Governors in places seeing huge spikes in coronavirus infections often cite statewide data to assure the public they have plenty of hospital capacity to survive the onslaught, even as the states routinely miss the critical benchmarks to guide their pandemic response.
Public health officials and experts say the heavy reliance on statewide hospital data is a misleading and sometimes irresponsible metric to justify keeping a state open or holding back on imposing new limits.
That is because statewide statistics can be deceiving, especially in large states where individual hospitals can be in crisis mode even while the overall capacity numbers look OK.
Thomas LaVeist, dean of the Tulane School of Public Health and Tropical Medicine in New Orleans, said basing pandemic and reopening policy on statewide hospital bed capacity ’’is incredibly irresponsible.”
“To cherry-pick hospital capacity and to use that one metric without the context of number of cases, number of deaths, is shocking,” LaVeist said.
The issue of hospital capacity has gained urgency across the nation this week as Florida, Texas, California, Arizona and other states reported skyrocketing case numbers. Governors have repeatedly invoked hospital capacity in arguing against new business restrictions, though the dynamic began to shift today when Texas and Florida clamped down on bars amid an increasingly dire situation with COVID-19.
At the first White House coronavirus briefing nearly two months today, Vice President Mike Pence also cited hospitalizations in discussing the outlook for the pandemic.
Two months ago, Pence said 15% of patients were being hospitalized. Now it’s about 5%. That means the health care system is better positioned to cope with a resurgence in cases, he says.
In Texas, the state health department’s website on Thursday showed 12,951 available beds, 1,320 available ICU beds, and 5,850 available ventilators. What it doesn’t break down is how bleak the situation is in some particular places, including Houston, the nation’s fourth-largest city. Hospital beds in Houston are filling so fast that Texas Children’s Hospital is starting to treat adult patients, and 97% of ICU beds at Texas Medical Center were in use.
In Miami, Homestead Hospital confirmed Tuesday it was at capacity. The hospital was transferring patients to other hospitals and preparing to convert regular beds to beds for ICU and acute care patients, if needed.
In Arizona, Republican Gov. Doug Ducey has declined to impose new restrictions on business activity or a stay-at-home order, repeatedly citing ample capacity in the state’s hospitals as the reason he is comfortable staying open.
“That’s what’s most important when there’s a rise in cases,” Ducey said earlier this month.
Ducey has condemned as “misinformation” the notion that hospital space is running short, even as state data shows that 85% of Arizona’s hospital beds are occupied. Arizona has about 2,500 hospitalized COVID-19 patients.
At the same time, the state is badly missing the mark on the benchmarks established by the White House task force to guide the reopening of the economy, with 23 percent of COVID-19 tests coming back positive in the past week in Arizona.
The task force does not include statewide hospitalizations as part of its criteria that states are supposed to meet before reopening. Those criteria include a downward trajectory of cases within a two-week period. They also specify that hospitals should have enough intensive care unit capacity to treat a surge in patients and should have a robust testing program in place for at-risk healthcare workers, including virus antibody testing.
Dr. Joseph Gerald, associate professor of public health policy and management at the University of Arizona, said that if the trend continues, cases will likely exceed statewide hospital bed capacity within the next several weeks.
Dr. Colleen Kraft, associate chief medical officer at Emory Hospital in Atlanta and a member of Georgia’s coronavirus task force, said regional hospital bed capacity would be a better metric than statewide capacity. She lamented that the pandemic has seemingly devolved into a “political situation.”
“As someone who came into medicine to serve people, it’s difficult to watch,” Kraft said.
Robyn Gershon, a professor and public health expert at New York University, called using statewide hospital bed capacity to guide policy “completely unethical.”
‘’It’s unethical to say let’s just go about our business and by the way, we can handle the overflow,” Gershon said. “A better measure is the 14-day and seven-day case infection rate. That’s what’s telling us what’s going on right now.’’