CHARLOTTE, N.C. (Hannah Smoot and Lauren Lindstrom / Charlotte Observer) - As officials in Mecklenburg County this week announced an order for residents to stay home for three weeks, leaders of the area’s hospital systems issued a warning.
“Our predictive models show that we have hours, not days, to flatten the curve in a way that does not overwhelm critical services,” Atrium Health CEO Eugene Woods and Novant Health CEO Carl Armato wrote to County Manager Dena Diorio in a letter Monday supporting the stay-at-home order. “Each hour that passes, more and more residents are coming into contact with others.”
Government officials and health care systems across the country are warning that American hospitals could soon be overwhelmed as COVID-19 spreads. Many have raised alarms about a potential shortage of hospital beds, as well as critical supplies like ventilators and personal protective equipment for health care workers.
Reporting from ProPublica on a Harvard University analysis shows that if 20% of those who are infected become hospitalized — and if the infections are spread over six months — the Charlotte area would need about twice as many hospital beds as it currently has.
Hospital leaders in Charlotte say they have taken proactive steps to anticipate a surge in patients needing treatment for COVID-19, including reducing elective procedures and seeking additional locations to treat people if needed. But lags in testing make it difficult to anticipate the region’s demand for hospital beds and other equipment, they say.
HOW MANY HOSPITAL BEDS ARE AVAILABLE?
North Carolina hospitals may not have enough beds to care for all the coronavirus patients who will need to be admitted, according to the Harvard analysis. The study’s projections show the Charlotte region is among the spots that could run out of hospital beds if the virus spreads quickly.
About one in five, or 21%, of confirmed COVID-19 cases in Mecklenburg County have required hospitalization as of Monday, county spokeswoman Rebecca Carter said. The county had 108 confirmed cases at the time, but the number has swelled to at least 204 as of Thursday afternoon.
Carter did not directly respond to a question asking for the county’s projections of how many people could be hospitalized or the number of beds that might be needed, but said public health officials are “using that (20% hospitalization rate) information to prepare for future needs.”
Dr. Sid Fletcher, Novant Health’s Chief Clinical Officer, said Novant and Atrium are in talks with county officials to find additional “non-traditional” treatment space such as conference rooms on hospital campuses, in adjacent buildings, or elsewhere in the county if needed.
“One of the things that is largely unknown is we don’t know how big the surge may be with some of the modeling. It’s been challenging without having all the testing,” he said. “I think it makes it difficult to know where we are.”
North Carolina health officials have announced plans to change how they track COVID-19 cases as testing supplies dwindle and wait times increase.
Mecklenburg County Public Health Director Gibbie Harris said this week the county was receiving “intermittent data” on testing, with 3,000 COVID-19 tests still pending.
State health department head Mandy Cohen said the state will begin tracking the virus with surveillance techniques instead of relying on tests – the same way the state tracks the flu each year.
And on Thursday, the state asked people with only mild symptoms to stay home, and skip the test. That’s to help limit the spread, and save critical supplies for people with serious illnesses.
Atrium Health, Charlotte’s biggest hospital system, plans to increase its number of hospital beds to 140% capacity if needed, Atrium trauma surgeon Dr. Cynthia Lauer said Thursday.
Atrium has stopped all non-essential surgeries to conserve hospital beds, Lauer said.
“Our hospital is usually operating at max capacity,” she said. “And now we’ve significantly dialed that back.”
North Carolina’s licensed acute care hospitals have about 21,000 beds, according to data from the N.C. Department of Health and Human Services’ 2020 State Medical Facilities Plan.
The plan, which uses 2018 data, projects the medical facility needs for the state and local governments. Mecklenburg, with 1 million residents, has more than 2,100 acute care beds, where patients receive short-term medical care in the hospital.
According to department data, one-third of North Carolina’s licensed acute care beds serve residents of the state’s five urban counties — Mecklenburg, Wake, Forsyth, Guilford and Durham, meaning a large share of the beds are concentrated in population centers.
The other 14,000 acute care beds are spread across the state, many of which are in small, rural hospitals that cover multiple counties and hundreds of square miles.
PREPARING FOR A SURGE
It’s not clear how long people with serious cases of COVID-19 would need to be hospitalized.
But COVID-19 patients who need ventilators could be hospitalized for several weeks, said Lauer, the Atrium surgeon. Patients with milder cases of COVID-19 would likely require much shorter hospital stays.
Harris has said that some of the COVID-19 patients who had been hospitalized in the county have already been released.
Mecklenburg had seen no deaths from COVID-19, the illness caused by the new strain of the coronavirus, as of Thursday afternoon. The state announced its first deaths from the illness early Wednesday, in Cabarrus County.
Gov. Roy Cooper said Wednesday a state team is working to identify places that could serve as temporary hospitals if the need arises.
“We want to be ahead of this – hope we don’t need it, but be ready in the event that we do,” Cooper said in a news conference.
Novant and Atrium have been involved in every policy decision made in Mecklenburg County, Charlotte Mayor Vi Lyles said Wednesday, adding that the city is not immediately planning to use city real estate to set up temporary hospitals.
“The health care systems have not expressed that kind of need,” she said.
For Atrium the plan is for COVID-19 patients to remain at the hospital where they were admitted, Lauer said, adding that it “prevents Carolinas Medical Center from being completely overrun.”
Patients who test positive and need ongoing hospitalization within the Novant System will be transferred to Presbyterian Medical Center to centralize resources and standardize care, Fletcher said, while those who may be treated and discharged the same day would stay where they are admitted.
Presbyterian Medical Center has 622 licensed beds and Carolinas Medical Center has 874, according to the hospitals’ websites. Each are the largest hospitals for Novant and Atrium, respectively, in the Charlotte region.
Novant spokeswoman Megan Rivers said there were open hospital beds within that health system Wednesday, but said she couldn’t provide more information in response to questions about what steps, if any, Novant had taken to increase the number of beds, because numbers fluctuate daily at each facility.
“The State of North Carolina lifted restrictions that will allow us to open more beds if needed,” she said. “We can temporarily add and relocate beds into any space that meets federal safety requirements if we have a surge.”
County Commissioner Susan Harden said she has asked county administration if Mecklenburg has enough hospital beds to handle the crisis.
Harden said she was assured there was enough capacity to absorb additional patients from the coronavirus outbreak.
“What I was told is because the hospitals planned for (population) growth, they built excess capacity,” Harden said. “Everybody I have talked to feels good about the capacity. Nobody has talked about needing extra space.”
But Lauer said she is concerned after seeing hospitals in other U.S. cities reach capacity.
“It gives me concern about the future,” she said. “We could be in a similar situation. My only hope is that we have acted soon enough that it slows things down so that we can manage (COVID-19 hospitalizations) over time instead of as an acute rise.”
Staff writers Ames Alexander, Fred Clasen-Kelly and Gavin Off contributed to this report.
This work was made possible in part by grant funding from Report for America/GroundTruth Project and the Foundation For The Carolinas.