Demand for medical services expected to spike as threat of COVID-19 overwhelms resources

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Elliot Hospital emergency room in Manchester. Photo/InDepthNH


New Hampshire hospitals are bracing for a major crisis as severe cases of COVID-19 threaten to overwhelm the state’s capacity to treat patients.

With 44 reported coronavirus cases in New Hampshire as of Thursday, and community transmission confirmed in at least four counties, demand for hospital beds, ventilators, protective gear, and healthy medical staff is expected to spike in the coming days and weeks.

“We’re in full storm-center mode,” Dawn Fernald, spokeswoman for Wentworth-Douglas Medical Center in Dover, said Tuesday, before the hospital had admitted a single patient with COVID-19.

New Hampshire hospitals may face a severe shortage of hospital beds, with sick patients needing up to 10 times the state’s projected intensive care capacity, according to the most extreme scenarios outlined in a new nationwide study from health system researchers at the Harvard Global Health Initiative and the T.H. Chan School of Public Health.

Even under the study’s best-case projections, in which social distancing slows the spread of COVID-19 during the months ahead, hospitals from Lebanon to Concord to Portsmouth would have just enough beds to care for patients.

In Seattle and other coronavirus hotspots around the country, soccer fields are being converted to make-shift hospitals and military medical ships are being called to shore to prepare for COVID-19 cases.

“Almost no one’s going to get through this without adding additional beds,” Dr. Ashish Jha, a public health scholar and director of the Harvard Global Health Institute, told reporters during a conference call to discuss the study results. “We really have to think about things like, how are we going to repurpose an old high school, or the current high school.”

The Harvard study was published in coordination with ProPublica, which produced an interactive website that allows users to explore specific projections for each region. The Harvard Global Health Institute has also made its data and background information available for public review.

The hospital-capacity estimates cover a range of scenarios, projecting COVID-19 infection rates of 20, 40, and 60 percent of the population, with the spread occurring over periods of six, 12, and 18 months. They draw from data on infection rates in China, and other statistics about how fast COVID-19 has spread around the world in recent weeks. The study includes presumptions that hospitals will take preparatory steps to open as many beds as possible to receive COVID-19 patients.

Even under the moderate scenario, with 40 percent infection, the situation in New Hampshire could be dire, if that infection rate is reached within six months. 

The Manchester Hospital Referral Region, which covers much of central and southern New Hampshire, could need more than nine times the number of projected available ICU beds, and three times as many standard-care beds, according to the Harvard study. 

The Lebanon, New Hampshire hospital district, which covers much of the western part of the state and some areas of Vermont, could need more than five times the number of projected available ICU beds. Dover, Rochester, North Conway and other eastern New Hampshire cities are included in the Portland, Maine hospital district, which is also projected to be overwhelmed by patient demand.

Most COVID-19 infections do not require hospitalization, but severe cases can be fatal, particularly among the elderly and those with underlying health conditions.

“We went with a 20 percent hospitalization (of all patients) rate and 4 percent ICU rate,” Jha said. “We think that’s the middle ground of where the evidence is today.”

At a press conference Thursday afternoon, Gov. Chris Sununu said the state has created an emergency $50 million fund to help hospitals secure resources. He said hospitals will make individual plans for how to best allocate bed space as needed.

“But we’re coordinating all of that at the state level, so we can have capacity when the surge comes,” Sununu said.

Meanwhile, New Hampshire hospitals have been taking preparative steps ranging from restricting visitors, to canceling elective surgeries, to juggling staff schedules.

Steve Ahnen, president of the New Hampshire Hospital Association, detailed priorities in a letter to Gov. Chris Sununu on Tuesday. Chief among them: procuring more protective gear and easing licensing procedures for medical workers. 

Hospitals expect to face significant staffing challenges, as some healthcare workers are exposed to COVID-19 or infected, and must self-quarantine, and others need to stay home due to school closures.

At Catholic Medical Center in Manchester, staff are using social media pages to connect staff who need childcare with other employees whose older children are at home and could potentially provide babysitting services.

Hospitals have strategic plans in place for natural and manmade disasters. But the COVID-19 pandemic causes particular challenges, as resources are taxed around the country and the world. New Hampshire health care facilities have to work closely together to maximize resources.

“We can’t really look anywhere else where they’re not having to deal with this right now,” said Lauren Collins-Cline, spokeswoman for Catholic Medical Center. “We’re really having to look at how to make the most out of what we have.”

Ventilators to treat patients with severe respiratory complications related to COVID-19 are also expected to be in short supply. Jha said Harvard’s study could not measure just how bad that problem will be, as there is no reliable data on how many ventilators exist.

“We clearly do not have anywhere near the number of ventilators we’ll need,” he said.

At Concord Hospital, the main entrance is locked; a sign directs patients to alternative entrances, as visitation is restricted, and efforts and resources go toward preparing for the arrival of COVID-19 cases. 

The extent to which the predicted scenarios materialize at hospitals across New Hampshire depends a lot on how the virus spreads in the coming days. Reported cases of COVID-19 have roughly doubled every 2.5 days. In the United States, and New Hampshire, testing has been limited. Jha and other public health experts suspect the reported numbers do not accurately reflect true COVID-19 transmission and infection rates.

Thomas Tsai, a surgeon and researcher at Harvard’s Chan School of Public Health who collaborated with Jha on the recent study, said there is a chance that early social distancing to slow the spread of COVID-19 will help diminish the anticipated hospital-capacity crisis, but “that window of opportunity is rapidly closing.”

Tsai urges everyone to follow directives to stay home and minimize exposure to others.

“Flattening the curve (of infection) decreases the risk of overwhelming the U.S. healthcare system,” he said.


These stories are being shared by partners in The Granite State News Collaborative. For more information visit collaborativenh.org.