In Cullman, Ala., Ray DeMonia was having a cardiac emergency and sought treatment at his local hospital, but he was not admitted because there was no ICU bed available. The local hospital contacted 43 other hospitals in three states, and all were filled beyond capacity. He was eventually transferred to a hospital in Mississippi about 200 miles away, but it was too late to save his life.
In Bellville, Texas, Daniel Wilkinson was diagnosed in his local emergency room with gallstone pancreatitis. He needed immediate surgery, but the hospital was not equipped to perform the procedure. His emergency room physician tried for seven hours to locate another hospital where the surgery could be performed. Finally, a bed became available at the VA hospital in Houston, but by the time he was airlifted to the hospital, it was too late to perform the surgery and he died.
In Alaska, as well as other states with high levels of Covid-19 cases, “crisis standards of care” have been implemented to allocate scarce resources in a state where vast distances between hospitals often makes it infeasible to transfer patients in a medical emergency. Medical staff members were forced to decide which patients got life-saving dialysis, the use of a ventilator or an ICU bed.
The pandemic has killed over 700,000 Americans, but it has indirectly killed many more — all the people with treatable health emergencies who were unable to obtain care at hospitals overwhelmed with Covid patients.
It’s easy to point to the pandemic — and all the attendant controversies, from masking to vaccines to lack of preparedness — as the cause of all these ancillary deaths. But Covid-19 didn’t create this particular crisis, it merely revealed it. The underlying problem is the decades-long decline in the number of hospital beds and the federal government’s failure to address the issue. Had public health officials heeded earlier warnings, many lives could have been saved.
Between 1975 and 2019, the total number of hospital beds in the United States plunged from 1.5 million to 919,000 due to consolidation and the closure of some small and rural hospitals. Excluding neonatal and pediatric ICUs, there were about 80,000 ICU beds in 2021.
Now, in some states hard-hit by Covid, over 90 percent of ICU beds have been filled. Overall, Covid patients made up only about 27 percent of ICU patients, but this surge was enough to overwhelm the system in many places.
Despite recent gains, the country is a long way from the end of the worst pandemic in a century. An analysis of what went wrong in our response to Covid, and the lessons learned, undoubtedly will be difficult and contentious. Nevertheless, it is hard to dispute that the U.S. needs more hospital beds, including ICU beds, to treat patients like Ray DeMonia and Daniel Wilkinson, who had the especially bad fortune to become critically ill during a public health emergency.
They, too, are victims of Covid-19, but also the relentless efforts of both public and private hospitals to avoid the expense of excess capacity resulting in unused equipment and facilities.
The easiest and most likely way to increase surge capacity for public health emergencies is for the federal government to subsidize the construction and maintenance of reserved medical facilities.
By designating and equipping standby hospital floors or ICU units that can be used only when state or federal officials declare a public health emergency, these surge facilities can be placed into immediate operation. Surge planning also requires additional trained staff already in place. Currently, some hospitals have met their extra staffing needs during the pandemic by using medical students, retired providers and military personnel to provide care, but this limited, ad hoc approach has been inadequate.
The surge capacity developed for a future disease outbreak also would be extremely valuable in treating victims of hurricanes, fires, floods, earthquakes, mass accidents or terrorism.
Developing this capacity will take time, coordination by all levels of government and substantial funding. But it is essential to maintain the capacity of our hospitals to treat the influx of patients during a public health emergency without adversely affecting the health care of “regular” patients in need of varied levels of care.
In 2003, after the SARS epidemic in Canada and several Asian countries, the Centers for Disease Control and Prevention commissioned a report to examine what the U.S. should do to prepare for the next public health emergency. I was the lead author of that report, along with experts in infectious diseases, public health practice, epidemiology and law. One of our recommendations: “Surge capacity hospital space for public health emergencies needs to be developed for every area of the country.” Unfortunately, no action was taken.
Now, a similar reckoning is taking place in the wake of the Covid pandemic. Some lawmakers, led by Rep. Debbie Dingell, have proposed bipartisan legislation to address some of these issues, but it is time to act. Congress should put increasing hospital surge capacity at the top of its post-Covid to-do list. There’s no excuse to fall short again.
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( Information from politico.com/agenda was used in this report. To Read More, click here )