LOCAL

Coronavirus: Experts, data say WNC is 'underwater' in having hospital beds to fight COVID-19

Elizabeth Anne Brown
Asheville Citizen Times
A room in Orthopedics at Mission Hospital.

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ASHEVILLE - As U.S. Navy ships are dispatched to New York City to support hospitals overwhelmed with COVID-19 patients, Western North Carolina residents are wondering if the area has enough hospital beds to respond to a local spike in cases. 

As Mission Hospital confirmed its first positive case Saturday, the need for local space and equipment is now more than theoretical. 

The Citizen Times asked Patrick Baron, program director of the school of health sciences at Western Carolina University, to review data collected from state hospital licenses and assess the area's readiness. Baron holds a PhD and Masters of Science from the Johns Hopkins Bloomberg School of Public Health. 

According to the American Hospital Association, there are six hospitals in the Asheville area with a combined total of 1,267 beds. 

That's not nearly enough, according to Baron. "We are underwater with regard to being prepared for this," he said. "We're starting from such a deficit." 

Patrick Baron (PhD and Masters of Science in Public Health from Johns Hopkins Bloomberg School of Public Health) is the health sciences program director at Western Carolina University.

An average of 64% of those hospital beds are in use on any given day, according to the AHA. But in areas like Asheville, where residents of nearby rural  communities commute for medical care, that rate is often higher, Baron said.

Based on census data, Asheville's "core-based statistical area" is home to about 445,625 people, and about 125,064 are over age 60. The same point from above — rural residents traveling from outside this area to access care — also makes this a conservative estimate. 

More:Coronavirus: What quarantine in Buncombe County, Asheville would look like

Estimates of the eventual infection rate in the US range between 20-80% of the population. The Imperial College COVID-19 response team's report — which has been credited with spurring the Trump administration's abrupt about-face on the outbreak — predicted a worst-case scenario of a US infection rate of 81%. On March 19, California governor Gavin Newsom announced projections that roughly 56% of the state population will be infected.

Data released by the Harvard Global Health Institute, as reported by Pro Publica and the New York Times, also analyzed scenarios where 20%, 40%, or 60% of adults are infected, and how many hospital beds would be needed at six months, a year, and 18 months. Using 40% as a conservative estimate, the study indicated hospitals across the state would be likewise overwhelmed. 

Baron said he, too, considers a 40% infection rate in North Carolina a conservative estimate.

If 40% of the local population contracts COVID-19, the Asheville core-based statistical area would see about 178,250 infections.  

According to the World Health Organization, about 13.8% of people diagnosed with COVID-19 develop severe symptoms (labored breathing, low blood oxygen saturation, >50% of the lungs filled with matter, among others) and 6.1% develop critical symptoms (respiratory failure, septic shock and/or multiple organ dysfunction/failure). If 40% of the local population is infected, that would translate to 24,598 severe cases and 10,873 critical cases.

Generally, only severe and critical cases require hospitalization while about 80% of people infected are able to recuperate at home, according to the WHO. In the 40% infection scenario Baron posits, about 35,500 people would need to be hospitalized in the Asheville core statistical area. 

More:Buncombe coronavirus test sites closed March 20

If a third of all hospital beds are available (as per the AHA estimate), the Asheville core statistical area would have 456 beds available to COVID-19 patients. In this scenario, assuming a conservative rate of infection and a generous number of hospital beds available, there would be 77.9 patients per available bed. 

"The idea of 78 patients to a bed shouldn't be taken to imply that we have more than one person in a bed — there's 77 people going without care," Baron emphasized. "They're set up in a hallway, they're set up in a parking lot. And that increases the number of fatalities." 

If the region's hospitals devote all hospital beds to COVID-19 patients, a 40% infection rate would result in 28 patients per bed. 

A pre-print study of Chinese cases by Los Alamos National Laboratory sets the average hospital stay of COVID-19 patients at 11 days. Based on an 11-day average hospital stay, the Asheville area would need to spread out COVID-19 cases over about 10 months to manage a surge of that size if all hospital beds were devoted to COVID-19 patients.* (See end of article for calculations)

Filled beds means 'care rationing'

"Filled hospital beds don't just mean COVID-19 patients not getting treated," Baron explained.

"If you get into a car accident, if you have a heart attack, if you've got cancer and you need surgery — that is the kind of care being delayed and rationed across other countries' healthcare systems," Baron said.  "I fear personally that we may be in for worse than Western Europe because they have better organized healthcare systems." 

Licensed Hospitals in Western North Carolina by size 

This data is drawn from the North Carolina Department of Health and Human Service's list of licensed in-patient hospitals as of March 2020. 

  • Mission Hospital, Asheville: 815 beds
  • Pardee Memorial Hospital, Hendersonville: 222 beds 
  • Haywood Regional Medical Center, Haywood County: 154 beds 
  • Rutherford Regional Medical Center, Rutherfordton: 143 beds 
  • Charles George VA Medical Center, Asheville: 119 beds 
  • Advent Health, Hendersonville: 103 beds
  • Harris Regional Hospital, Sylva: 86 beds
  • Transylvania Regional Hospital, Brevard: 82 beds
  • Cherokee Indian Hospital, Cherokee: 72 beds 
  • Mission Hospital McDowell, Marion: 65 beds 
  • Angel Medical Center, Franklin: 59 beds 
  • Erlanger Murphy Medical Center, Murphy: 57 beds
  • Swain Community Hospital, Bryson City: 48 beds
  • Blue Ridge Regional Hospital, Spruce Pine: 46 beds
  • St. Luke's Hospital, Columbus: 35 beds
  • Asheville Specialty Hospital: 34 beds 
  • Highlands-Cashiers Hospital: 24 beds 

Ventilators 

  • Mission Health: 84 ventilators in the HCA system, Dr. William Hathaway said in a March 18 briefing. "On an average day in our health system, we have between 20 and 35 patients who need a ventilator," Hathaway said. 
  • Pardee Memorial Hospital: 14 ventilators, "in communication to acquire two more," according to spokeswoman Erica Allison. 
  • AdventHealth: 6 ventilators, with another 11 on the way, according to spokeswoman Victoria Dunkle.
  • This list will be updated as more facilities respond with their number of ventilators. 

Baron described the number of ventilators available in the Asheville area as "very bleak." 

"Our needs are going to vastly outstrip those supplies very quickly," Baron said. "We are already probably at a point where existing cases will account for those supplies and then some.

"And this is a cumulative effect," he said. "People don't recover very quickly when they are sick, even if they are going to recover.

"That (referring to the number of ventilators at Mission, Pardee and Advent) is a scary, scary low number," Baron said. 

Elizabeth Anne Brown is the trending news reporter for the Citizen Times. Reach her at eabrown@citizentimes.com, or follow her on Twitter @eabrown18.

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