THE WALL STREET JOURNAL. ** Friday, March 13, 2020 |A
A woman who tested positive for the coronavirus is brought to a hospital, above, while the University of Utah hospital has erected negative-pressure screening tents..FROM TOP: CHRIS MACHIAN/OMAHA WORLD-HERALD/ASSOCIATED PRESS; GEORGE FREY/REUTERSvention. “I pump gas and put
on Purell,” she says. “He’ll just
pump gas and then scratch his
face. I’m like, What are you
doing?”
Erika Boissiere, a marriage
and family therapist in San
Francisco, says that while peo-
ple are preparing for good rea-
sons, excessive coronavirus
preparation is likely a re-
sponse to fear. “What do we
do when we get scared? Westart to try and control what
we can,” she says. “That’s why
we see people buying out
Costco.”
Mrs. Boissiere’s own hus-
band, also a couples therapist,
is more of a germaphobe than
she is. The couple recently
talked about whether she
should travel to a couples-
therapy workshop in Mexico,
which had been booked since
October.Some of Jocelyn Wiser’s supplies. ‘My husband thinks I’m being
paranoid,’ she says.JOCELYN WISERHospitals
Challenged
By Virus
FROM PAGE ONE
ples all over the world are ex-
periencing everyday tensions
and a steady stream of eye rolls
tied to one fundamental ques-
tion: Which of us is reacting
appropriately?
Up for debate are issues tied
to both prevention and pre-
paredness: What’s all this toilet
paper doing in the house? Will
we never go to the movies
again? And did you seriously
just touch a doorknob at the
doctor’s office and then try to
touch my face?
Ms. Krieg says she believes
her husband doesn’t think
she’s taking the virusseriously
enough. Her husband says,
through his wife, that he is
taking it seriously enough for
the both of them. He declined
to comment further.
For Kimberley Bernier, 52,
of Ottawa, differences with her
husband over the coronavirus
are more about basic preven-
Continued from Page One
tion. She says she has obses-
sive-compulsive disorder and
washes her hands a minimum
of 20 times a day. “I’ve been
talking about the whole idea
of a pandemic for years,” she
says. Meanwhile, he likes to go
around touching things.
“It’s just everything. It’s
like even if he doesn’t have to
touch it, he touches it,” says
Mrs. Bernier, a teacher.
Recently, Mrs. Bernier says,
her husband used his bare
hand to turn the doorknob at
the doctor’s office and he han-
dled the magazines she esti-
mates have been sitting there
for 10 years. Then he tried to
touch her. “I was like, hello,
coronavirus?” she says. “If he
wants to get sick that’s his
business but don’t get me
sick....It’s a dog-eat-dog
world.”
Mark Bernier, 51, an engi-
neer, confirmed that he does
like to give hugs and kisses,
and that he may not always
remember to wash his hands
before he’s affectionate with
his wife. He added that she
tends to exaggerate about him,
a lot. “I think in your day-to-
day interactions, you have to
touch things and that’s just
howitis,”hesays.
Kari Jackson, 54, and asales representative in Seattle,
says her husband was already
the type to have food on hand
in the event of some kind of
doomsday scenario. Coronavi-
rus fears have kicked his prep-
aration tendencies into high
gear. “He felt the need to go to
the grocery store and get 40
cans of tuna, probably 10 to 15
boxes of Hamburger Helper,”
she says. “I’m like, honey,
there’s not going to be any
hamburger meat so I don’t
know what you think we’re go-
ing to do with the Hamburger
Helper.”
Her husband, Mark Jackson,
54, is a former first responder
who says he has experienced
earthquakes, wildfires and ri-
ots. “You see the fringe of
what society could turn to
quickly,”hesays.“There’san
old adage in the preparedness
community: If you prepare for
the zombie apocalypse, a hur-
ricane is just a breeze.”
Mr. Jackson says he has
three months of provisions in
the house, and that he’s
thought about taking an “ex-
tended vacation” in a remote
location if things get really
dire. What perplexes Mrs.
Jackson is that her husband
isn’t taking equally careful
measures with respect to pre-“There wasn’t a disagree-
ment per se,” says Mrs. Bois-
siere, speaking from a lounge
chair in Puerto Vallarta. “He
would have preferred me not
to have gone.”
Phil Boissiere says, “She’s
taking the most appropriate
precautions that she can take
if you’re in agreement that go-
ing on a plane to Mexico is ap-
propriate to begin with.” His
wife ultimately flew with hand
sanitizer, a face mask and
gloves—which he provided.
Danny Wiser, 33, a technical
onboarding specialist from
Omaha, Neb., says he’s just
naturally not a worrier. “I‘m
one of those people who is go-
ing to deal with stuff as it
happens,” he says. “I think
having 10,000 rolls of toilet
paper isn’t necessary.”
His wife, however, keeps
adding more things to the cart
when they’re at the grocery
store.
