Central Arkansas hospitals collectively could add 700 new beds to existing surge capacity should a model predicting the need for 3,000 beds statewide by fall prove accurate, University of Arkansas for Medical Sciences Chancellor Dr. Cam Patterson said in an interview this afternoon.
Patterson has spent the past two days talking about the need to prepare for a surge in cases based on those models, addressing the UAMS board of directors Wednesday and the Arkansas Legislative Council Thursday. He warned them that models also show the state would need 900 intensive care beds and 800 ventilators.
The state has a total of 8,917 beds, according to the Arkansas Department of Health figures. Of that total, 972 are intensive care beds. The state also has 896 ventilators. The numbers for ICU beds and vents are cutting it close, should the model prove close to being accurate, and no additional capacity was built.
UAMS has already prepared for the surge by converting 43 rooms on three floors of its central hospital to negative pressure rooms, and has converted more rooms on a fourth floor. Dr. Steppe Mette, CEO of UAMS Health, has said UAMS can handle 241 COVID-19 patients now. Baptist Health CEO Troy Wells told legislators today that the hospital could increase its critical care beds from 198 to 295.
The new beds would be created by turning existing beds, such as post-surgical beds and endoscopy suites, into ICU beds, Patterson said. More health care providers would be “repurposed” to handle the additional demand, and staffing might change from ratios of one nurse to two ICU beds to four. Arkansas would be in the same boat New York hospitals were in six weeks ago, he said. Elective surgeries would once again be halted and those needing emergency treatment might choose to stay home, as the CEO of Washington Regional Medical Center told legislators today had happened in Fayetteville. Hospitals, already expected to lose many millions of dollars from the earlier surgery shutdown, would be in further financial trouble.
“The good news is that as time goes by, we have learned how to better care for these patients,” he said. There is a new therapy for very sick patients, the long-used steroid dexamethasone, which British research has shown to cut the risk of death by a third for patients on life support.
There is “no secret sauce” to prevent what is a fairly bleak scenario — but not even the worst-case scenario projected by models — from happening, Patterson said. Social distancing, good hand hygiene and wearing masks are still recommended. Asked if he would make mask-wearing mandatory, Patterson demurred, saying he would leave that to people who “manage public policy.”
Governor Hutchinson will not make mask-wearing mandatory, and has said that while he won’t challenge local ordinances to that effect in Fayetteville and Little Rock, he stressed at his COVID-19 presser in Fort Smith today that local laws cannot override state law.
If the governor asked his opinion on the issue of masks, “I’d say we need to be wearing masks,” Patterson said.
Washington Regional CEO Larry Shackelford make another salient argument for a mask mandate across Arkansas when he told legislators this morning that positive tests for the new coronavirus by his hospital had risen from 2 percent in mid-May to 14 percent this week.
That exceeds the 10 percent infection rate considered by some, but not all, epidemiologists as an indicator that transmission is under control. Hutchinson makes a point at his COVID-19 updates to display a graph indicating that Arkansas has exceeded the 10 percent rate only twice since mid-May.
The 14 percent positive rate should dispel any notion that testing, not spread of the virus, accounts for the almost doubling of total cases since the end of May, Shackelford said. “This is a health crisis,” he said. The region’s hospitals, which he said were handling as few as 3 COVID-19 patients in May, saw patient numbers in the mid-80s this week. Washington Regional’s 60 ICU beds were 75 percent full this week, Shackelford added.
Models that project disease transmission and hospitalization are not crystal balls. For example: Projections in March from the University of Washington’s Institute for Health Metrics and Evaluation for the outbreak in Arkansas were dire: 1,000 hospitalizations in mid-May. As of June 19, hospitalizations stood at 226 — a state record, but nowhere near 1,000.
National projections quickly changed, however, as states instituted shelter-in-place rules and other safety measures, and that information changed the math that epidemiologists used to create the models.
Two weeks ago, the Fay Boozman College of Public Health at the University of Arkansas for Medical Sciences, which created the models that Chancellor Patterson has been referring to, estimated that the number of persons infected with the coronavirus would reach almost 10,500 by June 23. That was an undercount: By June 19, a total of 13,606 Arkansans had been infected. The model for hospitalizations — which projected 200 for the week of June 1-7 — was a bit high; June 2 hospitalizations were 132, but that number jumped to 226 on June 19, as Northwest Arkansas cases surged.
No, the models are not predictions, but projection formulas updated weekly with ever-changing data input from the health department. “In many ways it’s like forecasting the weather,” College of Public Health Dean Mark Williams said. Models serve to predict a trend, not to give exact numbers. “What we’re looking for is slopes: Is it coming up? How rapidly is it coming down?” The farther out the prediction, both he and Patterson have stressed, the less confidence there is in the data.