Are Our Hospitals Ready? What If We Run Out of Ventilators? ELi Bringing Answers

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Wednesday, April 1, 2020, 8:40 am
Emily Joan Elliott

Photo: Sparrow Hospital's drive-through in a photo for ELi by Gary Caldwell

Today’s “Ask ELi” column brings together questions we’ve received from readers about the coronavirus in terms of medical concerns. As always, these are actual questions received from readers. If you have a question you want ELi to investigate, contact us.

Question: What is our local hospital capacity to take care of me if I am sick with COVID-19 and need to be hospitalized in an ICU bed, or worse yet, need a ventilator? What is the capacity of our local hospitals in this regard (especially given that there are already other patients there for other reasons), and how much demand have patients with COVID-19 placed so far on this capacity?

We contacted both Sparrow and McLaren Hospitals to ask them about their bed capacity, and neither was willing to give a specific number. However, according to their websites, Sparrow Hospital has 676 licensed beds, and McLaren Greater Lansing has 310 acute care beds.

That said, Dr. Aron Sousa, interim Dean of the College of Human Medicine, cautions that the reported numbers are not the actual numbers available today. Both hospitals have some surge capacity built-in and are actively looking for ways to increase capacity.

John Foren, a representative for Sparrow Hospital, confirmed that Sparrow is currently operating below capacity. He also reminded readers that Sparrow also has community hospitals in Eaton, Ionia, Clinton, and Carson City, which would help mitigate surges.

Sparrow Lansing is considering every possible space to see how it could accommodate more patients. It has also stopped all elective surgeries, freeing up space, ventilators, and personal protective equipment (PPE). Foren thanked the community for its generosity in donating PPE.

Sousa explained that canceling elective surgeries was important for increasing capacity. Empty operating rooms provides spaces for beds. Additionally, patients undergoing surgery are often put on ventilators, so this measure also increases the number of ventilators available for COVID-19 patients.

ELi’s Alice Dreger reported yesterday morning that, according to Linda Vail, the Health Officer for the Ingham County Health Department, 13 people with COVID-19 in Ingham county are currently hospitalized. A few others had been hospitalized and released.

Sousa explained there are concerns that hospitals in Michigan will exceed capacity, but it is unclear what a statewide projection means for our area. Hospitals in southeastern Michigan are currently at capacity, but it is unlikely that they would send their COVID-19 patients to Lansing-area hospitals. Sousa said they may send non-COVID-19 patients here if the situation deteriorates further.

McLaren Greater Lansing would only share that it is currently operating below capacity.

Question: I have heard that the public has been asked to give blood, but how do they know who may have the coronavirus? Wouldn't giving infected blood to another person cause them to be infected?

Answer: Even before the COVID-19 pandemic, the American Red Cross, which oversees most blood drives and donations in the area, has always performed screenings for infections. Prospective donors answer a series of questions and, for example, cannot donate blood if they have traveled to certain countries recently. Staffers also check prospective donors’ temperature and blood pressure to make sure that they are well enough to donate.

These processes alone do not necessarily preclude an asymptomatic person with COVID-19 from donating blood, but Dr. Sousa explains that after someone donates blood, the agency that has collected it screens it for a series of viruses and other pathogens. Moreover, blood donations are actually spun out and washed, destroying and removing viruses. Sousa also said that COVID-19 can be detected in the blood.

We tried to contact the American Red Cross to see if they had changed their policies following COVID-19, but due to the high volume of callers, we could not get through.

Question: What if any assistance is MSU – with its two medical schools and a nursing school – providing or planning to provide in terms of medical personnel, supplies, and physical space?

MSU has provided supplies, including personal protective gear, to hospitals in the Lansing and Grand Rapids areas. MSU was able to donate these supplies since it had canceled labs and simulations for its students. The university has also offered backup lab space to the State of Michigan. Other spaces on campus may be used to house patients and care providers.

MSU announced this week that its medical students would be graduating early so the newly minted physicians can assist during the crisis. Sousa also stated that MSU employs the largest group of physicians in the Lansing area. MSU faculty in the two medical schools and nursing schools work at both McLaren and Sparrow helping patients.

University professors and physicians have also been developing tests to help with screening for COVID-19.

And, as ELi has previously covered, Dr. Nigel Paneth has been tirelessly working with physicians across the United States to make convalescent serum available to those afflicted with COVID-19. That project, known officially as the National COVID-19 Convalescent Plasma Project, launched its website this week.

Just as realities on the ground change by the second, so does the website. The website currently offers information for health care providers; those who have recovered from COVID-19 and would like to donate their antibodies; and patients. Those interested can also find scholarly articles, news updates, and data from China’s epidemic.

Above: Nigel Paneth at his front door in the Glencairn neighborhood, in a photo taken with a zoom lens by Gary Caldwell

Those who recovered from COVID-19 can sign up to receive information on how they can donate their plasma. Paneth and his team are working to post information on where recovered patients can test to ensure that they are virus free and have antibodies as well as locations where they can donate their plasma.

