of infections so it doesn’t get as bad as Italy has gotten in a short period of time.
“When you are where you are in Italy, the cat’s out of the bag, it’s hard to recover,” Hoffman said.
And, he said, there might be a point where it’s difficult to manage.
“If it’s enough of a surge, I honestly don’t care what you do, you’re going to be overwhelmed,” Hoffman said of health systems in general. “Hopefully we don’t get to that point.”
Pennsylvania Department of Health spokesman Nate Wardle said the state believes hospitals are prepared for what may come.
“Obviously, there is the potential for that to change, but at this time, we are confident in the work that has been done to prepare for an infectious disease outbreak,” Wardle said.