Surge of coronavirus patients could cripple Oahu hospitals

Hawaii hospitals could be under tremendous strain as more patients diagnosed with the new coronavirus and other serious medical conditions inundate medical facilities.

The situation might get substantially worse if the state doesn’t “flatten the curve” of infection now, with an estimated 40% of the adult population potentially being infected over a year in a moderate-case scenario, according to a ProPublica analysis based on a model by the Harvard Global Health Institute.

Over 12 months Honolulu hospitals could get an estimated 93,700 coronavirus patients, requiring 3,120 beds, nearly four times the number of available beds, based on moderate estimates. That would overwhelm intensive care units that have an average 73 available beds, 9.3 times times fewer than what is needed, the data shows.

The state currently has 340 intensive care unit beds and 561 ventilators — machines that provide oxygen for patients unable to breathe on their own in severe respiratory distress, according to the Healthcare Association of Hawaii.

State officials are urging the public to distance themselves from one another to stop the rapid spread of COVID-19, warning that the health care system will collapse if too many people get sick at once. Hospitals statewide have a total of 3,069 beds, including 166 isolation rooms currently in use, and routinely run at or near capacity.

“Many of the hospitals are basically full right now, and there’s very little capacity right this minute so if you add even 50 more patients, you overwhelm the system,” said Dr. James Ireland, a community physician. “If you add 200 more patients in the system, there’s nowhere for them to go, and if you add more than that, they may have to decide who gets lifesaving treatment and who doesn’t.”

What’s more, there are global shortages of personal protective equipment that health care workers use to keep from contracting contagious diseases. Surgical masks, gloves and disinfecting products are also in short supply as consumers wipe out shelves in panic buying.

Medical supplies are “critically needed for our health care workers” and must be used judiciously “so that our supplies can be spread out over the marathon of this pandemic,” state Epidemiologist Sarah Park said at a news conference.

Jason Chang, president of The Queen’s Medical Center, said the hospital has more than two weeks’ worth of N95 masks and at least a month’s worth of personal protective equipment.

“Ventilators are something the entire state is short on. They’re not things you can go rent from somewhere, and it takes respiratory staff trained to use them,” he said, adding that the hospital is bringing on an additional 30 ICU-trained traveling nurses in anticipation of an influx. “We don’t know how it’s going to affect us. Queen’s is doing our part to be as prepared as we could possibly be. (But) if we had 1,000 elderly patients, no one would be prepared. We don’t have 1,000 ICU beds in the state. We’re looking at information every day trying to get more intelligence on what we can expect … but quite honestly, we don’t know.”

Authorities are imploring people without symptoms — even if they think they may have been exposed — and those who might have the coronavirus but are only mildly ill, to recuperate at home instead of seeking medical care. The exceptions are seniors and those with underlying medical conditions who are at high risk for developing serious complications, and those whose symptoms worsen.

There is no treatment for COVID-19, so in many cases testing would not make a difference, Park said. Patients without serious illness should treat it similar to the flu: Stay home, get lots of rest, stay hydrated and let the virus run its course.

The dozens of COVID-19 screening clinics that providers have set up to increase testing capacity in the state are also being flooded by the “worried well,” who are needlessly “stressing our fragile health care resources,” said Health Director Bruce Anderson. Only those with symptoms — including fever, sore throat and shortness of breath — and a physician’s referral will be tested.

“Our emergency rooms are being flooded now with ‘worried well’ people who have minor symptoms. It’s creating a real problem for the health care industry right now,” he said. “The flu has put stress on the hospital already, so there’s very little resilience in hospitals. There’s already scarcities of supplies, swabs and other materials used in testing. We don’t have the time and probably the resources to build new hospitals in the short term, but we are looking to utilize other facilities and to maximize existing spaces that we have.”

The state is considering options to accommodate an expected surge in patients in nonhospital settings. In addition, a 150-bed mobile hospital could be established to treat those with less severe ailments, freeing up hospital space for the critically ill.

“We worry, of course, if the disease becomes widespread where on top of the flu you’re going to have respiratory illnesses,” Anderson said. “It’s difficult to tell what will happen in the long term. It depends how widespread it becomes. That’s one of the reasons we don’t want people walking into the emergency rooms. They would needlessly use up lots of precious supplies.”