Hospitals plan for 'COVID cabanas,' conference rooms to house patients

FILE PHOTO: Newly erected negative pressure screening tents are set up outside the emergency room entrance at University of Utah hospital as they prepare for coronavirus testing, in Salt Lake City, Utah, U.S., March 9, 2020. REUTERS/George Frey

(Reuters) - U.S. hospitals, bracing for a surge in demand as more Americans are infected with the novel coronavirus, plan to use tents, conference rooms and cafeterias to house overflow patients.

Scripps Health, which operates five hospital campuses in San Diego County, is starting to set up tents outside its clinics to screen people for the virus. "By Friday we will have what we are euphemistically calling COVID cabanas at two of our clinics," Chris Van Gorder, its chief executive, told Reuters.

Cedars-Sinai Medical Center in Los Angeles on Thursday began seeing patients in tents set up in its parking garage. "Patients who present to the emergency department will be screened. If they have respiratory symptoms they will potentially be sent to this area," said Jeff Smith, the centre's chief operating office. "We are anticipating that some will test positive for coronavirus."

Members of the American Hospital Association have been advised to prepare for 96 million cases in the next few months, with 4.8 million additional admissions, 1.9 million intensive care unit (ICU) admissions and 480,000 excess deaths - or about 10 times the number caused by a severe flu season.

"If we have a full-blown outbreak, as is predicted by almost all the modellers, we may have a situation where we are 75,000 to 100,000 ICU beds short," Dr. Irwin Redlener, director of Columbia University's national centre for disaster preparedness (NCDP), told Reuters.

Experts estimate that about 80 percent of people infected with the virus, SARS-CoV-2, will have only mild symptoms. The Centers for Disease Control and Prevention recommends that these patients remain at home, isolating themselves as much as possible.

COVID-19, the disease caused by the virus, is a highly contagious respiratory illness. About half of the remaining 20 percent of infected individuals are likely to develop serious symptoms, with the most severe cases requiring hospitalization. The elderly and people with underlying health conditions, such as diabetes, heart disease and cancer, are most at risk.

There are currently 95,000 ICU beds in the United States, the NCDP says.

The number of coronavirus cases in the country has risen steadily to over 1,300, with 38 deaths, according to a tally by Johns Hopkins University in Baltimore.

Smith at Cedars said the two-hospital centre currently has adequate ICU capacity, but is anticipating that the number of patients will grow. "Contingency plans could include caring for patients in anaesthesia recovery units or other areas within the hospital," he said.

The 1,400-bed Scripps hospital group has 99 negative pressure isolation rooms used to contain airborne contaminants, three of which are in use - including one patient with COVID-19.

If the number of COVID-19 patients surpasses that, Van Gorder said temporary air handlers can be brought in to convert standard rooms - or even an entire wing or floor of a hospital - into isolation units. Tents could also be used to house patients if needed, he said.

California Governor Gavin Newsom on Thursday issued an executive order clearing the way for the state to "commandeer property," such as hotels, to quarantine or treat COVID-19 patients.

"A lot of our care we are planning to do remotely via telemedicine or video medicine," the Scripps CEO said. "Hospital beds would be reserved for seriously ill patients."

Scripps has been working to make sure personnel are "fit tested" for masks, including reusable powered air purifying respirators, or PAPRs, that can be cleaned in about 25 minutes.

"We generally have about 1,000 beds that are free on any given day for a surge in illness," Los Angeles County Public Health Department Director Dr. Barbara Ferrer said at a press conference this week.

Ferrer said an influx of seriously ill patients who need treatment in an intensive care unit could overwhelm hospitals in the nation's most populous county.

"We are going through the process of identifying decommissioned beds, and other areas within the hospital where we have the ability to expand," said Jeremy Baker, executive director clinical quality, risk and safety at two Los Angeles-area hospitals run by Providence St. Joseph Health, a 51-hospital chain. "We are constantly reviewing our surge capacity plan to identify other units we could use, such as conference rooms, for less acute treatment."

He said Providence is also looking to put up screening tents at its clinics to isolate possible COVID-19 patients from emergency rooms, and could shift some non-coronavirus care to its associated nursing homes.

"As part of our normal disaster planning process, we do have the ability to put out a call for physicians. We do have an emergency credential process for that," Baker said.

In New York City, Mayor Bill de Blasio said on Thursday that they were entering "a situation where the only analogy is war, and a wartime dynamic," referring to how the city will deal with a surge in demand for hospital beds.

"Hospitals will create brand new capacity," de Blasio said at a news conference. "I'll take a parking lot and put up a tent and turn it into an ICU. We'll turn a cafeteria into an ICU."

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