On Wednesday, Dr. Brian Monahan, the physician for the United States Congress, predicted about one-third of Americans could be infected by the new coronavirus that causes COVID-19 in the next year.
In Nevada, where the population hovers around three million, that would be one million people.
Of those, about 80 percent – or 800,000 people in Nevada — would likely recover with little to no medical intervention, according to Vital Surveillances: The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19), the largest study in China on COVID-19, as well as U.S. health officials.
“However, about 15 to up to 20 percent of individuals – usually those who are elderly and in risk groups wind up getting serious disease requiring supportive care. That could be oxygen. That could be intensive care. That could be intubation or even more dramatic interventions,” Dr. Anthony Fauci, director of the National Institutes for Allergy and Infectious Disease told Congress last week.
In Nevada, that’s as many as 200,000 who may need help breathing. About five percent — 50,000 Nevadans — may need to be placed on ventilators at some point, not all at once but over the course of the next year.
“Most people infected with COVID-19 virus have mild disease and recover. Approximately 80% of laboratory confirmed patients have had mild to moderate disease, which includes non-pneumonia and pneumonia cases, 13.8% have severe disease (dyspnea, respiratory frequency ≥30/minute, blood oxygen saturation ≤93%, PaO2/FiO2 ratio <300, and/or lung
infiltrates >50% of the lung field within 24-48 hours) and 6.1% are critical (respiratory failure, septic shock, and/or multiple organ dysfunction/failure),” the study from China says.
Fauci and others are hoping the practice of social distancing – keeping your distance from others and avoiding crowds – will prevent the kind of hospital surge that has buried health care systems in other countries.
Uncertainty about COVID-19 is rampant. Little is known about the virus that has infected more than 133,000 people worldwide and killed about 5,000.
What is known is that Nevada begins the battle at a disadvantage to some other states.
- Nevada ranked 48th in 2018 in the Total Active Patient Care Physicians per 100,000 Population, with 185.8 compared with the national median of 227.2
- Nevada has approximately 6,000 staffed hospital beds throughout the state. That’s 2.1 hospital beds per 1,000 people, lower than the national average of 2.4. South Dakota has the highest number at 4.8, followed by the District of Columbia, at 4.4.
- Nevada ranks higher than some states in the percentage of senior citizens. About 475,000 residents are 65 or over. That’s 15.7 percent of the state’s population, according to the Census Bureau’s 2018 population estimates. Nationally, 16 percent of Americans are 65 or older.
Nevada hospitals say they are ready to handle whatever the novel coronavirus brings.
St. Mary’s Medical Center in Reno has 380 acute care beds, according to its website. The hospital has 29 intensive care beds and 45 mechanical ventilators, according to a spokeswoman.
University Medical Center in Las Vegas has 541 beds, according to the state. The public hospital has 115 ventilators “on campus now,” says spokeswoman Danita Cohen.
Mountain View Hospital, owned by HCA, has 408 beds, according to a 2018 state report. The hospital has 50 conventional ventilators, three adult transportable units and one adult MRI-compatible ventilator, says spokeswoman Jennifer McDonnell.
HCA’s other Las Vegas hospitals, Southern Hills (186 beds) and Sunrise (690 beds), did not respond to requests for comment.
Most hospitals contacted by the Current declined to provide information on the number of ventilators on hand.
“Unfortunately, I don’t know the answer to those specific questions,” said Steve Burrows, Director of Communications for Northeastern Nevada Regional Hospital in Elko. The hospital has 75 beds and is the only facility in a vast area of the northeastern corner of the state.
“Renown (Regional Medical Center) has more than 40 isolation rooms with special equipment and in the event that more resources are needed, we could convert an entire floor at Renown Regional to care for these patients,” a spokesperson for the Reno hospital said in a statement. The hospital would not disclose the number of ventilators in service.
“Sorry I don’t have any specific equipment counts available to share with you,” said Dignity Health spokesman Gordon Absher. The company operates three hospitals in Southern Nevada under the St. Rose Dominican brand.
“Dignity Health-St. Rose Dominican hospitals in Nevada have the supplies and equipment needed to effectively manage the care of any suspected or confirmed COVID-19 patients and we are continuously assessing the volume of supplies at our hospital,” Absher said.
