Ohio’s top health official says as many as 100,000 people may have novel coronavirus COVID-19 undiagnosed — a figure that could put strain on a number of the state’s vital systems soon.
As Ohio Health Director Amy Acton made that stunning announcement March 12, executives and physicians from five area hospital systems said they’ve been working to prepare for the outbreak that is likely coming to Greater Cincinnati.
CEOs from Bon Secours Mercy Health, UC Health, TriHealth, Christ Hospital and Cincinnati Children’s Hospital spoke on their efforts through a collective group called the Health Collaborative to make sure the area’s medical systems have enough capacity to handle those who may get the sickest from the virus. Mayor John Cranley and Hamilton County Commission President Denise Driehaus were also at the briefing.
The group of local health leaders and medical experts faced some tough questions about what is to come. But they say they’re working together and preparing for a coming surge in demand, especially if Greater Cincinnati residents take proper steps to keep from getting the virus and avoid going to the hospital if they don’t need urgent, life-saving care.
What is COVID-19?
COVID-19 is a new variant of coronavirus that emerged late last year around Wuhan, China. Since that time, more than 126,000 cases have been discovered around the globe, causing more than 4,600 deaths. The U.S. has seen roughly 1,300 cases and 39 deaths so far.
Most cases of the virus — about eight in 10 — are mild enough they won’t require hospitalization, especially among the young and healthy. Others will be moderate cases, but about 5 percent will be serious.
“I recognize that this is a significant health challenge for our communities,” UC Health CEO Dr. Rick Lofgren said. “What I want to say is that we’re prepared. This is a community that has had to take time to think well in advance in cases like this about how we would respond. I have great confidence in the fact that we’ve been working among all the health systems to make sure we’re prepared.”
Ohio Health Department Director Amy Acton said at a news conference yesterday in Columbus that, due to signs of so-called “community spread” of the virus presented in the last two of Ohio’s five cases, 1 percent of the state’s population — more than 100,000 people — could have the disease undiagnosed. Acton also said as much as 40 percent of Ohio’s population could end up contracting the virus over time. If the percentage of serious cases holds in that scenario, there could be as many as 14 patients needing hospitalization for each hospital bed in the state.
“This is certainly an unprecedented time,” she said. “It is this one in 50 years pandemic that we have been planning for that we talk a lot about in my over 30 years in public health. We have never seen a situation exactly like this.”
There are some things individuals can do to prevent stressing hospitals, of course — washing your hands often, keeping distance of at least six feet from other people whenever possible, avoiding large gatherings and staying home if you feel sick. But even then, it seems likely a wave of COVID-19 cases is coming to Greater Cincinnati.
Is There Enough Capacity?
The potential surge of patients to come is the crucial test, experts say. That surge has overwhelmed hospital capacity in other countries, including Iran and Italy, the latter of which has seen more than 15,000 cases and more than 1,00 deaths.
One point of worry nationally is that the U.S. has fewer hospital beds per capita — roughly 2.8 per 1,000 people — than Italy’s 3.2 beds. Some estimates suggest COVID-19 could cause millions of hospital visits here.
Local health care leaders say there is a shared network that assesses on a daily basis the number of empty beds as well as other resources like ventilators — the Health Collaborative has about 100 extra of those right now. In addition, hospitals are reassessing their staff rotations to make sure there are enough healthcare workers to go around.
Dr. Dustin Calhoun of UC Health says area hospitals collaborate at least once a year on a test of extra capacity. The last test, performed earlier this year, found that hospitals had between 20 percent to 50 percent extra capacity each.
The exact number of extra hospital beds that represents is complicated, he says, because personnel must also be considered and some beds best serve specific purposes. But generally, hospitals in the area have in the “high three digits or low four digits” of extra beds collectively.
That doesn’t include other locations that could be used to house and care for less-severe cases, including a large, tent-based triage site the Health Collaborative could set up in an emergency. The main challenge, local medical leaders say, is reserving that extra space for those who are truly sick while helping people with less-severe cases care for themselves.
