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Severe coronavirus cases on pace to overwhelm ICU availability in urban and rural areas

But hundreds of counties lack even a single critical-care bed

By: Jill Riepenhoff, Jamie Grey and Lee Zurik

(InvestigateTV) – Far from a big city, Cleburne County Arkansas is a coronavirus hotspot, where 24 out of every 10,000 residents has COVID-19.

Its infection rate is among the highest in the U.S.

It’s also a county without a single ICU bed.

For residents in five northern Mississippi counties, the nearest ICU bed is in Memphis, Tennessee. Two weeks ago, those counties didn’t have any coronavirus cases. Now there are 71.

In Colorado’s Eagle County, ill patients are straining its limited hospital resources. It has five ICU beds and a growing outbreak with more than 41 coronavirus cases for every 10,000 residents.

As cases mount across the country, millions of Americans live in areas with too few intensive care beds to meet the potential demand of a deadly virus, InvestigateTV has found.

Take, for example, the current situations in Arkansas, Ohio and Oregon – three states that fully disclose the number of COVID-19 patients who are hospitalized. About a third of hospitalized patients in those states are in the ICU.

InvestigateTV analyzed hospital bed data and COVID-19 county-level case data compiled by Kaiser Health News and Johns Hopkins University, respectively, and identified dozens of places where the demand for treatment could far outpace the supply.

Critically ill COVID-19 patients put an unusual stress on the ICU system because they can require stays of up to 21 days. The average stay in intensive care for all other patients is about three days, experts have said.

“I am very concerned right now,” said Dr. Janis Orlowski, chief health care officer for the Association of American Medical Colleges. “This potentially will overrun our healthcare capacities.”

For 25 states, including Michigan, New York and Washington – states with surging cases – the lack of hospital beds can be partly blamed on state laws that heavily regulate how facilities expand.

Without these decades’ old regulations, “we would have more beds and more supply in order to help critically ill patients,” said Thomas Stratmann, a professor of economics and law at George Mason University.

And the strain is coming. In Mississippi, Oklahoma, Ohio and Maryland, more than a quarter of their COVID-19 patients were in the hospital on April 1.

None have been on the radar as virus hotspots.

Analysis exposes potential weak spots in critical care availability

Pockets of the country are more likely to run out of ICU beds than others if their positive cases keep pace, according to InvestigateTV’s data map analysis.

The Santa Cruz, California area has the fewest ICU beds compared to its population. It has about 10 beds per 100,000 adults in its hospital region, a measurement often used in healthcare research that groups areas together where people are most likely to use medical services in the area.

Analysis of the hospital regions and their available ICU beds published by Harvard University’s Global Institute reveal other regions where the bed-to-adult ratio is potentially problematic if there are many severe cases in the area:

  • Fort Collins, Colorado: 11 ICU beds per 100,000 people
  • Traverse City, Michigan: 14 ICU beds
  • Dubuque, Iowa: 14 ICU beds
  • Everett, Washington: 15 ICU beds
  • Wichita Falls, Texas: 16 beds

Collectively, those five regions serve 1.3 million people.

Hospital regions with the most ICU beds, and thereby capabilities to handle severe COVID-19 cases, are in Slidell, Louisiana (137 total ICU beds); Duluth, Minnesota (217 ICU beds), and Florence, South Carolina 224 beds).

Map Data Visualization: Charles Minshew, IRE for InvestigateTV

On a county level, InvestigateTV compared available ICU beds to positive cases to identify clusters where cases may soon or already be overwhelming critical care units.

Based upon statistics from Louisiana and Ohio, the current estimate is nearly 10% of tested-positive cases may end up requiring intensive care.

That could be dire in many regions of the United States, according to InvestigateTV’s analysis of Johns Hopkins University and Kaiser Health News data.

Already, county clusters in central Arkansas and northern Mississippi are showing numbers that could be pushing the nearest ICU facilities to their limits.

An outbreak in a ski resort area of Idaho highlights what happens when a more rural county faces a spike in cases.

Blaine County has 192 confirmed cases. The resort area ranks first in the country for cases per population. There are no ICU beds in the county.

If the estimated 19 people just within the expansive and jigsawed county needed intensive care, only two surrounding counties have beds. And there are only 11 – the closest facility 1 hour and 45 minutes’ drive away.

More than half of the nation’s counties don’t have a single ICU bed. In 770 of those counties – home to more than 20 million people – coronavirus already hit their communities by April 1.

“It’s not a question of if it’s going to happen,” said Dr. Amy Townsend, a family medine/hospitalist in Texas. “It’s a question of when it’s going to happen and how severe it’s going to be.”

Models show hospital overcrowding without extreme social distancing

If one group’s predictions are on target, Arkansas could exceed its hospital-bed capacity in early May.
COVID Act Now is a nonprofit organization of scientists, epidemiologists and doctors from across the country who analyzed the country’s hospital-bed capacity, disease rates here and in other countries and social distancing requirements in place across the U.S. to help communities plan for an unprecedented outbreak.

