'A Very Real Capacity Gap' In Mass. Hospitals If COVID-19 Transmission Is Not Flattened, Say Harvard Researchers

Global health and policy experts at the Harvard T.H. Chan School of Public Health have spent the last week crunching numbers on the availability of hospital beds around the country. They completed their analysis of the data Tuesday, in hopes of showing what needs to happen to bring the coronavirus outbreak under control and allow hospitals to keep up.

The numbers in Massachusetts are daunting. The Harvard researchers determined that if the virus transmission doesn't slow considerably, hospitals will have a drastic shortage of intensive care beds.

WBUR's All Things Considered host Lisa Mullins spoke with Dr. Thomas Tsai, one of the scientists who did the analysis. He's a surgeon and health policy researcher at Brigham and Women’s Hospital and in the Department of Health Policy and Management at Harvard.

Interview Transcript:

The takeaway is that if we don't flatten the curve on transmission of COVID-19, there's a very real capacity gap between the available beds in Massachusetts versus the likely demand for beds for patients with COVID-19.

Lisa Mullins: Flattening the curve, again, means what?

Decreasing the risk of transmission. So we spread out the number of infected individuals over time. The problem is, if we don't do that, then there's an increased demand that is going to outstrip the supply of hospital beds and, most critically, mechanical ventilators and [Intensive Care Unit] beds.

So you looked at figures for what percentage of ICU beds will be needed at the six- month point into the virus, twelve-month point, and beyond that. The numbers are startling. Let's look at Boston and at Worcester. Again, this is ICU beds. What did you find?

What we're finding is in the Boston hospital region, if we are not able to flatten the curve, the anticipated demand for ICU beds is going to far outstrip the available beds. What we're finding is that the excess demand over capacity is over 600%. But if we're able to flatten out the curve to 12 months, we can decrease that to 200% ... And then we have a real fighting chance, if we can decrease the demand down when we spread the disease out to 18 months. And that gives us — the physicians and clinicians in the hospitals — a chance to appropriately treat all the patients that may become infected.

The story [in Worcester] is also very similar. Most of this is driven largely by the population density and the likely population at risk from infection. In Worcester, there's a similar shortage of ICU beds. It's over a 731% capacity gap between the likely demand and supply of beds. But if we can spread that out to 18 months, then we can decrease that down to 239%.

This is assuming we're able to free up the capacity by approximately 50%. I've spoken with some hospital leaders this morning in the Mass General-Brigham system, and hospital leaders and clinicians have been anticipating the likely gap over the last several days and weeks. And contingency plans are in place to help meet this demand.

So, even though the numbers are very scary and daunting, I think clinicians and hospital leaders have realized this fact and are working hard behind the scenes to decrease elective surgical admissions — which is one way to increase the availability of beds, as well as ICUs — and also think about creating creative capacity. So, flexible ICU units in the post-anesthesia recovery areas, and even considering using operating room ventilators and operating rooms for excess ICU capacity.

So, I think if we can let state and local leaders realize the gravity of the situation and continue efforts at social distancing, then we basically buy time for the hospitals to ramp up their capacity.

You mentioned social distancing. Is it OK that there is no ban right now on non-essential services and businesses that have more than 25 people in them? I mean, all kinds of retail stores that don't sell groceries, you can still go there. Nail salons, massage therapy facilities, hair salons. People are in pretty close contact there. There is no ban. Is that OK?

I don't think that is. I think, even if there is no government ban or guidance from public health officials, I think everybody has an individual responsibility to stay at home at this very critical moment. So even though the guidance may allow getting your hair cut, or going to the nail salon, or going to get a massage, I think that's socially irresponsible at this moment in time.

And the best outcome is, we look six months, a year, 18 months from now, and say we overreacted, that the disease wasn't as bad as everybody predicted. That's a good thing; that meant that the public health efforts really worked to decrease the transmission and not overwhelm the health care system.

Should we be sheltering in place the way San Francisco is? Should we not go out at all?

I think we should. And the main reason for that is we are so behind in testing that we don't know where to target our our efforts. The ideal situation would have been able to identify clusters of infection early and quarantine those clusters of infection, or engage in massive testing as they have done in South Korea. But that moment's passed. That train's left the station.

So now, we're left with a situation where the only tool that we have left is to stay at home. And if we don't do that — I don't have a crystal ball but we can look to the future in terms of what's happened already in Italy. And if those numbers apply to here, we're just days or weeks behind the situation that we're seeing there.