The Washington Post - 27.03.2020

A10 ez sU THE WASHINGTON POST.FRIDAy, MARCH 27 , 2020

the coronavirus pandemic

BY ARIANA EUNJUNG CHA,

BRITTNEY MARTIN

AND STEVEN MUFSON

Louisiana is renting c abins and
trailers in state parks to isolate the
ill. The county that includes Seat-
tle is erecting a 200-bed facility on
a soccer field. And New York is
setting up a medical surge center
inside the six-block-long Jacob K.
Javits Convention Center on the
west side of manhattan — better
known f or hosting auto s hows and
Comic-Con.
As the United States enters a
new stage of the p andemic, hospi-
tal systems are being reconfigured
in radical ways to handle the
growing number of sick people,
and over the next few weeks, hos-
pitals appear likely to look and
operate very differently than they
do today. With the need for social
distancing even among the sick,
securing and configuring spaces
large enough to handle the load
has become one of the biggest
challenges facing state officials
and hospital administrators.
“What we’ve done is shift from
all daily operations to preparing
for mass numbers of people with
covid-19,” said omar Lateef, chief
executive of rush University med-
ical Center i n Chicago.
The mounting costs of the hos-
pital build-out are being borne
mostly by individual state treasur-
ies and private medical centers,
with some help from the federal
Emergency management Agency
and Army Corps of Engineers. B ut
there is an expectation that the
federal government will provide
some additional relief. T he $ 2 tril-
lion aid bill Congress is rushing to
pass this week contains $100 bil-
lion for hospitals to offset expens-
es related to the coronavirus
surge.
Part of the reason for the need
for auxiliary, emergency mea-
sures is that many hospitals have
closed in recent years because of
financial trouble. The United
States has fewer beds per capita —
2.7 per 1,000 people — than many
other countries. That compares
with 6.5 per 1,000 for South Korea
and france, for example, and 4.
for China.
The United States has 924,
hospital beds, most of which are
occupied on a typical day, accord-
ing to a 2018 survey from the
American Hospital Association.
But in a severe pandemic situa-
tion, such as the one the country
faced during t he 1918 flu pandem-
ic, experts have estimated that 38
million people would need medi-
cal care, resulting in 9.6 million
hospitalizations and 2.9 million
intensive care stays.
The ongoing transformation of
the American hospital system
mirrors what was done in other
countries t hat faced the pandemic
earlier.
There was the Chinese mega-
lopolis Wuhan, where patients
were sorted by severity of disease
into different hospitals — 10 tem-
porary ones for the mildly sick or
contagious in sports stadiums and
similar facilities, 39 for those with
critical illness or who were 65 and
older and six reserved for critical

care. In Italy’s Lombardy region,

the hospital system was essential-

ly cleaved into two: one for coro-

navirus patients with 55 hospitals,

and the remaining few hospitals

reserved for those experiencing

more ordinary emergencies such

as strokes, accidents or childbirth.

With public health officials es-

timating that millions of Ameri-

cans — up to a fifth of the popula-

tion — may need to be hospital-

ized, states and hospitals are tak-

ing creative approaches to

housing the ill while containing

the contagion.

Plans remain in flux in many

areas, but health officials describe

four general tiers of treatment.

The first is triage, which in-

cludes drive-through test sites

and tents in parking lots. This is

where most patients would have

initial contact with the hospital

system. They would be swabbed,

and their temperatures taken. At

mount Sinai Hospital in New

York, staff members stop those

who enter the emergency room

and direct anyone with flu-like

symptoms to a separate area.

“We took over a clinic space

right next to the emergency de-

partment, and we made it a zone

for patients with respiratory ill-

ness,” said Jolion mcGreevy, the

hospital’s emergency department

medical director. A dedicated

team in protective gear treats pa-

tients escorted to that area.

The second tier is for the m ildly

ill or those awaiting test results.

Chicago is renting thousands of

hotel rooms. San francisco is set-

ting up rVs in the Presidio, a park

in the northern part of the city.

