Gov. Kate Brown’s warning Thursday that Oregon should be prepared for thousands of coronavirus cases put an exclamation point on the challenge facing the state’s health-care system.
“Let me be clear. Coronavirus is in our community,” Brown told reporters. “We should be prepared for thousands of cases in Oregon.”
Oregon’s outbreak — ruled a pandemic on a global scale — is testing the state’s healthcare system and its capacity to care for a surge of patients and maintain an adequate supply of respirators and other supplies.
So how prepared is Oregon for those thousands of cases the governor warned of?
More than 250 Oregon doctors responded to Gov. Brown in an online letter with a resounding, "no."
“We see ourselves making decisions in the next two weeks on who will live and who will die because we don’t have resources sufficient to care for them,” wrote the physicians — 259 of whom had added their names to the letter by 5:30 p.m.
“We have heard the stories second- and farther-hand from China and Italy and have no reason to think Oregon won’t suffer the same fate.”
The letter points to several reasons for concern. They range from an inadequately coordinated statewide response to a lack of hand sanitizer at all business entrances to hospitals that still need the ability to test patients for COVID-19.
In addition, medical clinicians and experts are questioning whether Oregon’s hospitals’ staffing levels and patient-bed capacity will be overwhelmed by a surge of those in need of COVID-19 treatment.
Based on projections by Seattle researchers, there could be as many as 75,000 cases in Oregon by May of this year, said Dean Sidelinger, the health officer and state epidemiologist for the Oregon Health Authority.
At the same press conference Thursday morning where Brown addressed reporters, Sidelinger said that the number of people infected by the virus has grown exponentially in Italy and Seattle.
The big question? How many of them will require hospitalization.
“I’m concerned our hospitals are not ready, and many of them don’t have a strategy how to deal with this pandemic, when there are more patients,” said Chunhuei Chi, the director of the Center for Global Health at Oregon State University.
Chunhuei said he’s watching the ways hospitals are responding in Oregon. He’s particularly worried about the number of beds available, and the number of life-saving ventilators and oxygen.
One study of 44,000 cases in China found that about 15% of diagnosed cases required hospitalization with 5% needing intensive care. If numbers in Oregon are similar, Oregon could see 11,250 patients who need to be hospitalized and 3,750 people could need intensive care.
But Oregon hospitals only have 6,601 staffed beds statewide. And those beds aren't vacant; other people without COVID-19 need them, too. According to data maintained by the Oregon Association of Hospitals and Health Systems, in 2018 Oregon hospitals reported an average of around 64% for the yearly occupancy rate.
OHA also says there are 688 ventilators in the state. Ventilators are necessary for treating patients with severe respiratory illnesses.
Lynda Pond, the president of the Oregon Nurses Association, a union that represents nurses throughout the state, says nurses in all corners of Oregon are raising concerns about staffing levels in the event of a coronavirus surge, and the availability of both personal protective equipment for the healthcare workers and ventilators for patients.
“Some facilities are still behind the eight-ball, and I’m sure that their nurses are incredibly frustrated,” Pond told OPB.
“The lack of ability to have proper PPE (personal protective equipment) will definitely impair our ability to treat patients.”
And if nurses and other healthcare workers get sick, that means less staff available to care for even more patients.
Some urban hospitals might have extra nurses they can call on, and some have the option of calling on traveling nurses from out of state. But Pond says that in an emergency, those nurses might already be busy elsewhere. If staff, nurses, CNA’s, and housekeepers get sick, “there is not a readily available pool from which to replace that.”
Chunhuei at OSU is focused on how different nations and regions are responding to the pandemic, and the ways those responses have affected the spread.
“This COVID-19 has one very dangerous and nasty characteristic,” Chunhuei said. “That is its capability of overloading a healthcare system, or even collapsing the healthcare system, as we observed already happened in Wuhan and South Korea and in Italy and Iran.”
In Italy, Chunhuei said, hospitals are so overloaded that doctors are making hard decisions about which patients they can save, and which ones are beyond treatment.
While much of the concern has surfaced in Oregon’s main population hub in and around Portland, other medical systems were taking a more confident position on their readiness for the coronavirus.
The message from Asante Rogue Regional Medical Center in Southern Oregon is that everything is under control. The hospital serves as a regional trauma center for a large rural area that extends down into Northern California.
“Asante drills for incidences like this every year. Having people come in who have an infectious disease, that's something that happens every day or frequently. So COVID-19 is just another one of those types of diseases, and we are prepared for it,” said spokesperson Laruen Van Sickle.
She says the hospital is at or near capacity every day already, but doesn’t think they’ll run out of rooms if there’s a spike in Covid-19 cases.
“We should have capacity,” she said.
The 24-bed Lake District Hospital in rural Lakeview has been told by its equipment suppliers that hospitals will only be given limited deliveries.
“Every hospital has an amount that is their average. And we've all been told that we won't get the full amount, so we're getting a percentage of what we would typically expect it to use. So we're trying to be judicious in how we use our current supply,” said Teresa Squires, chief nursing officer at the hospital.
Squires says they should be OK going forward as long as only the people who actually need hospital care come in.
“If we have a lot of people coming in unnecessarily, then we have to use personal protective equipment unnecessarily. And I'd rather save it for the patients that need it. That's really my biggest concern,” she said.