Gary Rhodes for The Texas Tribune
A surgical
suite at Eastland Memorial Hospital in North Texas on March 10, 2019. Gary
Rhodes for The Texas Tribune
The front
lines of Texas’ health care workforce are preparing for the possibility of
widespread COVID-19 infection — and sounding the alarm about the state’s
limited number of hospital beds.
Some
hospitals are restricting who may visit and screening outsiders for fever. Some
are asking doctors and nurses to work longer hours. Others are building
drive-through testing sites, temporary triage centers and fever clinics in
anticipation of high patient volumes.
And all of
them are urging Texans to stay as isolated as possible in order to slow the
spread of the new coronavirus, because there aren’t enough hospital beds to
care for critical patients if too many people get sick at once.
“If we can
get people to stay out of crowds, stay out of crowded environments to slow down
the transmission of this virus from person to person, we should be able to
stretch our resources to the point where we can take care of the entire
population that needs hospitalized care,” said Craig Rhyne, the Lubbock-based
regional chief medical officer for Covenant Health.
The Texas
Tribune interviewed more than a dozen doctors, nurses and other health care
workers about how ready the state’s health care system is for an expected spike
in coronavirus cases. Most spoke on the condition of anonymity because their
employers did not allow them to talk to reporters.
Because
COVID-19 is a respiratory disease that attacks the lungs, some doctors worried
that they would run short on ventilators, machines that provide oxygen to
patients who become so sick they cannot breathe on their own.
“Capacity is
a big problem if this thing continues to continue to prove to be a nasty bug,”
said one emergency room doctor who works at multiple suburban and rural
hospitals in North Texas. “The doomsday scenario that we’re worrying about is
what does a relatively small hospital do when we’re using all four or five of
our ventilators.”
Texas’
hospital capacity — the number of beds available per person in the general
population — is about 2.9 beds per 1,000 Texans, according to state regulators.
The U.S. rate is about 2.8 beds per 1,000 people.
That’s less
than the capacity of other countries that have already seen widespread
transmission of coronavirus. Italy, where more than 2,100 people have died from
COVID-19 and the nation’s hospital system has been overwhelmed, has 3.2 beds
per 1,000 people, according to the Organization for Economic Cooperation and
Development. European media reported that Italian doctors were
prioritizing ventilators for the patients considered most likely to survive,
while the country ordered manufacturers to ramp up ventilator production.
South Korea,
where the government has aggressively tested its population for the virus and
the number of new infections has leveled off, has more than 12 hospital beds
per 1,000 people — roughly four times more than Texas. The country reported 75
deaths from COVID-19 as of Monday and has seen the daily rate of new
cases fall from more than 900 in late
February to less than 100 this week.
Texas health
care workers say those figures underscore the need to slow the number of new
infections so that hospitals can keep up.
“We need to
do the best we can to try to slow down the virus so that our hospital systems
are not overwhelmed,” said Mary Dale Peterson, president of the American
Society of Anesthesiologists and chief operating officer of the Driscoll Health
System in Corpus Christi.
Other health
care workers expressed fears that supplies of personal protective equipment,
such as N95 respirator masks, could quickly run
out.
Allen was
able to place a limited order for masks last week, he said, but a backlog of
orders kept the manufacturer from fulfilling the complete request. He estimated
his clinic had enough protective equipment to last roughly three months under
normal conditions and said he had been told to reuse masks as long as the
patients they came into contact with hadn’t tested positive for
COVID-19.
“Literally, my boss,told me to hide them,” said Allen, an X-ray technician at a Central Texas clinic who keeps the masks under lock and key. Many patients he sees get X-rays to check for pneumonia or other respiratory conditions.
“I’ve heard
from some of our members that they’re struggling just to get the disposable
surgical gowns that they would use in the operating room and are having to
resort back to cloth gowns that they would have to launder and sterilize,” said
Serena Bumpus, director of practice for the Texas Nurses Association.
In the eyes
of Peter Hotez, the ability to protect health care workers from becoming sick
is “our weakest link right now in our U.S. response to COVID-19.”
Hotez, dean
of the National School of Tropical Medicine at Baylor College of Medicine, told
CNN this week that keeping workers safe will be paramount in ensuring the
health care system can handle an influx of sick patients.
“If we have
multiple frontline health care workers, ER physicians, nurses go down in this
epidemic, a situation where we have colleagues taking care of colleagues in the
intensive care unit, there’s nothing more destabilizing for the United States
and we have to make this our highest priority,” he said.
Two
emergency room doctors were reported to be in critical condition this week from
coronavirus infection, one in New Jersey and the other in Washington. And on
Monday, the U.S. Centers for Disease Control and Prevention announced one of
its employees had tested positive for COVID-19.
Texas reported its first
coronavirus-related death, a Matagorda County man in his late 90s, late Monday.
For
Peterson, the Corpus Christi anesthesiologist, a main concern is the lack of
testing, which can limit hospitals’ ability to perform effective triage, or
sorting of patients based on how immediately they need care.
One nurse at
MD Anderson Cancer Center in Houston said the hospital had begun building a
temporary structure in an ambulance bay to serve as a triage space. Brette
Peyton, a hospital spokesperson, said it was one of “numerous proactive
measures aimed at minimizing risk to our particularly vulnerable patient
population.”
And
Jacqueline, a nurse at Parkland Health and Hospital System in Dallas, said her
hospital was assigning some nurses to solely focus on patients who had tested
positive for coronavirus.
“In my years
of experience in nursing that’s absolutely unheard of because we just don’t
have the staff for that,” she said. “I’m grateful, though, because that’s
really what needs to be done.”
Other nurses
were being asked to prepare healthier patients to be discharged more quickly,
she said, “because they don’t want them exposed to anything in the hospital and
because we may need that bed.”
A Parkland spokesperson did not respond to
emailed questions.