state, and local officials reported that hospitals needed
additional equipment and capital improvements— including
medical stockpiles, personal protective equipment, quaran-
tine and isolation facilities, and air handling and filtering
equipment—to enhance preparedness. According to our
hospital survey, availability of medical equipment varied
greatly between hospitals, and few hospitals seemed to have
adequate equipment and supplies to handle a large-scale
infectious disease outbreak. While most hospitals had, for
every 100 staffed beds, at least one ventilator, one personal
protective equipment suit, or one isolation bed, half of the
hospitals had, for every 100 staffed beds, fewer than six
ventilators, 3three or fewer personal protective equipment
suits, and fewer than four isolation beds.”
Preparedness Best Practices
As Toner and Waldhor (2020) observe, “The current
COVID-19 epidemic looks very much like an early influenza
pandemic in many important respects. It is spreading from
person to person efficiently, much like influenza, including
some degree of pre-symptomatic spread. Although the true
case fatality rate is as yet uncertain, all evidence suggests
that it is as severe as, if not more severe than, influenza
pandemics of the last century. The case fatality rate (CFR)
of confirmed COVID-19 patients in China is estimated to
be 1 percent to 3 percent, although this may not account
for all mildly symptomatic or asymptomatic infections. In
some regions of China outside Hubei, the CFR has been
less than 1 percent. For comparison, the CFR of the 2009
influenza pandemic was around 0.1 percent, the 1968 and
1957 pandemics in the U.S. were about 0.5 percent, and
the CFR of the 1918 pandemic was estimated to be 2.5
percent in the U.S.”
Toner and Waldhor (2020) add that, “The impact of a
COVID-19 pandemic on hospitals is expected to be severe in
the best of circumstances. Currently, U.S. hospitals routinely
operate at or near-full capacity and have limited ability to
rapidly increase services. There are currently shortages of
healthcare workers of all kinds. Emergency departments
are overcrowded and often must divert patients to other
hospitals. In recent years, there has been a reduction in the
overall number of hospitals, hospital beds, and emergency
rooms. During an epidemic, the healthcare workforce would
be greatly reduced. Healthcare workers would face a high
risk of infection because of contact with infected patients;
many would need to stay home to care for sick relatives,
and, in the absence of vaccine, others might fear coming
to work lest they bring a lethal infection home to their
families. The provision of medical services to both COVID-19
and non–COVID-19 patients may be adversely affected in
most communities.”
Detailed modeling projections for COVID-19 have not yet
been released by the U.S. government or WHO; however,
the U.S. Department of Health and Human Services (HHS)
released official planning assumptions for pandemic
influenza, ranging from a moderate pandemic like 1968 or
1957, to one based on a very severe pandemic like 1918.
They differ by more than 10-fold in the number expected
to need hospitalization, intensive care, and mechanical
ventilation, emphasize Toner and Waldhor (2020).
16
HHS PANDEMIC PLANNING ASSUMPTIONS
Moderate Scenario (1968-like)
NEEDING
MEDICAL CARE NEEDING
HOSPITALIZATIONS NEEDING
ICU
38 Million 1 Million 200,000
Very Severe Scenario (1918-like)
38 Million
9.6 Million
2.9 Million
Toner and Waldhor (2020) define preparedness as “Every
hospital, in collaboration with other hospitals and public
health agencies, will be able to provide appropriate care to
COVID-19 patients requiring hospitalization while maintain-
ing other essential medical services in the community, both
during and after a pandemic.” The experts say healthcare
facilities should focus their initial preparedness efforts in the
following priority areas:
➊ Comprehensive and realistic planning based on actual
CDC FluSurge projections in each hospital, and collaborative
planning among all hospitals in a region.
➋ Limiting the nosocomial spread of the virus to protect
the healthcare workers and, thus, maintain a hospital work-
force; prevent the hospital from being a disease amplifier;
and protect the non–COVID-19 patients from infection, so
as to maintain the ability to provide essential non–COVID-19
healthcare.
➌ Maintaining, augmenting, and stretching the hospital
workforce.
➍ Allocating limited healthcare resources in a rational,
ethical, and organized way so as to do the greatest good
for the greatest number.
To implement these priority goals, Toner and Waldhor
(2020) say hospitals should undertake the following
specific actions:
● ● Implement a comprehensive and realistic planning
process that includes employing at least one full-time hospital
emergency manager in each hospital as well as dedicate
a full-time infection preventionist to work on infection
prevention aspects of the preparations, including education,
training, and exercises.
● ● Create a pandemic preparedness committee (or use an
existing emergency management committee) that includes
representatives of all clinical and support departments as
well as senior administrators.
● ● Participate in a local healthcare coalition, which includes
neighboring hospitals, local public health agencies, and
emergency management. Members of multi-hospital health
systems should integrate system-wide planning with local
planning with other local hospitals.
● ● Be able to make 30 percent of licensed-bed capacity
available for COVID-19 patients on one week’s notice. About
10 percent to 20 percent of a hospital’s bed capacity can
be mobilized within a few hours by expediting discharges,
using discharge holding areas, converting single rooms
to double rooms, and opening closed areas, if staffing is
available. Another 10 percent can be obtained within a
few days by converting flat spaces, such as lobbies, waiting
areas, and classrooms.
april 2020 • www.healthcarehygienemagazine.com