As shown in a photo that went

viral monday, Yale University in

New Haven, Conn., is setting up

rows of beds in its gymnasium.

Yale s pokeswoman Karen N. Peart

said the space would be activated

if the school’s health center fills

up. She said it would offer only

general care such as the monitor-

ing of vital signs and provision of

food and water.

“We hope we never have to use

it. But it could support those who

are unable to care for themselves

at home, yet are not sick enough

for hospital admission,” Peart

said.

In L ouisiana, Lt. Gov. B illy Nun-

gesser (r) said cabins in state

parks will temporarily shelter the

homeless or people who cannot

return to their homes while await-

ing coronavirus test results. A

park ranger will stand watch to

make sure “nobody goes in and

out unassisted.” State police will

also guard the cabins, Nungesser

said. A caterer will provide meals

to be delivered to each cabin.

“By putting one person in each

cabin, if it comes back negative,

then they can just reuse the cabin.

If it’s positive, then they’ve got to

clean that cabin good, but they

can then just reuse that cabin,”

Nungesser said in an interview.

The third level of care consists

of the existing hospital system,

and administrators interviewed

in recent weeks said they antici-

pate handling mostly severe to

critical cases. many major medi-

cal centers in several large cities

said they would continue accept-

ing patients with ordinary emer-

gencies ranging from heart at-

tacks to births, but they have con-

fined coronavirus patients to sep-

arate areas so they cannot

transmit the virus to other pa-

tients.

of particular concern is finding

enough room for the large num-

ber of patients expected to need

mechanical ventilators to

breathe.

At Northwestern memorial

Hospital in Chicago, doctors are

working to increase the 97 inten-

sive care beds to 240. richard

Wunderink, medical director for

one of the ICUs, said rooms have

been shifted to create a dedicated

covid-19 unit that has negative

airflow to prevent infectious ma-

terial from contaminating other

areas.

In some parts of the country,

existing facilities such as m

Health fairview Bethesda Hospi-

tal, a long-term acute-care center

in St. Paul, minn., are being re-

made as covid-19 c enters. Bethes-

da has 90 beds, including 35 inten-

sive care beds. m Health fairview,

which o wns the property, said cur-

rent patients were being trans-

ferred to other facilities in prepa-

ration.

In New York, the epicenter of

the virus in the United States and

where the ill are mounting, con-

struction of the four temporary

hospitals inside the Javits Center

began this week. Each will have

250 beds and occupy 40,

square feet. New York Gov. An-

drew m. Cuomo (D) has said an-

other 1,000 beds could be added

for those who are less ill if needed.

Some states are preparing for

patients who have received signif-

icantly less attention than the

sick: the recovering.

Ta king lessons from a surge in

coronavirus patients that over-

whelmed hospitals in Washington

state, Colorado hospitals are set-

ting up a system that would allow

patients recovering from the ill-

ness to transfer out of hospitals to

make room for the critically ill,

said Julie Lonborg, s pokeswoman

for the Colorado Hospital Associa-

tion.

Lonborg said the s tate had talk-

ed to other states that were seven

or 10 days ahead of Colorado in the

outbreak and asked what they

wish they had done differently.

“They said part of what was s tress-

ing the system was that once pa-

tients were no longer critically ill,

but still needed to be cared for,

they were taking up space in the

hospital that could be used by

critically ill patients,” s he said.

With nursing homes refusing

to accept patients without a nega-

tive coronavirus test, recently va-

cated college dormitory rooms

and hotels in Denver may be

pressed into service, she said.

“It’s a pressure relief valve on

the back end,” s he said.

[email protected]

[email protected]

Martin reported from Houston. Ben

Guarino in new york, Juliet eilperin in

Washington, Jennifer Oldham in

Denver, steve Burkholder in

Connecticut and shirley Wang in Iowa

City contributed to this report.