“I think there’s this really
fine line between panicking
and just being smart,” says
Jocelyn Wiser, a 33-year-old
software configuration man-
ager who has developed
chapped hands from washing
them so much. “My husband
thinks I’m being paranoid. I
think I’m being prepared.”Hospital executives say they
are scouring inside and out-
side their walls for space to
put patients, tightly managing
dwindling stocks of medical
supplies and hunting for criti-
cal equipment and extra
health-care workers, who are
already in high demand and at
risk for quarantine from expo-
sure while on the job.
They acknowledge there are
limits to what they can do.
“We have a finite number of
rooms,” said Ron Rittenmeyer,
chief executive of Tenet
Healthcare Corp., one of the
nation’s largest hospital com-
panies. “That’s it.”
Steps to limit large-scale
gatherings and encourage peo-
ple to stay home—which are
ramping up around the coun-
try—could help reduce the im-
pact of an outbreak in at least
some places, epidemiologists
say. In addition, government
and hospital officials’ contin-
gency plans could add capacity
in hard-hit regions.
Still, America’s hospitals
are ill-prepared for a wide-
spread outbreak, lacking
enough space and critical
equipment like ventilators to
handle a flood of contagious
and seriously ill patients, say
hospital and infectious-dis-
eases researchers. Critically,
the nation’s efforts to contain
the spread have been ham-
pered by problems expanding
testing for infections, allowing
the virus to spread unde-
tected.
“You’re setting yourself up
to fail if you can’t identify who
has the illness,” said Lauren
Sauer, director of operations
for the Johns Hopkins Office
of Critical Event Preparedness
and Response.
The limits of America’s hos-
pital system are an unexpected
downside of progress in effi-
ciency, advances in technology
and pharmaceutical break-
throughs that have made it
easier to keep patients out of
the hospitals. Insurers have
accelerated the trend by steer-
ing patients to less-costly care,
pushing for more procedures
to be done on an outpatient
basis, often outside hospital
walls. The number of hospital
beds—and hospitals—has con-
tracted in recent decades,
dropping 16% and 12%, respec-
tively, between 1975 and 2018,
survey data from the American
Hospital Association show.
U.S. hospital beds per
American have declined in the
past two decades to a ratio of
2.8 beds for every 1,000 peo-
ple as of 2016. That ranks
among the lowest across com-
parable countries, a Kaiser
Family Foundation analysis of
Organization for Economic Co-
operation and Development
data shows. The average
across those countries, includ-
ing Japan, Germany and Aus-
tralia, is 5.4 beds per 1,
people. “We are operating on a
thin margin across the board,”
Ms. Sauer said. Hospital beds
include those in general, psy-
chiatric and other hospitals.
In a widespread outbreak of
Covid-19, the respiratory dis-
ease caused by the new coro-
Continued from Page One
navirus, not all patients would
need to be hospitalized. The
vast majority could recover at
home, the experience of China
and other nations suggest, as
most patients have moderate
symptoms, or none at all. But
about one in five with
Covid-19 become more gravely
ill, according to a report by a
World Health Organization-led
mission to China.
The most severe cases suf-
fer organ failure. One estimate
by an infectious-disease spe-
cialist with the University of
Nebraska Medical Center pro-
jected 96 million infections in
the U.S., with 5% needing hos-
pitalization, or 4.8 million
people.
Globally, estimates for the
death rate from the virus have
varied, from as high as 5.8% to
less than 1%.
The new viral strain, which
the WHO declared a pandemic
this week, has sped across
borders and strained or over-
whelmed hospitals from Wu-
han, China, where it emerged,
to Italy and South Korea. Eu-
ropean doctors have called for
stricter measures to slow con-
tagion, warning that health-
care systems are unprepared.
Soaring demand for medical
supplies has left doctors and
hospitals globally grappling
with shortages.
U.S. officials are taking
steps to contain the spread, in-
cluding a recent ban on travel
from most European countriesand quarantining contacts of
those infected. But public-
health officials say it may not
be enough to prevent wide-
spread outbreaks on domestic
soil.
If the U.S. experienced an
epidemic similar to that in
Wuhan, which has had more
than 49,900 confirmed cases,
the patient need for intensive-
care unit beds might be triple
the number of unoccupied ICU
beds typically available here,
according to an analysis by
Marc Lipsitch, a professor of
epidemiology at the Harvard
T.H. Chan School of PublicHealth, Ruoran Li, a graduate
student there, and others. Only
around a third of U.S. ICU beds
are typically open, he said.
“An experience like what
happened in Wuhan would be
devastating to our health-care
system,” said Eric Toner, a se-
nior scholar with the Johns
Hopkins Center for Health Se-
curity. “We have nowhere near
the capacity to handle that.”
