Can Michigan hospitals handle expected surge in coronavirus cases?

Michigan's hospitals are bracing for a surge in coronavirus cases that experts caution would leave them crunched for space and supplies, and their staffs depleted.

Michigan has about 25,375 licensed beds across more than 100 hospitals, according to state records. But as the number of confirmed COVID-19 cases increased to 110 on Wednesday, industry officials worried that health care facilities would have to take drastic measures to handle a surge in patients. 

Beaumont Hospital Royal Oak staff members perform curbside testing for COVID-19  and the flu for people at the North parking lot at Beaumont Hospital Royal Oak in Royal Oak, Mich. on Mar. 15, 2020. Patients have to meet specific criteria and have a respiratory illness or be mildly sick before testing is done.

Hospitals say they can handle the demand now, but the worst-case scenario is "incredibly troubling," said Brian Peters, CEO of the Michigan Health & Hospital Association.

If people don’t follow the protocols for washing their hands and keeping their social distance from others, “there’s a very real risk that the hospital system and the health care system, broadly speaking, could be overwhelmed," Peters said.

Michigan had nearly two-thirds of its hospital beds filled on average in 2018, according to an Associated Press analysis of Centers for Medicare and Medicaid cost reports data.

Michigan's bed capacity puts it in the middle of the road nationally, ranking 23rd among the highest average occupancy rates. And it doesn't account for hospitals tending to be more crowded during the flu season. 

Michigan counties with the most reported coronavirus cases also had some of the highest average hospital bed occupancy rates. Washtenaw County led the state with at 78% of beds filled in 2018, followed by Kent County at 75%. Michigan health officials reported Wednesday that Washtenaw has seven cases and Kent had five, ranking fourth and fifth statewide. 

Oakland and Wayne counties led the state with 23 coronavirus cases each, and both averaged a 68% occupancy rate in 2018. Macomb was at 64% and has 10 reported coronavirus cases.  

The data shows that Detroit Receiving Hospital and the University of Michigan Health System had the highest average hospital bed occupancy rates in 2018 at 85%. Beaumont Hospital Dearborn was at 83%. 

There already are signs that Michigan hospitals are becoming overwhelmed. The spread of the virus has prompted some to ration supplies, said Jamie Brown, president of the Michigan Nurses Association labor union.

"I've seen it myself," said Brown, a critical care nurse at Ascension Borgess Hospital in Kalamazoo. “The nurses in the state of Michigan are worried about not having enough personal protective equipment to keep us safe.

"They get only one N95 mask per shift per patient, and they put it in a paper bag in between. They’re supposed to be for one-time use only."

Ascension Michigan is following Centers for Disease Control and Prevention guidelines regarding COVID-19 cases and the use of personal protective equipment, spokeswoman Melissa Thrasher said.

Beaumont Health’s eight-hospital system is well-stocked with ventilators, surgical masks and other equipment, said Dr. Nick Gilpin, the system's medical director of infectious diseases and epidemiology. But hospitals can’t afford having people with mild symptoms and without chronic illnesses come to hospitals, he said, adding it’s better to quarantine at home and recover.

From left, Dr. Nick Gilpin and Beaumont Health Chief Nursing Officer Susan Grant hold a press conference at be Beaumont Service Center in Southfield, Mich. on Wednesday, March, 18, 2020.  This was the announcement of the first death of a patient with COVID-19 in Michigan.

"We need to preserve our precious resources," Gilpin said Wednesday as he talked about Michigan's first death of a Wayne County resident in one of Beaumont's hospitals.

While the state has 110 cases reported, Beaumont hospitals already are treating "dozens" of coronavirus patients, he said, without giving a specific number. 

"And right now, our precious resources as health care providers are our testing capabilities, our personal protection equipment, our beds and our staff. Those are the things that are more precious to us than gold right now."

Representatives with the Detroit Medical Center and St. Joseph Mercy Health System say they, too, have supplies, such as face masks and ventilators, needed for now. 

Some are optimistic hospitals can handle what's ahead because of aggressive steps taken by Gov. Gretchen Whitmer to stem the spread of COVID-19 and give hospitals more flexibility to add beds as needed. An order issued Tuesday would allow hospitals to increase their number of beds beyond what is usually permitted under state guidelines and authorize the construction of mobile facilities to deal with an expected influx of patients.

“There are enough beds to cover the health systems if this doesn’t explode," said state Rep. Henry Vaupel, R-Fowlerville, who chairs the House Health Policy Committee.

To try to prevent a surge in patients, Whitmer already has shuttered Michigan schools for three weeks, banned public gatherings of more than 50 people and closed movie theaters, bars and dine-in service at restaurants.