Health o∞cials prepare for onslaught with soccer fields, convention centers

DAn renzettI/yAle UnIVersIty

Yale university’s gym is being outfitted with beds, with officials planning to activate the space if the school health center fills up. Only general care, such as monitoring of vital

signs, would take place there, “but it could support those who are unable to care for themselves at home, yet are not sick enough for hospital admission,” a spokeswoman said.

threat from t he pathogen that has

infected more than 80,000 and

killed more than 1 ,100 i n the Unit-

ed States. The White House said

Trump will travel to Norfolk on

Saturday to help send off the

USNS Comfort, a floating h ospital

vessel that the administration is

dispatching to assist New York,

one of the states hit hardest.

But on the front lines, where

medical workers are lacking pro-

tective equipment and emergency

rooms are being overrun, the

Trump administration is letting

states take the lead. Pence said

that the federal Emergency man-

agement Agency was coordinat-

ing with the states, but that the

approach to the outbreak is “local-

ly executed, state managed and

federally supported.”

Inslee was not the only gover-

nor to sound the alarm, a ccording

to one person briefed on the call,

with Louisiana Gov. John Bel Ed-

wards ( D) raising a range of issues

as New orleans and his state

brace for turmoil, with the num-

ber of cases and deaths there ris-

ing.

maryland Gov. L arry Hogan (r)

spoke first for the governors on

the call as head of the National

Governors Association. He made

a plea for maryland, Virginia and

Washington, D.C., to get their own

testing facility since the region is

home to much of the workforce

that keeps the federal government

running, according to people fa-

miliar with the call. A White

House official said that was in the

works.

Washington mayor muriel E.

Bowser (D) voiced objection to the

federal relief package that treats

the District as a territory, the p eo-

ple familiar said. Virginia Gov.

ralph Northam (D), a physician,

asked Birx for her best- and worst-

case scenarios. She said she was

still looking at modeling, people

familiar with t he call said.

The personal protective equip-

ment shortage for health-care

workers was the biggest concern

expressed by governors, who said

they believed the country needed

a federal response so states are not

competing for medical s upplies —

a running theme of the discus-

sion, according to the people on

the call and b riefed on it.

other moments of note includ-

ed when Gov. Jim Justice of West

Virginia (r) voiced concern about

nursing home cases, the people

familiar said. meanwhile, Gov.

Henry mcmaster (r-S.C.), a

Trump ally, told the president that

small businesses cannot sustain

too much more of the economic

shutdown, aides familiar with the

call said.

Trump referred to the situation

as “crazy” and emphasized that

the country has got to get back

open for business, the people fa-

miliar said.

“A lot of progress is made, but

we’ve got to go back to work,”

Trump later told reporters. “We

may take sections of our country,

we may take large sections of our

country that aren’t so seriously

affected and we may do it that way,

but we’ve got to start the process

pretty soon, so we’ll be talking to

you more about that next week.”

[email protected]

[email protected]

[email protected]

[email protected]

tom Hamburger, Ovetta Wiggins,

seung Min Kim and Felicia sonmez

contributed to this report.

the Defense Production Act to or-
der private companies to produce
items such as masks and ventila-
tors, a step the president has re-
sisted after announcing last week
he would invoke the federal law.
Inslee, citing the dire situation at
Washington state’s nursing
homes, called on the Pentagon to
press defense companies to pro-
duce lifesaving materials.
Trump responded defensively,
two of the people said, and told
Inslee that he and the federal
government have already done
much for Washington and other
states in recent days, ticking off
several initiatives.
“The President is using the DPA
everyday as quiet leverage to en-
hance w hat is already the greatest
mobilization of America’s indus-
trial base since World War II,”
White House trade adviser Peter
Navarro said in a statement
Thursday evening. “ These private
enterprises are eager to assist and
have said “yes” to helping the
country at every turn, so DPA
hasn’t b een needed yet.”
Navarro added that “at the
President’s direction, Seattle has
received considerable inventory.”
A spokesman for Inslee de-
clined to c omment.
Speaking to reporters in Wash-
ington after the call, Inslee said of
the discussion with Trump, “I am
not going to go into great detail,
but I will say that I told them that
the states should not be compet-
ing against each other. We are
grateful for their assistance in