It was created to see “if we are prepared,” said Dr. Leo Nissola, one of the group’s researchers. “It’s a valuable tool for decision makers.”

The model is updated every four days as more data becomes available.

The group’s model this week shows that Arkansas, which hasn’t enacted state-wide stay-at-home orders, will exceed its hospital bed capacity on May 2.

The state has about 8,500 hospital beds of which 732 are reserved for patients in intensive care.

At the peak of the state’s surge – even with weeks of social distancing – researchers predict more than 26,000 people will be hospitalized on May 22 with COVID-19.

The model also shows that, without stricter measures such as stay-home orders, Arkansas’ death toll could reach 44,000.

“We need to raise these flags and make sure we are prepared in our community in case it hits at the same strength in which it hit in Lombardy, (Italy),” Nissola said.

By comparison, states such as Michigan, with a stay-at-home order in place since March 24, could avoid running out of hospital beds if there is strict compliance with the regulation. Even with cases surging in the Detroit area, the state could escape without exceeding its statewide hospital bed capacity if residents follow the rules, the data shows.

“There’s no shortage of unknowns,” Nissola said. But, “we do know that there are many counties in the country that do not have ICU beds . . . we do know the number of the population at risk or vulnerable is a pretty large number.”

How quickly the situation can go from bad to worse

Phoebe Putney Memorial Hospital in Albanay, Georgia is located near one of the country’s hotspots for the coronavirus. Dougherty County was ranked fifth in the nation for cases per capita (in counties with more than 50,000 people). As of April 1, the hospital had at least 54 patients in the facility, and 31 patients had died. Courtesy: Phoebe Health/WALB

In South West Georgia, Dougherty County sits in the midst of the Cotton Belt. Luckily, it has 50 ICU beds in the county.

But every one of those beds are filled – with more desperately needed.

Dougherty County, home to Albany, Georgia, has more cases of COVID-19 per capita than any other county in the state, with nearly 55 patients for every 10,000 residents.

It is among the virus’ hottest spots in the nation based on per capita rates, ranking ahead of New York City.

It’s first case was detected in early March. By mid-March, there were no available ICU beds even as dozens of patients needed them.

The virus has claimed 27 victims – and has the highest death rate among counties in the U.S.

This week, Gov. Brian Kemp called in the National Guard to help. It brought medical personnel and five ventilators, according to InvestigateTV’s sister station, WALB.

It also helped create a fourth intensive care unit.

The situation in Dougherty shows how quickly a situation can deteriorate.

In Green County, Tennessee, the staff and administrators of Greenville Community Hospital have been planning and preparing for weeks for a potential surge of coronavirus patients, said CEO Tammy Albright.

Greenville has six ICU beds and its county, thus far, has only had 12 confirmed cases, according to federal and state data.

The hospital has been an active voice in the community, blasting social media campaigns to residents about the importance of social distancing, hand washing and other precautions that hopefully will keep them out of the intensive care ward, Albright said.

But if the unimaginable becomes reality, Albright said her rural hospital is better situated than some others because it is a part of a health care system that includes 21 hospitals in Tennessee and Virginia.

That gives them the ability to deploy and shift services as needs ebb and flow, she said.

“Right now, I’m less concerned about beds than keeping the staff safe,” she said.

Chittenden County in Vermont is another hotspot of coronavirus. Home to Burlington, nine out of every 10,000 people have COVID-19.

But Chittenden is also serving four counties without ICU beds and a growing number of cases.

Bed shortages have roots in some states’ laws

The lack of hospital beds in Vermont and two dozen other states can be blamed on laws that require hospitals to get state approval to expand bed capacity or build new medical wings.

These laws, the first of which was enacted in New York in the 1960s, require hospitals to receive a certificate of need from their respective state regulator. The purpose was to hold down health care costs, said Stratmann, the George Mason University professor.

But over the years, the process to obtain these certificates has become time consuming, expensive and prone to politics from competing hospitals, he said.

And, they no longer do much to contain costs, he said.

“These certificate of need regulations definitely threaten lives because they reduce the ability of medical services,” Stratmann said.

Among states that regulate the number of hospital beds are Maryland, Michigan and New York – states whose healthcare systems in some cities are overwhelmed by coronavirus cases.

“Without these certificate of need regulations, we would have more beds and more supply in order to help critically ill patients get over this disease,” Stratmann said. “Lifting restrictions now is a step in the right direction but it will not solve the immediate crisis.”

Instead, in this time of crisis, communities large and small are erecting tents, opening shuttered hospitals and repurposing parks and stadiums to care for the sick and dying.

Data sources used in this story: Johns Hopkins University, Kaiser Health News, and Harvard Global Health Institute. Maps built exclusively for InvestigateTV’s data analysis by: Charles Minshew, IRE.

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