In places where social dis-
tancing and other tactics to
reduce the spread were imple-mented in a timely way, the
outbreak’s effects were less
than what was seen in Wuhan,
he said. In the U.S., “we have
to be preparing for a spectrum
of possible outcomes. It won’t
affect every hospital at the
same time.”
By one survey, U.S. hospi-
tals operated roughly 97,
intensive-care beds in 2018,
though the figure excludes
federal hospitals and included
responses from about 80% of
the nation’s hospitals, accord-
ing to the AHA, which con-
ducted the survey. This in-
cludes specialty beds, such as
burn care and neonatal inten-
sive care.
Another pressure point,
said Dr. Toner, would likely be
mechanical ventilators, since
thesickest Covid-19 patients
may have trouble breathing.
The U.S. has around 100,000 to
150,000 ventilators, including
other types of equipment that
could be used to ventilate pa-
tients in a crisis, he said.
At the peak of the Wuhan
outbreak, roughly 2,
Covid-19 patients were on me-
chanical ventilation, from a
city about the size of New
York, he said. “I would be very
surprised if New York could
accommodate an extra 2,
people requiring mechanical
ventilation.”
The New York City Depart-
ment of Health and Mental Hy-
giene said the city’s hospital
system had roughly 1,000 ven-tilators, but didn’t provide a
citywide number including pri-
vate hospitals.
New federal guidance this
week on some procedures for
handling coronavirus patients
may allow hospitals to bypass
some stringent precautions in
place since the outbreak be-
gan, under certain circum-
stances, following updates
from the CDC.
The Centers for Medicare
and Medicaid Services said
coronavirus patients could be
safely isolated in a typical
room, rather than a so-called
negative pressure room, as
long as they were alone and
not undergoing procedures
that could spread the virus in
the air, such as intubation.
Health-care workers can
now use surgical masks as
protective gear where recom-
mended masks, known as N
respirators, are in short sup-
ply, CMS also said.
Major groups representing
doctors, hospitals and nurses
sent a letter Thursday asking
President Trump to declare a
state of emergency to “ensure
that health care services and
sufficient health care items are
available to respond to the
Covid-19 outbreak.”
Hospitals typically plan for
a surge in patients during
emergencies, assessing where
they might squeeze in more
beds, canceling elective sur-
geries and stepping up efforts
to send home patients as soon
as they are ready. Hospitals in
recent weeks have also urged
patients to stay away unless
directed by a doctor to an
emergency room. Some have
used telemedicine and chat
bots to screen patients re-
motely. Others have set up
tents outside emergency
rooms to screen patients who
never enter a waiting room.
HCA Healthcare Inc., one of
the nation’s largest hospital
systems, is asking staff across
its roughly 180 hospitals to
look for anywhere it might
modify to put more patients,
from storage closets to shut-
tered buildings, said Jane Eng-
lebright, the company’s chief
nursing executive.
“We don’t want to be
caught unprepared,” she said.
Its hospitals operate in com-
munities that get hit by earth-
quakes, wildfires and hurri-canes, she said. “We were
thinking that would be one of
the most challenging years.
Now we’re thinking it might
be this one.”
The Cleveland Clinic’s con-
tingency plans call for ending
elective procedures and set-
ting up 150 hospital beds,
complete with IVs, in a nearby
hotel or, potentially, a field
hospital, said Robert Wyllie,
the Ohio-based health system’s
chief of medical operations.
That would give the Cleveland
Clinic another 1,000 beds to
accommodate Covid-19 pa-
tients, he said. The Cleveland
Clinic would probably put non-
Covid-19 patients who were
close to discharge in the
rooms outside its main facility,
as their needs would likely be
less acute, he said.
Infectious-disease experts
are urging hospitals to sepa-
rate patients with confirmed
or suspected Covid-19 into
dedicated wards. Nebraska
Medicine, the hospitals and
clinics affiliated with the Uni-
versity of Nebraska Medical
Center, set up one such ward
this week and has plans for
another, which would require
hospital staff to relocate pedi-
atric patients to empty space
scheduled for renovation, said
Dr. John Lowe, head of re-
search for the Nebraska Bio-
containment Unit.
Providence hired temporary
nurses in Seattle, where it has
eight hospitals, and where the
largest U.S. coronavirus out-
break is under way, said Amy
Compton-Phillips, Providence’s
chief clinical officer.
Six of its hospitals in Wash-
ington and California had two
dozen patients with confirmed
coronavirus cases as of
Wednesday, with another 38
patients awaiting test results,
she said. Hospitals still have
room for more patients, she
said, but that could change
with the area’s widening out-
break.
Its crews are fashioning
new isolation rooms with por-
table equipment, she said. “It
looks like MacGyver has been
working in our hospitals,” said
Dr. Compton-Phillips. “We
have fans and filters and holes
that have been filled up
through any means necessary.
Duct tape solves a lot of prob-
lems.”Stockpiling
Divides
Couples
‘It looks like
MacGyver has been
working in our
hospitals.’