“Eighty percent will have a simple cold,” Calhoun says of those who contract COVID-19. “The important thing is that we manage to maintain the functionality of our healthcare system during that so that the sicker amongst us can get the care that they need, and so that those who are affected by medical conditions that they deal with every day… can get the health care that they need in a system that isn’t overwhelmed with people who don’t necessarily have to be in the middle of other patients.”
TriHealth CEO Mark Clement says that comes down to communicating with patients and making sure they don’t panic.
“We’re actively communicating with more than 500,000 members of our community to advise them on what to do if they’re exhibiting symptoms,” he said. “What we’re advising them is don’t present to one of our emergency departments or urgent care facilities or primary care practices. Rather, call your physician or our call center and we will provide direction on how to be assessed in a way that ensures your safety and minimizes the spread of this disease.”
How Will People Be Tested for The Virus?
Part of the strategy is making sure a greater level of testing is accomplished without intake into the traditional medical system. To that end, multiple hospitals are working on temporary sites to assess patients’ conditions and administer COVID-19 tests. Medical leaders agreed that testing capacity so far has been less-than-ideal, but that changed this week as private companies came online with tests for the virus.
TriHealth plans to have testing centers at its hospital campuses as soon as this weekend. Those facilities will be separate from other hospital functions and will require a physician referral.
Christ Hospital next week will open a testing site at a location to be determined. That site will test for COVID-19, but will require a physician referral for patients experiencing symptoms that may be from the virus. That center could be ready by Monday.
Those testing facilities — as well as ramped-up testing at other sites — will add a new dimension to our understanding of the virus’ likely presence in the area.
COVID-19 Is Coming — Or May Already Be Here
So far, there haven’t been any cases confirmed here, but hospital leaders say it’s just a matter of time.
Part of the lack of cases may come from strict limitations on testing brought about by lack of supplies. Ohio currently has the capacity to test about 1,000 people, and a week ago, that number was much lower.
One local woman who self-quarantined after a family member visited two cities in Kentucky with confirmed cases found it difficult to get a test, despite the fact she was exhibiting symptoms. The woman’s employer, Cincinnati Public school the Academy of World Languages, closed for two days due to her status and deep-cleaned the school.
As cases come to light, Bon Secours Mercy Health’s Dr. Steve Feagins said cooperation among hospitals will be the biggest part of addressing the upcoming challenge.
“The coordination of care is key,” he said. “We’re ready to know who is coming where and when they’re coming so we can prepare for them and so we can have protocol in place to care for them.”
Impact On Other Systems
The hospital response is just one part of a larger picture, Mayor Cranley acknowledged at the briefing. He said new measures are being assessed daily to slow the spread of the virus, including the cancellation of many public gatherings, a three-week shutdown at Cincinnati Public Schools starting March 17 and other efforts. Some restaurants were considering going drive-thru only if they have the capacity, he said.
“This isn’t about stopping work, it’s about working differently,” Cranley said.
Workplace closures and business slow-downs could be “devastating” for the local economy, the mayor said.
Elected officials are thinking about that, however, and looking for ways to help.
Cincinnati City Councilmember Greg Landsman yesterday wrote to Gov. DeWine asking for assistance with several systemic issues that will likely arise if the virus causes widespread shutdowns.
The help he is requesting includes unemployment benefits or temporary financial assistance for hourly workers losing pay due to closures or slowdowns, financial support for smaller businesses that could be impacted by the virus, support for understaffed senior centers and service providers and continued meal service for students who rely on free and reduced meals served via public schools. Landsman also asked the governor to order utility disconnections and evictions halted until after the pandemic passes.
“Finally, please consider providing additional support for local governments as our first responders and health professionals are on the front lines,” Landsman’s letter concludes. “These investments will help Ohio families and our economy.”
Preserving the city’s capacity for basic services could mean slow down on some city functions, Cranley said, including police and fire response.
“It’s going to be difficult for all of us,” he said.
This article appears in Mar 4-17, 2020.