ST. PAUL — Early April could be a turning point for the pandemic in Minnesota — depending on how seriously residents adhere to social distancing, according to a metro area doctor in a key emergency planning role.
This week may be a relatively quiet in terms of hospitals fielding new cases of coronavirus, but “our anticipation is they’ll get tougher next week, and then really ramp up after that,” said Dr. John Hick, a physician at Hennepin County Medical Center in Minneapolis.
And how intense will that ramp-up be?
“We can’t really give any good numbers on where this is headed,” he said. “Are a third of the people in the metropolitan area going to get this? Are 60 percent? Are 90 percent? We don’t know because we haven’t had the testing … (but) the cases are going to double every 5 to 7 days in the community.”
Hick is the medical director of the Metro Health and Medical Preparedness Coalition, a series of hospitals and health networks that will collaborate to activate vacant nursing homes, hotels and other alternative sites if medical facilities reach capacity during the coronavirus pandemic.
'A little bit anxious and fearful'
Staying at home and other distancing efforts have shown some promise in areas such as Seattle. Minnesota appears to be ahead of hard-hit areas such as New York City in implementing social distancing.
But “we’re right to be a little bit anxious and fearful,” he said. “We will probably exceed our healthcare system’s resources to a significant degree.”
Virus symptoms may not reveal themselves in many patients for five days. And then they can take another five days to become full-blown. During that 10-day period, an infected patient could infect many others who may need hospitalization.
That surge could begin as soon as early April. “A lot of people are on life support or in critical care for weeks at a time,” Hick said.
On the flip side, each “decreased contact you have right now decreases pressure on the healthcare system weeks down the road,” Hick said. “The (results of the) changes you make today won’t be seen for weeks. You’re always a couple cycles behind the curve.”
Hick, who is also the medical director for Emergency Preparedness at Hennepin Healthcare, participated in a conference call with media outlets Tuesday.
Here are some takeaways.
In recent days, testing has been reserved for the very ill, as well as some seniors and healthcare workers. Hick said he is hopeful that will soon expand with added resources, from new test kits to more swabs.
“We want to be sure to offer more testing so we can make sure those cases that are positive are isolated,” Hick said. “Not knowing the attack rate makes every attempt at modeling complete guess work.”
Working with the Minnesota Department of Health, statewide healthcare coalitions are working on a “one-stop process for referral” so smaller out-state hospitals don’t have to call multiple facilities looking for beds for the critically ill.
That’s one example of collaboration, but there are plenty of others. Sites such as the Xcel Energy Center in St. Paul have said they’re at the ready if they need to used for bed space.
“On the healthcare side, we’ve seen unprecedented planning going on,” Hick said. “We’ve had no issues with partner agencies saying ‘no, I don’t think we should do that.’ We’ve had a very collective approach to this for years, and I think that’s paying off right now.”
The Metro Health and Medical Preparedness Coalition has yet to activate any alternative care sites, but expect health networks to look at their own facilities before designating a hotel or public building.
M Health Fairview, for instance, has converted Bethesda Rehabilitation Hospital in downtown St. Paul into a 90-bed coronavirus care hospital.
Bed space for the very sick continues to be a concern. Even with influenza season waning and elective surgeries postponed, intensive care units for the most critically ill always operate near capacity.
“We’re looking at 15 percent bed availability,” Hick said. “It’s extraordinarily rare to have anything more than 15 or 20 percent of our ICU bed space available.”
On ventilators in Minnesota
There’s roughly 1,180 ventilators available to Minnesota medical facilities, about half of which are in the metro.
How many more do we need?
“There’s no way to predict peak needs,” Hick said. “There’s a lot of contingency things that we can do. On an average day, Hennepin Healthcare operates around 50 ventilators, but we can use sleep apnea machines, machines that we use during patient transport … to double that. That’s pretty usual … but a lot of those are already counted in the 1,000 count, and over half are in the metro area. .. Back orders (can take) months.”
Regular hospital care
For now, elective surgeries are being postponed statewide. Hospitals are reconfiguring themselves internally in order to “cohort,” or keep patients with similar conditions together.
Floor care, or non-intensive care, for patients who do not have coronavirus will become increasingly segregated, and “some of that care is going to have to move out to alternate locations,” Hick said.
On mask shortages
The hospital network received a shipment of industrial-grade N95 masks, which are being distributed to long-term care facilities. That takes some demand off regular hospitals, but not much.
“We are reusing masks and using masks throughout shifts, which is not ideal,” Hick said. “We’ll be continuing to do that as the number of cases increases. … In some ways, we’re seeing less consumption of masks a few weeks ago when people were discarding them. We are getting some allocations from the federal stockpile.”
While typical household masks may not stop the virus, “from a public standpoint, one of the best things a mask can do is keep you from touching your nose and mouth.”
Symptoms of coronavirus
A bad cold is not a good indication of the virus, but a brief fever followed by dry cough and extreme fatigue is telling. “This virus tends to cause a pretty significant fever within a day or two of onset,” Hick said.
Seek medical care for chest discomfort and severe symptoms. Health networks are expanding their online tools to schedule testing and provide diagnosis via tele-medicine.
On social distancing
“Seattle implemented controls fairly efficiently (after dozens of seniors tested positive at the suburban Life Care Center) and so far they are keeping their curves lower than projected. If the models are correct, all of us need to reduce our social contacts by 90 percent.”
And yes, that includes seemingly invincible college students. “It’s not that younger people don’t die from it,” Hick said. “They just do it at lower rates.”
On senior housing
As families socially isolate, seniors are coming and going to visit relatives in their homes, and that’s a problem, he said.
“Long-term care facilities, we’re really trying to keep the residents in the residences,” Hick said. “Protecting those populations in place is a really aggressive focus for us right now. … One of the issues that we’re having is those are not closed environments. It’s a major concern. A lot of these populations, they’re the most fragile, and they’re also going to wind up being the dominant victims of this disease.”
On isolation after you get better
Many have wondered when it’s safe for a person who had been infected to rejoin the general population or even volunteer to help others, once they’re most likely immune.
“What the CDC recommends is that patients self-isolate for seven days, or at least three days after the symptoms go away, whichever is longer,” Hick said.
A regional database of immunized former patients is still in the planning stages, but that will be invaluable if the virus spreads widely. “There’s going to be lots of opportunity for people to contribute,” he said.
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