If the latest COVID-19 disease model from the Institute for Health Metrics and Evaluation, which says hospitalizations will peak April 24 with a need for 350-plus beds, holds, Arkansas hospitals should be able to handle that surge. That good news can be attributed to social distancing and other measures the state has taken to “flatten the curve” of infection.
But hospitals and nursing homes and emergency health care providers are still staring down the possibility of shortages of personal protective equipment — PPE — to take care of the patients and protect against spread now. The first shipment of state-procured equipment came in Saturday: 50,000 units, mostly surgical masks, according to the Joint Information Center at the Arkansas Department of Health. At Baptist Health, as at all Little Rock hospitals, administrators and medical personnel meet at noon every day to discuss “how much PPE do we have today, how many days supply?” Chief Nursing Officer Michele Diedrich said during an April 2 interview. “Today I’m in a very good position. I’m clarifying: today. … Tomorrow may be a whole other ballgame.”
PPE “is something we are working on 24 hours a day,” CHI St. Vincent Medical Director Dr. Gerry Jones said. “We’re holding our own.”
Jones said he gets “a dozen phone calls or texts everyday, ‘Hey, I know a guy who has 10,000 masks,’ and we run down every lead. Most turn out to be something we can’t use, but we’re trying to leave no stone unturned.”
Good samaritans, like Ruth Tippett of the Cashsaver in Heber Springs, have donated personal stores of PPE; Tippett gave Baptist 1,200 N95 masks and Jones said national corporations, painters and electricians have made donations to Baptist.
David Wroten, the executive vice president of the Arkansas Medical Society, said the society has been working with state agencies to address “the shortage or complete lack of personal protective equipment” for doctors in private practice. He said they’re due to receive around 10 percent of the supplies the state is spending $76 million to procure.
Wroten said around 100 to 150 clinics have responded to the society’s inquiries on needed PPE. “We’re now faced with the difficult task to find out how to get it to them,” Wroten said. “It’s the hardest thing I’ve ever had to do.”
The University of Arkansas for Medical Sciences has put out a call for homemade masks, though not as a supply for its critical care workers. The homemade masks are for labor and delivery, for mothers and their one attendant, who are now required to wear masks. “Also, some of our patients and caregivers have asked for them,” as well as employees, spokeswoman Leslie Taylor said Thursday. Donations should be taken to the volunteer office at the Winthrop P. Rockefeller Cancer Institute.
Personnel at the Conway Human Development Center and other human development centers run by the Department of Human Services are being asked to reuse surgical masks, storing them in paper bags when not in use, DHS spokeswoman Amy Webb confirmed. That’s allowed under CDC and state emergency guidelines.
The IHME, an arm of the University of Washington, which offers one of the most optimistic COVID-19 models, estimates that Arkansas hospitals will need 359 beds, 74 of them intensive care beds, to handle the April 24 surge of patients. It estimates a need for 63 ventilators. Arkansas has 732 ICU beds, though not all would be used for COVID-19 patients; some are NICU beds and there are also burn unit beds. As of April 4, there were 551 ventilators available.
Hospitals and the health department, however, have been preparing for a much greater surge of patients. The ADH has been working with hospitals and the U.S. Army Corps of Engineers to prepare for 1,000 beds if needed. Hospitals are freeing up beds by not doing elective surgeries, fitting out rooms with negative pressure — to keep air from leaving a patient’s room — and making plans for expanding their critical care beds.
UAMS Health, which has 400 beds, for example, has dedicated 43 rooms on three floors of its central hospital to COVID-19 patients, and is modifying the ninth floor for more. If needed, 80 critical care beds can be dedicated to COVID-19 patients; ICU beds for other patients could be created in post-anesthesia and operating rooms, CEO Dr. Steppe Mette said. In all, UAMS is creating capacity for 241 COVID-19 patients.
“We are not letting our guard down,” Mette said today. “The predictions are that it will come back. And that’s why we are not shying away. This will help us for any other pandemic that comes down the pike.”
Baptist Health has 90 total critical care beds at its 648-bed Little Rock campus, Diedrich said; it can increase that to 125 critical beds during a surge by repurposing surgical suites. (The hospital does not disclose the number of COVID-19 patients it’s treating.)
As of April 8, 369-bed CHI St. Vincent had 14 critical care beds dedicated to its patients with confirmed or suspected cases of the new coronavirus, medical director Jones, who is a cardiothoracic surgeon, said, “and of course we have the ability to expand.”
Arkansas Children’s Hospital is considering raising its age limit — now 21 — in the case of a surge, and would take non-COVID-19 patients from other hospitals in case they needed more beds.
UAMS is hiring nurses; Baptist has ICU nurses in all areas of the hospital to draw on, Diedrich said. The nurse-patient ratio in ICUs is generally one-to-one, though that could change in a surge. Both St. Vincent and UAMS have had to quarantine medical staff; Baptist declined comment on staff quarantines.
CHI St. Vincent has staffed its COVID-19 rooms with volunteer health care providers. “We have more people who have said, ‘I’m willing to go up there and help’ than we have slots at any one time,” Jones said. “One of our housekeepers who volunteered to go up there has got a disposable jumpsuit that she wears along with her PPE, and I saw up there one day she’d drawn a logo on the back of her jumpsuit that said ‘Covid Killer.’ She’s incredibly loved by the staff.”
Hospitals are showing “unprecedented cooperation in dealing with this crisis,” Jones told the Times. “These are hospitals that compete fiercely, yet we have been very open,” working together on Little Rock’s COVID-19 task force.
While the need for beds and ventilators and nurses may be less than feared at surge — now a little more than two weeks away, according to the IHME projection — there is the possibility that the new coronavirus, like the flu virus, will return in fall. “We’re very happy to be over-prepared,” Jones said. Is there such a thing? “It’s a good point. I don’t think you can be over-prepared.”