UHS, which owns the Northern Nevada Medical Center and six hospitals in Southern Nevada — Valley, Desert Springs, Centennial, Spring Valley, Summerlin and Henderson — did not respond to requests for information about their ability to treat patients in need of mechanical ventilation.
The Nevada Hospital Association is unaware of how many ventilators are available in its members’ facilities, according to spokeswoman Amy Shogren.
“I have no specific numbers on ventilators but the one thing everyone is aware of is our mutual aid agreement and that means they will share equipment, staff, the whole nine yards,” says Shogren. “So any time we identify a shortage we are quick to act and alleviate the shortage through our other hospitals.”
“The MMAA (Master Mutual Aid Agreement) has been in effect since 2006 and has been effective in managing shortfalls in equipment, supplies and even staffing during crisis,” says the NHA’s website.
Hospitals, not only in Nevada but throughout America, are not equipped to handle the surge in patients that may appear in the coming weeks, experts fear.
A survey of 5,752 hospitals in 2010 revealed the “number of mechanical ventilators per US population exceeds those reported by other developed countries, but there is wide variation across states in the population-adjusted supply.”
“Accounting for nonrespondents, we estimate that there are 62,188 full-feature mechanical ventilators owned by US acute care hospitals,” researchers wrote. The study found another 98,000 ventilators lack some features but could still function.
“The true number of machines capable of providing mechanical ventilation is undoubtedly larger than this study found,” said a 2010 editorial published by the Society for Disaster Medicine and Public Health. “Whatever the actual number, it is probably still insufficient to meet the demands of a severe influenza pandemic.”
Based on the 2010 study, the only inventory of ventilators in the last decade, the median number of intensive care unit beds with mechanical ventilators per 100,000 population for states was 20.5. By contrast, Canada has only 8.7 beds with ventilators per 100,000 people, according to a 2018 fact sheet from the U.S. Department of Health and Human Services.
“The US Department of Health and Human Services (HHS) estimates that 865,000 US residents would be hospitalized during a moderate pandemic (as in 1957 and 1968) and 9.9 million during a severe pandemic (as in 1918).”
In a moderate pandemic, HHS says 64,875 Americans would need to be ventilated. In a severe pandemic, that number would rise to 742,500.
The U.S. has the capability to ventilate about 160,000 people, according to HHS.
“In addition, the CDC Strategic National Stockpile has an estimated 8,900 ventilators as of 2010,” HHS wrote, adding the ventilators “could arrive within 24-36 hours of the federal decision to deploy them.”
Hospitals would make the request to local health departments and emergency management agencies, which would request approval from a state’s governor. The request is then made to the Department of Homeland Security or the Centers for Disease Control.
“In times of crisis, the request can be initiated at the federal level,” according to HHS.
Dr. Tom Frieden, who led the CDC during the Obama administration, told Medscape that “during his tenure at the CDC, they drastically increased the number of ventilators stored as part of emergency supplies maintained by the federal government called the Strategic National Stockpile, ‘because we recognized this as a vulnerability.’”
But Frieden said even with the increase, which he said is “many times greater than 10,000,” there still may not be enough.
“Not fully. Not in the worst-case scenario. Hundreds of thousands of people needing ventilator support at the same time,” he said.
The U.S. has fewer hospital beds per 1,000 people than other countries that have been overwhelmed by cases of the coronavirus.
In 2016, the U.S. had 2.8 beds per 1,000 people, according to the Organisation for Economic Co-operation and Development (OECD). By contrast, Italy had 3.2 and China has 4.3.
Nevada hospitals had 6,304 beds in 2017, the last year on record, according to Becker’s Hospital Review. Clark County had 4,412, Washoe had 1,583, and 309 were reported in rural counties. Occupancy rates at acute care hospitals average in the 60 to 70 percent range, according to a state report.
In 2017, the last year on record, Nevada had 2.1 hospital beds per 1,000 population, below the national average of 2.4 beds. Washoe County has 3.1 beds per 1000 population, Clark County has 2 and rural Nevada has far fewer — in some cases just one bed per 1000 population.
Fewer than 1,000 of the state’s acute care hospital beds are designated as intensive care, according to the Nevada Hospital Association.
But hospital officials and the NHA remain confident they are prepared, even for the unknown.
“Any shortages of supplies will be addressed by our master mutual aid agreement,” says Shogren of the Nevada Hospital Association. “There’s nothing everyone is out of.”