Harvard Global Health Expert: Mass. Hospitals Face Capacity Problem If Coronavirus Cases Spike Quickly

Coronavirus cases are mounting in Massachusetts. State officials announced Tuesday that 51 more people had tested positive since the day before.

Hospitals are focusing on capacity and whether they're equipped to handle a possible surge in patients.

Italy has a top-notch health care system-- and it's been overwhelmed by an explosion in coronavirus cases. Hospitals in the northern region of Lombardy are in danger of running out of intensive care beds.

Dr. Ashish Jha has spent the past day evaluating how prepared hospitals in Massachusetts are to deal with a potential onslaught of COVID-19 patients here.

Jha is director of the Harvard Global Health Institute. He's also an internist, a professor of medicine at Harvard Medical School, and the K.T. Li Professor of Global Health at Harvard T.H. Chan School of Public Health.

Jha spoke with WBUR's All Things Considered host Lisa Mullins about what the numbers are telling him.

"Some of the best epidemiologists in the world are estimating that between 40 and 70% of adults will end up getting an infection. Even if we begin with that low end of 40% of adults in Massachusetts, that's 2 million people getting infected. If we take data from China that says 20% of people needed hospitalizations, that's 400,000 hospitalizations. Even if we said 'No, that's too many, we can cut that in half,' that's 200,000 hospitalizations. At any given time in Massachusetts, we think there are [3,000 to] 4,000 hospital beds open at most ... And so, if you start doing the numbers, you very quickly realize we do not have anywhere near capacity to take care of tens of thousands of people with [COVID-19] who might need hospitalization ... But if we can spread that out over many, many, many months — ideally a year — then I think we have a shot of being able to take care of everybody who will need the care."

How how does that happen, that it becomes spread out?

"So, what we know is that this idea that people talk about social distancing — this is why Harvard University today just canceled classes. In-person classes; we're going online. In our offices, were now encouraging everybody to work remotely ... Certainly all large gatherings should close. I'm pleased to see the city of Boston having canceled the St. Patrick's Day parade — a parade I've always loved watching, but I think it's not the right time to have it. Getting rid of all of those mass gathering events is going to be absolutely critical to spreading this infection out over time."

When you talk about reducing the crunch on the [hospital] beds, are you saying that hospitals need to do that right now — clear out beds, make more available?

"So right now, the problem that hospitals are facing is because we've had a complete fiasco with testing and our inability to test people. Hospital beds are filling up with ... people under investigation ... Maybe they traveled somewhere. They have symptoms. And because testing has been so slow and difficult and they can't get tested quickly and eliminated, they're sitting in hospitals, and they're in beds and they're in places we want opened up for people who actually have the infection. And it's not the hospital's fault; and I have to tell you, it's not the state's fault. States are trying very, very hard here. It's the federal government that has really dropped the ball on [the testing].

"Once we finally fix the testing problem, which hopefully will happen very soon and we can test people more broadly, some of those beds will open up. But I think it's a matter of weeks, not months, before hospitals face a real crunch. And what hospitals are going to have to do is they're going to have to cancel elective surgeries. They're going to have to think about converting things like operating rooms into ICUs. They're going to have to think about where else they can put patients and take care of them safely. We're going to have to start thinking about things like ambulatory surgical centers, and can we use them as places for very sick people. We're going to get very, very creative about expanding the supply of hospital beds and ICU beds, particularly if we're going to get through this period."

And is there a great disparity in the availability of hospital beds and ICU beds, in particular, in different parts of Massachusetts?

"There is obviously a large concentration of hospitals, hospital beds, especially ICU beds in eastern Massachusetts and the Greater Boston area. Of course, that's also where a large chunk of the population is. But once you get out to western Mass., it is much more of a problem. You have far fewer ICU beds out there. In the Springfield area, we estimate 70 to 80 ICU beds ... If cases spike out there, you might see a lot of those patients coming into central or eastern Massachusetts."
Some people listening to this would be understandably alarmed. What should people hearing this keep in mind?
"We don't really know the risk because we're not testing people. And so we don't know how many cases there are in the community. We're not testing people because there has been this total fiasco with testing. Every major country in the world is doing a better job testing and isolating people than America is. So I think people should be very frustrated about that and make sure that the public health officials and public officials — political officials — understand how badly we've messed that up."
Has that not changed because more testing kids have apparently been become available?
"It is getting better. We are have more testing kits available. We have nowhere near the number of tests, testing kits we need. We're still way behind where every other country is."
And why is that?
"It is incomprehensible to me, actually, how it is that the decision making happened here. WHO, the World Health Organization, created and certified a testing kit that works very well that every country in the world is using. The administration decided not to use the WHO kit and develop its own American test."
So you're saying the Trump administration?
"The Trump administration — somebody in the White House or in the leadership of the CDC — decided not to do that. And then the development of the American test has been a debacle, one after another. And instead of saying, 'OK, we'll just use the WHO approach until we develop our own,' they just decided not to use the WHO testing kit.
"You know, Vietnam has tested more people than the United States has. Almost every country is testing more people than America has. And this is a choice that our administration has made. And while I've been talking to health officials from states across the country, most of them — still even this morning — have a limited number of kits and are rationing testing, trying to think about whom they can test and not. This is not where we should be at this very far stage of the game."