Physicians can use the convalescent serum for non-trial, compassionate use. Paneth is developing a form for doctors to document some information about their patients and to provide short, daily updates, usually of just one word, such as “improved,” or “worsened.”

The serum will also be tested through clinical trials.

Question: Should our local hospitals ever fill up with COVID-19 patients, what procedures do they have in place to decide who gets that last ventilator, who gets taken off a ventilator to save a patient who is more likely to survive, etc. Is this guided by some kind of professional or statewide set of “rules” or is it hospital by hospital, or practitioner by practitioner?

Late last week, a letter from Henry Ford Hospitals, which outlined whom they would help once resources became too scarce, was leaked and showed that the hospital was working on plans to prioritize “patients who have the best chance of getting better” in the event the hospital was overwhelmed and did not have the capacity to try to save everyone with every measure.

Representatives at Henry Ford said this is not current policy at the moment and could be revised. The Federal Office for Civil Rights released a statement the next day, stating that denying ventilators on the basis of age or disability was discriminatory.

Both Paneth and Sousa emphasized two points: in the event there is an overwhelming surge, triage will happen and hospital ethics boards will determine guidelines.

Triage comes from the French “trier” or to sort. The term is often associated with medical care in Napoleon’s Grande Armée, when those more likely to survive were separated from those more likely to die. In a military situation, resources are scarce and those in charge have to make tough decisions about whom to treat first. Should our hospitals become overrun, patients will be triaged.

Above: Aron Sousa (photo courtesy of MSU)

Sousa elaborated that medical professionals prioritize saving as many people as possible with the resources they have. This could result in either treating the sickest first or prioritizing those with the greatest chance of survival – it depends on what is available to the nurses and doctors trying to save lives and what is known about the course of the disease in terms of mortality risks.

While there are various hypotheses on how triage would work, Paneth and Sousa really emphasized that Sparrow’s and McLaren’s hospital ethics boards would make decisions. These boards existed before the COVID-19 pandemic to address other issues. When making decisions, they usually consider guidelines from the American Medical Association and the American College of Physicians.

Question: I recently heard that health ministries in Britain and France are advising against taking ibuprofen, arguing that patients who take it tend to have worse outcomes. Instead, they are recommending that people with COVID-19 symptoms take acetaminophen. Should I worry about taking ibuprofen?

Paneth believes that this has gotten more media attention than medical. Sousa stated that this conclusion was “based on the most tenuous information going.” Sousa pointed to a series of changing statements from various organizations. At one point, the W.H.O had recommended against the use of ibuprofen but later stated it was no longer recommending against it. He explained that the level of evidence is on the case level. No controlled, randomized scientific study or trial has proven this. There is not high enough quality evidence to draw a conclusion.

Paneth said that if your doctor told you to take ibuprofen or you have been told to take a medicine that contained ibuprofen, absolutely do not stop taking your medicine without speaking to your doctor. You should never stop taking a medicine without consultation because the effects could be severe. However, Paneth believes that the average person at home who needs a pain killer or fever reducer can opt for acetaminophen instead of ibuprofen and put their minds at ease.

Question: From this situation, it is clear that hand washing, covering coughs and sneezes, and social distancing are important for stopping the spread of the disease. Some years, the flu kills 60,000 people a year. Do we not take the threat of the flu seriously enough?

Sousa believes that we can always do more to take the flu more seriously, but he also strongly emphasized that COVID-19 is not the flu.

Without the measures being taken, the death rate for COVID-19 would blow the flu out of the water. In fact, a few hours after speaking to Sousa, Dr. Anthony Fauci and President Trump acknowledged that 100,000 to 200,000 Americans may die of COVID-19, even as we continue social distancing. The death count will be much higher if we do not.

It's also worth noting that there is no vaccine for COVID-19 like there is for the flu.

In flu seasons to come, at-risk populations should get the flu shot, and we should continue the good habits that we are learning such as hand washing. But, we should not conflate the coronavirus and the flu.

Above: Photo for ELi by Gary Caldwell

Question: My hands are dry and cracked from the constant washing. Is it possible that I am washing my hands too much?

No; keep on washing. Paneth recalled his time as a resident on rotation in a nursery ward. Between caring for each baby, he had to wash his hands. Yes, they will chafe but embrace moisturizer and lotion to help you through.

When I wrapped up my conversation with Paneth, he asked me to pass along to readers that they should take precautions to protect their mouths and noses when interacting with others. If you have an open box of masks that a hospital cannot take, use them. (If you have an unopened box, local hospitals would be delighted to accept your donation.)

Paneth does not think that those without masks should go out and buy them. Consider wearing a scarf or handkerchief over your mouth and nose. According to Paneth, we are past the point of worrying about perfection. Anything protecting your respiratory system and the respiratory systems of others is better than nothing.

ELi has a special section dedicated to our reporting on COVID-19 for East Lansing. See it here and sign up for ELi’s mailer to stay informed © 2013-2020 East Lansing Info