trump from A1 what they have provided so far.”
Though the president has faced
mounting bipartisan calls to use
his powers to compel private com-
panies to help, he has said he is
employing the law as leverage to
win voluntary cooperation. His
campaign on Thursday tweeted a
list of major corporations, includ-
ing 3m, that have said they will
increase production of such sup-
plies.
Behind the scenes, business
leaders h ave lobbied Trump not to
invoke the law and conservative
advisers have warned the presi-
dent that doing so would draw a
backlash and could cut into his
argument of running against so-
cialism in the fall, said two admin-
istration officials.
on Thursday, a union leader
representing health-care workers,
Lee Saunders, said the impossible
situation has already occurred,
noting that some health workers
in New York have donned garbage
bags because hospitals are short
of protective gowns.
“This is a train wreck happen-
ing in slow motion right before
our eyes,” S aunders told reporters.
“Do the moral thing, mr. Presi-
dent: G et t hose nurses and health-
care workers the protective gear
they need by invoking the Defense
Production Act.”
At a White House news brief-
ing, Trump called reports of ten-
sion on his call with the governors
“fake news,” insisting that Brady’s
name was raised “in a positive
way.” The president, after de-
nouncing the media, asserted that
the call was not contentious.

“I would say one person — a

little, tiny bit of a raising of a voice,

a wise guy a little bit,” Trump said,

without identifying the governor.

“But he’s usually a big wise guy —

not so much a nymore. We s aw t o it

he wouldn’t b e anymore.”

As news broke that jobless

claims had s urged by 3.28 million

in a week — by far the largest

weekly increase in history — the

president reiterated his desire to

restart segments of the economy

that have been virtually shut-

tered. He has cited Easter week-

end, just three weeks away, as a

target date, though medical ex-

perts have said the virus is still

spreading rapidly and that doing

so could severely undermine ef-

forts to “flatten the c urve” o f infec-

tions and provide relief to hospi-

tals.

“People want to go back to

work,” Trump said. “I’m hearing it

loud and clear from everybody.

We have to go back. This is the

United States of America. They

don’t want to sit around and wait.

... It’s going to happen pretty
quick. We may take large sections
of our country that are not so
affected and do it that way.”
It remains unclear exactly how
the system of county risk levels
announced by Trump on Thurs-
day would w ork.
Deborah Birx, the White
House’s coronavirus response co-
ordinator, said many states have
been collecting t he data needed to
make determinations and that the
Centers for Disease Control and
Prevention would play a major
role.

When asked how the govern-

ment would stop people from

high-risk areas from using busi-

nesses reopened in low-risk coun-

ties, she said much of those deci-

sions would be left to local offi-

cials and the hope is that residents

would continue to use good judg-

ment when it comes to helping

stop the spread of the virus.

“Part of this will be the need to

have highly responsible behavior

between counties,” she said. “A nd

I think the American people can

understand that, that they will

understand where the virus is,

because we’ll have the testing

data, and where it isn’t, and make

sure that they are taking appro-

priate precautions as they moved

in and out of spaces.”

She expressed confidence that

the government could determine

the risk levels of counties, saying

that this type of geographic “ laser-

like” f ocus is already being done in

sub-Saharan Africa to combat the

spread of HIV.

The White House has high-

lighted its 15-day social distancing

campaign that is set to expire

monday as its premier effort to

combat the pandemic.

Vice President Pence told re-

porters that the task force would

present Trump with a range of

recommendations for additional

guidance this weekend so that he

can determine what social dis-

tancing guidelines should be pro-

vided going forward.

Trump has sought to present

himself to the public as respond-

ing proactively to the crisis, after

initially having dismissed the

Governors at odds with president over way forward