One of the primary goals of “flattening the curve” is to make sure that, as cases of COVID-19 increase, the influx doesn’t happen so rapidly that there are more severe cases than hospitals have the capacity to treat. Specifically, there are concerns about the number of available hospital beds and ventilators.
Ventilators, which help patients experiencing respiratory failure breath mechanically, have been a major focus in other countries like Italy.
There, a shortage of ventilators has led doctors to make difficult decisions about which critical patients receive them — a choice that in most cases determines who lives and dies.
That is not necessarily a new problem during respiratory epidemics, though. There was a shortage of ventilators in some areas in 2009 during a surge in H1N1 cases statewide. Hospitals got around this by moving the resources available across the state to the areas where they were needed. ADPH also has pre-established guidelines that determine how patients are prioritized when resources are scarce.
According to the Alabama Hospital Association, there are currently 1,344 ventilators in Alabama, but 550 of those are in use on a given day. That leaves about 800 to address any surge in COVID-19 cases. There are around 14,900 hospital beds in Alabama, though only about 5,000 are available at any given time.
Locally, it’s more difficult to get a handle on the number of hospital beds and ventilators available in Mobile and Baldwin counties. Only two local hospitals Lagniappe reached out to this week responded, and only one was willing to share that information. A spokesperson for Springhill Medical Center said the hospital had 45 ventilators and 263 beds at its disposal as of last week.
University Hospital wouldn’t divulge its number of ventilators, but USA Health’s associate vice president of marketing and communications, Gary Mans, did release the following statement:
“USA Health, as part of its planning process, is taking all necessary steps to preserve the delivery of vital critical care services provided to patients in our region while preparing for the potential surge of patients with severe illnesses associated with COVID-19 infection,” Mans wrote. “Our planning follows local, state and national guidelines.”
A review of the websites of Mobile’s five hospitals indicates a total of 1,839 licensed beds in the city and, if those become filled, the Carnival cruise line docked on the Mobile River has agreed to allow its beds to be used in case of emergencies. Other alternative care sites have been identified in the area as well.
Still, the number of ventilators available locally remains unclear. Neither ADPH nor the state hospital association was able to break out local numbers from statewide data. This information is typically updated as part of the Alabama Incident Management System (AIMS) — a software program that allows ADPH to monitor hospitals, nursing homes and ambulance resources during times of disasters.
However, only public health officials and hospital administrators have access to that information and Rendi Murphree, an epidemiologist with MCHD, said she could not divulge that information publicly.
“We have a pretty good idea of what is out there in the community, but that’s protected information,” Murphree said during a March 23 press conference. “[AIMS] gives us pretty good certainty of how full the emergency elements are — like how many isolation rooms are occupied. Ventilators are something we have to ask about specifically sometimes, but I can’t give that information to you publicly.”
MCHD spokesman Mark Bryant also said the department would not make information about Mobile County’s room and ventilator availability public, but did not offer a reason when pressed. He did indicate that local hospitals do have access to more beds and ventilators if needed, although he did not say where they would come from or how long it might take for them to arrive in a time of need.
“We cannot divulge that information at this time but, if beds or ventilators are needed we have resources to request more,” Bryant said.
When asked why at a time when the community as a whole is undertaking extraordinary measures to prevent the local hospital systems from being overrun that it would not be appropriate for availability information to be public, Bryant forwarded the question to Eichold. The response was, “No healthcare facilities are sharing that information at this time. However, the Mobile County Emergency Response Healthcare Coalition meets twice a day by teleconference to discuss issues involving the COVID-19 coronavirus and their needs.”
Lagniappe reached out to Erin Coker, who leads the Mobile County Healthcare Emergency Response Coalition as well as Alabama Hospital Association CEO Don Williamson, but hasn’t received a response from either.
In previous public comments, though, Williamson has said he doesn’t anticipate a statewide shortage of ventilators or beds, but believes some areas may need to bring in outside resources if COVID-19 cases spike suddenly. However, he also said the system’s ability to handle COVID-19 as the number of cases peaks depends on how well Alabamians practice social distancing measures now.
“My biggest concern is that, if a tsunami approaches us in the coming weeks, we are going to be challenged to have enough ventilators in the state at large. That’s why we’re working so hard to flatten the curve,” Williamson said. “Ideally, you’d like to reduce the number of cases, but more importantly, you’re trying to keep the surge on the healthcare system from becoming so great that you can’t respond.”
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