Gov. Janet Mills has said that the situation will likely get worse before it gets better. And hospital bed capacity could be a major issue. Different models project that hospitals — in Maine and elsewhere across the country — don't have enough beds to handle a surge in patients. Patty Wight spoke with Nora Flaherty about the projections for Maine and what's being done to prepare.
Flaherty: What is the outlook for Maine as the cases of COVID-19 continue to grow?
Wight: First, let's talk about how many hospital beds there are in Maine. According to the Harvard Global Health Institute, which created a model to project hospital capacity, as of 2018, there were about 3,600 hundred hospital beds in Maine. That includes about 300 beds in intensive care units.
And looking at those numbers and how many beds are typically available, Maine will only have enough hospital beds under a best case scenario for the spread of the coronavirus. That best case scenario, according to this modeling from Harvard that was released in conjunction with ProPublica, is if only 20 percent of the adult population is infected with COVID-19 over the span of one year to a year and a half. If the infection rate is higher, or if it spreads more quickly, we're not going to have enough hospital beds to treat the patients who need it.
Flaherty: And estimates in this model are that about one in five adults who are infected will need to be hospitalized?
Wight: That's right. And of those hospitalized, another fifth are expected to be critically ill and need intensive care.
Flaherty: Okay, so under a best case scenario, where the infection rate is low, and it is spread out over a longer period of time, Maine will probably have enough beds. But what if we see a higher number of infections? How short of beds will we be?
Wight: Let's go to a moderate scenario, where 40 percent of the adult population is infected with COVID-19 over the course of a year. In the southern part of the state, we would need three and a half times the number of available beds we currently have. In the northern part of the state, we'd need more than double the available beds.
Those are just regular hospital beds. But for those critically ill patients who need to be in intensive care units, we have far fewer available. The projections are that we have been six and seven times fewer the number of ICU beds that we'd need.
So, the overall takeaway is that Maine needs to expand its hospital bed capacity even under a modest COVID-19 scenario. And we're not alone in this — hospital beds are a constrained resource across the country.
Flaherty: What are hospitals saying about these projections?
Wight: They are concerned, but not really surprised. Dr. James Jarvis from Northern Light Health said in an email Maine hospitals are already at or near capacity during normal times. And here's what Dr. Dora Anne Mills, from MaineHealth had to say:
"We could very quickly, within the next three or four weeks, run out of beds in Maine if we don't act now."
Hospitals have already taken some action. The three major health systems in Maine — MaineHealth, Northern Light Health and Central Maine Health Care — have all postponed most, if not all, elective procedures. That's one way to free up hospital beds. That also frees up staff. Another option is to set up additional beds at alternative care sites. Dr. Mills from MaineHealth says those sites include tents.
"And we have other, there are other buildings in our communities that are designated as possible alternate care sites, so we are in the process of looking at all of those."
And this is something that Dr. Nirav Shah, the director of the Maine Center for Disease Control, says is being explored throughout the state, in conjunction with the Maine Emergency Management Agency.
Flaherty: What else is being done at the state level?
Wight: Dr. Shah says health experts are working on getting a better understanding of which patients with COVID-19 can safely be cared for at home, versus who really needs to be hospitalized. That could help alleviate some pressure.
Dr. Shah also said the state is looking at staffing. Because if the state or hospitals set up more beds, we're going to need more health care workers to tend to those patients. As I mentioned earlier, staff that are being diverted away from elective surgeries would help. But for patients that require intensive care — staff needs more specialized training. And Dr. Shah says that's where telemedicine could help.
"...Among many options, so that if high numbers of people need to be on ventilators, experts from other parts of the country can adjust and fine tune those ventilator settings on an occasional basis, even if they may not necessarily be here."
Flaherty: We've talked about what the state and hospitals are doing to prepare. These projections for a lack of hospital beds also underscore what the public needs to do in terms of social distancing, doesn't it?
Wight: That is a huge part of this. If you look at these projections, it's pretty startling about what we could be facing, which, of course, Italy has already experienced. Dr. Mills from MaineHealth says the key takeaway is that people really need to adhere to social distancing to flatten the curve, to slow down and spread out the number of cases here.
"You can tell that that is what we absolutely have to be doing now to keep the surge down. And it's so critical. Because when you see these numbers that are projected of people who need hospitalization, they quickly become beyond the number of hospital beds in the state of Maine."
Originally published March 19, 2020 at 5:59 p.m. ET.