U.S. states scramble to slow virus spread, prevent hospital collapse

[March 13, 2020]  By Andrew Hay

(Reuters) - From cancelling Broadway shows to closing schools, U.S. states are scrambling to slow the spread of coronavirus and stop hospitals from being overwhelmed with a surge in critically ill patients, as has been the case in Italy.

After weeks of federal officials telling Americans they faced low risk from the virus, and with no widescale testing to track its spread, hospitals in hard-hit cities like Seattle are now fighting to save lives as COVID-19 tears through communities.

One Seattle, Washington hospital has triage tents outside, two for possible COVID-19 cases, one for anything else. Nearby walk in clinics ask patients who think they have the virus wait in cars to avoid the potential of infecting others.

In Hawaii, another state that rapidly responded to the outbreak, urgent care clinics offer drive-through testing.

U.S. hospitals are being helped by a rapid shift in state strategy from containing the virus to mass mitigation measures to slow its spread.

These measures, ranging from bans on large gatherings in Washington state and California to a containment zone in New York and school closures in Maryland and Ohio, are meant to reduce the rate at which people are infected and seriously-ill patients show up at emergency departments.

The goal is to prevent the kind of surges that overwhelmed Italy - a country with more doctors and hospital beds per capita than the United States - causing fatality levels to leap as doctors ran out of equipment to help people breathe.

U.S. states that wait too long to stem the spread of contagion may find hospitals trapped in this doom spiral, experts warn.

Italy's confirmed cases of coronavirus have leapt from around 300 cases at the end of February to over 12,000 Thursday, providing a preview of what awaits America if measures aren't taken quickly to mitigate the spread. The Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care published guidelines instructing healthcare workers to provide scarce hospital resources to those who stand "the highest likelihood of survival."

LIKE MAJOR QUAKE

The biggest U.S. battle is in greater-Seattle, an area with over a quarter of the country's more than 1,300 U.S. COVID-19 cases and the bulk of the 39 deaths.

On the front lines, with limited testing, it can be an individual nurse practitioner or doctor who decides if a person is treated as a COVID-19 patient, or not.

"Our staff can use their clinical judgment and consider that patient to be likely positive if they choose," said Megan Farnsworth, an emergency room doctor in Everett, Washington dealing with high patient volumes at clinics she oversees.

Washington officials have prepared residents for a large-scale outbreak of the virus ten times as deadly as the flu that would double in size every five to eight days.

"It's something similar to the infectious-disease equivalent of a major earthquake that is going to shake us for weeks and weeks," said Jeff Duchin, health officer for Seattle's King County.

Medics transport a patient into an ambulance at the Life Care Center of Kirkland, the Seattle-area nursing home at the epicenter of one of the biggest coronavirus outbreaks in the United States, in Kirkland, Washington, U.S. March 12, 2020. REUTERS/David Ryder

Few places in the United States are better prepared for this fight than the cities of Seattle and Everett, where their hospitals have been readying for a largescale community spread since late January when the area reported the country's first COVID-19 case. Despite limitations, greater-Seattle may have the best testing in the country.

"Being able to know who has the virus and who does not is able to free up beds, isolation units," said Alex Greninger, assistant director of University of Washington Medicine Clinical Virology Laboratories, which is testing over 1,000 people a day.

Doctor Janet Englund can get a test result back in between 12 and 36 hours.

"I think other states and sites are looking at what we are finding and what we are doing," said Englund, an infectious disease specialist at Seattle Children's, which has yet to see a high number of COVID-19 patients.

PROTECTIVE GEAR

Emergency medicine professionals in other U.S. states tell a different story, with doctors only able to test acutely ill patients and colleagues not wearing protective gear.

"None of the nurses, no one is wearing them. I put on my own N95 mask and everyone laughed at me," said an emergency room doctor in a southern U.S. state, who asked not to be named. "We don’t know who has it and, especially healthcare workers need to be tested, because we can give it to everybody else."

Jeremy Konyndyk, a senior policy fellow at the Center for Global Development in Washington, has heard similar accounts.

"Many hospitals in this country, as of last week, really had not woken up to what this was about to throw at them and had not begun putting measures in place to be ready for that," said Konyndyk, describing the federal government's "wait and see" public health guidance as "unspeakably irresponsible."

Personal protective equipment such as CAPR respirator masks used by emergency room staff are in high demand, Farnsworth said. Her hospital network is shifting supplies to areas in greatest need.

Ultimately, the ability of hospitals to save lives will rest on the speed at which states apply mitigation. If taken early enough, aggressive measures like lockdowns can all but flatten the spread of the disease.

"I think we do need to take more of a no regrets approach," said Konyndyk, adding that it might be impossible to enforce Wuhan-style, mandatory lockdowns in the United States.

(Reporting by Andrew Hay; editing by Bill Tarrant and Diane Craft)

[© 2020 Thomson Reuters. All rights reserved.]

Copyright 2020 Reuters. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.  Thompson Reuters is solely responsible for this content.