Tuesday's executive order permits the temporary registration of nurse aides who haven't met legal requirements. The Legislature also appropriated $50 million to fund capacity expansions through the Department of Health and Human Services.

On Wednesday, Whitmer called up the Michigan Army National Guard to assist the state health department with assembling and loading personal protective gear, such as gloves, gowns and face shields. Once packaged, the state will deliver the supplies to local public health departments, according to a press release.

More hospital beds needed

Michigan had 6,431 beds available or about 25% of its statewide supply, according to a March 2 inventory report. 

But some COVID-19 patients will require special rooms where air is exhausted to the outside or is filtered before re-circulation, according to the CDC. There are fewer of those types of rooms available in the state.

Regardless of the type of space available, researchers at the Harvard Global Health Institute and the Harvard T.H. Chan School of Public Health released data this week that showed Michigan hospitals would face capacity pressures even under the best scenarios of the projected spread of the virus.

The Harvard institute collaborated with the nonprofit news outlet ProPublica and The New York Times to model the spread of the virus in relation to the availability of hospital beds, based on data from 2018.

Even in some of the best scenarios under the modeling, which examined infection rates of 20%, 40% and 60% of the population, “the vast majority” of communities will need more hospital beds, said Dr. Ashish Jha, director of the Harvard institute.

“Additional capacity has got to be a part of everybody’s strategy,” Jha said during a conference call. “Almost no one is going to get through this without needing additional beds.”

Peters, who leads the Michigan Health & Hospital Association, said hospitals are concerned about capacity in "every sense of the word." But he also noted there are variations across the state when it comes to resources and population. The spread of the virus could play out differently in one area of the state than another.

"You’re going to see hot spots around the country and around the state," Peters said.

In northern Michigan, Munson Healthcare has nine hospitals and 89 negative pressure isolation rooms that COVID-19 patients may require, said Dianne Michalek, vice president of marketing and corporate communications.

"Based on predictive models we have seen, we are concerned about spread of this disease," Michalek said. "Even though we have pre-existing disaster plans in place for situations like this, knowing that this is a global pandemic and that all hospitals will need the same supplies and resources to care for patients should there be a surge, we are taking all measures to ensure we can handle the volume."

The Michigan Medicine health system at the University of Michigan in Ann Arbor on Monday opened a unit designed to serve COVID-19 patients. There are 32 private isolation rooms in the negative pressure Regional Infectious Containment Unit.

Other hospitals are taking steps to prepare for a spike in patients, as well.

Hospitals already are contacting contractors about projects to cope with the virus, said Tom Mittlebrun of the Southeastern Michigan Chapter of the National Electrical Contractors Association, who represents organized labor on the 11-member Certificate of Need Commission that usually oversees expansions of Michigan's licensed hospital beds.

"If the circumstances arise, and they’ve got to make gymnasiums into hospitals, that’s what we’ll do," he added.

The state and local officials have been planning for years to deal with a pandemic, said Jay Fiedler, director at the Michigan Department of Health and Human Services' emergency preparedness and response division.

Space in hospitals can be made available by moving patients with less serious conditions, Fiedler said. The state also has medical tents that can function as a 140-bed portable hospital, he said.

The worst-case scenario, Fiedler said, would be infections affecting health care workers. But he added that officials plan "for the people side of the surge."

Mask supply a concern

The Michigan Health & Hospital Association does not collect information on ventilators, but the organization is unaware of any ventilator shortages. Michigan hospitals are working with vendors to order additional equipment and possibly gain access from the national strategic stockpile, said John Karasinski, assistant director of communications.

General Motors Co. Chairman and Chief Executive Mary Barra contacted the Trump administration Wednesday about using idled factories to potentially manufacture medical equipment such as ventilators, said company spokeswoman Jeannine Givinvan.

The United Kingdom has approached automakers, including Ford Motor Co., on the possibility of manufacturing ventilators at their facilities. Ford is evaluating the feasibility of the inquiry, company spokesman T.R. Reid said.

There are regional and national stockpiles of health care supplies and equipment. Hospitals notify state healthcare coalitions of their needs, and the Michigan Department of Health and Human Services works with the coalitions to allocate the resources based on those needs. Michigan hospitals have received some of the state's portion of the stockpile, Karasinski said.

The most immediate concern in Michigan is staying ahead of a shortage of personal protective equipment, such as face masks, Karasinski said. The organization is in contact with state and federal officials over concerns that more supplies will be needed.

"Because of how workers must appropriately 'don and doff' supplies during care and testing, these supplies will continue to be used at a faster pace than usual," Karasinski said.

"Whatever manufacturers can be doing to increase production, they should be doing, but if we can flatten the curve and mitigate community spread, this won’t be such an issue. If we end up with extra, so be it."