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Within a week’s time, the District’s number of confirmed coronavirus cases jumped from 22 to 137 as of Monday evening. As testing becomes more widely available, positive cases that already exist will begin to reveal themselves. For some, it could be deadly. The District already saw two deaths related to coronavirus disease, COVID-19. The critical question now is whether D.C. hospitals are prepared for more COVID-19 patients.
Currently, there are 350 intensive care unit beds for patients and 400 ventilators for health care personnel in the city, according to DC Health. As of Monday, only 87 ICU beds were available and 250 ventilators were in use. The agency could not provide a total bed count.
Given that more than 705,000 individuals live in D.C., these numbers seem daunting. To better understand what this data means—and how concerned the public should be—City Paper reached out to Dr.Thomas Tsai, a surgeon and health policy researcher at Brigham and Women’s Hospital in Boston and the Department of Health Policy and Management at Harvard T.H. Chan School of Public Health. Tsai is one of the researchers that estimated how many beds are available and needed to care for COVID-19 patients over the coming months in 306 hospital markets across the country, including the greater D.C. area.
Tsai and his colleagues modeled various scenarios. In a moderate scenario, where 40 percent of the D.C. population is infected over 12 months and 8 percent require hospitalization, D.C. would need to exponentially expand total bed capacity. The New York Times read of this data has the city needing to add or empty the equivalent of 127 percent of its total occupied beds, not just ICU where severe acute cases are handled. This might not actually ever happen, but it could if everyone does not take action, says Tsai.
“As a public health researcher, I don’t want to be in a situation where we find out if  ICU beds are adequate,” he tells City Paper. “We don’t want to be in a situation like we are in Italy. The goal is to prevent these scenarios from happening.”
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As a means of prevention, hospitals need to maximize existing bed capacity (this means delaying non-urgent and non-essential surgery), and the public needs to not overwhelm the health care system (this means staying at home and engaging in social distancing). These actions will ideally buy time for the health care system to prepare for more COVID-19 patients, along with all the other patients who will require essential medical care as well.
“The important thing for hospital leaders and public health officials is that there is a current window to increase bed capacity that needs hard work,” says Tsai. “Waiting until that peak might be too little too late.”
During a press conference on Monday, Director of the Homeland Security and Emergency Management Agency Dr. Christopher Rodriguez said hospitals are trying to maximize bed capacity by discharging non-acute patients and canceling elective surgeries. The D.C. government is also looking to create more space for hospitals by seeking federal approval to use non-traditional spaces like hallways for medical care. In preparation for the worst, the emergency response team is already looking into using furloughed nursing homes or unused hotels.
“Our medium term plan is to shed load, which we have, and to look into expanding space in hospitals,” said Rodriguez. “So we have already taken a lot of steps to prepare for surge. And then as our modeling comes in and if we have to scale up we will be prepared to do that as well.”
Mayor Muriel Bowser says there are two private empty facilities that her team is eyeing in the event of a surge. She wouldn’t say what those facilities are. According to the Washington Post, D.C. officials considered at one point reopening Providence Hospital in Northeast D.C., which closed in 2019. But the president and CEO of Providence Health System, Tamarah Duperval-Brownlee, told the Post the facility was not suitable for inpatient care.
The fact that Providence’s parent system, Ascension, is against the idea is not deterring lawmakers. “We need to keep all options on the table,” Ward 7 Councilmember and chairman of the Committee on Health Vince Gray said in a statement to City Paper. “I have heard about the Providence proposal, and I think that needs to be on the table, even if it takes some capital upgrades. It is time for Ascension to prove they are a solution-oriented partner with the District.”
Gray is concerned about the District’s lack of hospital bed capacity. He says he was always concerned with limited resources at hospitals, particularly when Providence closed. The coronavirus just exacerbated the problem.
“The COVID-19 crisis proves yet again why the new hospital is desperately needed,” said Gray. “The partnership agreement and construction of a new hospital should be accelerated once this crisis has passed.”
Gray is shepherding the proposal to open a new hospital on the St. Elizabeths Campus in Congress Heights. Before the pandemic, the new hospital was expected to open in December 2022. When it opened, United Medical Center was scheduled to close. Even though he is concerned about past patient safety issues at UMC, Gray says he is “confident that the staff at UMC will continue to rise to the occasion” during this pandemic.
UMC, meanwhile, was cited by the mayor on Monday as an example of a hospital looking to optimize. It’s considering using a non-operational floor to expand space for a possible surge. Already, the hospital cancelled elective surgeries and instituted a number of restrictions, like no visitation to its nursing facility. A spokeswoman for the public hospital says they have seen an uptick in patients with respiratory issues, although not COVID-19 patients. UMC has only treated one individual who tested positive for COVID-19 last week, but that person is no longer being treated there. This is separate from a UMC staff member who tested positive on March 14; that individual was tested and treated elsewhere.
“Many of the individuals reporting to the ER are actually testing positive for MRSA,” says Toya Carmichael, a spokeswoman with UMC, by email.
Other hospitals in D.C. are also working to create greater efficiencies in their operations.
“We established an exterior tent to allow hospital staff to triage and assess patient needs as they arrive on campus,” writes a spokesperson with Sibley Memorial Hospital.
Children’s National Hospital, alternatively, announced Monday that it opened a drive- and walk-up location for testing. The testing site is located in the parking lot of Trinity Washington University in Edgewood. It’s the first drive-up site to open in the District. Primary care physicians can refer individuals up to age 22 for sample collection and testing. The site can test upwards of 100 young people a day but a doctor’s referral is needed. Drive-up testing reduces visits to the emergency department, thus reducing demand and exposure, and helps preserve protective equipment because less is used in this setting.
“While we wish we could provide testing for everyone who thinks they need it, we do not have that capacity—which is why getting a doctor’s referral is required,” said Dr. Joelle Simpson, the medical director of emergency preparedness at Children’s National, in a statement.
Aggressive testing proves to be the best way to stop the spread in other parts of the globe. But that requires protective gear and testing swabs, which Bowser says D.C. needs more federal assistance with. Testing also requires more health care workers. The District is accepting volunteers to help with medical screenings. Over 1,600 individuals have so far joined the DC Medical Reserve Corps.
Editor’s note: After this story was initially published UMC spokesperson Toya Carmichael emailed to correct her comments. Individuals at the UMC ER are testing positive for MRSA (Methicillin-resistant Staphylococcus aureus), not MERS (Middle Eastern respiratory syndrome).
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