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Morning Briefing

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Wednesday, Mar 25 2020

Full Issue

Hospitals Prepare For Reality Of Rationing Care: 'Priority Is Assigned To Those Most Likely To Be Saved'

Faced with bed and medical device shortages, hospitals will be put in the terrible position of deciding on which patients to devote their resources. Atlanta has already warned that the city's ICU's are at capacity and it's only projected to get worse. Meanwhile, health experts scour for locations that can be turned into hospitals.

Faced with more critically ill COVID-19 patients than equipment to treat them, hundreds of hospitals are mapping out how they can ration care and equipment in order to save the greatest number of patients possible. In the last two days, guidelines were provided to scores of hospitals around the country, including every hospital in Pennsylvania, that include a point system that could 鈥 in extreme cases 鈥 end up determining what patients live or die. (Abdelmalek, Folmer and Margolin, 3/25)

How do doctors and hospitals decide who gets potentially lifesaving treatment and who doesn鈥檛? A lot of thought has been given to just such a predicament, well before critical shortages from the coronavirus pandemic. 鈥淚t would be irresponsible at this point not to get ready to make tragic decisions about who lives and who dies,鈥 said Dr. Matthew Wynia, director of the Center for Bioethics and Humanities at the University of Colorado. (Frakt, 3/24)

The need for intensive-care beds for older Americans, the population hardest hit by Covid-19, may outstrip the supply in some regions of the U.S., a Wall Street Journal analysis shows. The Journal examined the number of beds in intensive-care units available for every 100,000 people aged 60 and older in 306 U.S. health regions. Although the national average is 116 ICU beds per 100,000 people 60 and older, nearly one in five regions have fewer than 75, and six have fewer than 50. The analysis was based on data from the Centers for Medicare and Medicaid Services and the U.S. Census Bureau. (McGinty, Maremont and Evans, 3/24)

Atlanta Mayor Keisha Lance Bottoms (D) said Tuesday that the city's intensive care units (ICUs)聽are at capacity and warned that hospitals in the area could soon be maximized amid the coronavirus pandemic. 鈥淚 suspect that at some point soon our hospitals may get near capacity,鈥 Bottoms told a local CBS affiliate.鈥淲hile there are still beds available ... our ICU units are at capacity. This is why we have gone a step further in Atlanta and asked people to please stay home,鈥 she added. (Budryk, 3/24)

Health experts are not leaving any building off the table if it might work as a converted hospital. Hotels, university dormitories, convention centers and gymnasiums are all being floated as possible locations for field clinics to treat COVID-19 patients in the coming days and weeks, says Dr. Josh Barocas, an infectious disease doctor at Boston Medical Center. (Chen, 3/24)

Massachusetts hospitals are scrambling to bring in more ventilators by almost any means possible, including buying and renting machines and repurposing other medical devices, in anticipation of an expected surge in critically ill coronavirus patients. But limited equipment is not the only challenge: Ventilators generally need rooms with a piped-in oxygen supply and staff who know how to run them. Some hospitals are retraining operating room staff or calling back retired providers to avoid a looming ethical crisis: If hospitals don鈥檛 have enough ventilators, how do doctors choose which sick patients get them? (Kowalczyk and Ostriker, 3/24)

Ohio's leaders have made it clear: the state doesn't have enough novel coronavirus tests. It doesn't have enough hospital beds. It doesn't have enough masks and other personal protective equipment for doctors.聽But how many of those critical resources聽does Ohio have? State health officials and hospitals are scrambling to compile聽those numbers聽in the middle of a novel coronavirus crisis.聽 (Balmert, 3/24)

As the number of coronavirus cases in Louisiana continues to surge, Gov. John Bel Edwards warned federal officials the New Orleans area is on track to run out of its ability to deliver health care by April 4.聽Edwards made the projection in a letter sent to the White House Monday, seeking a Major Disaster Declaration and federal aid to help Louisiana, which has one of the highest rates of coronavirus infections per capita in the U.S.聽 (Karlin, 3/24)

Health officials have worried for weeks that Pennsylvania and New Jersey won鈥檛 have enough ventilators to try to save the most critically ill COVID-19 patients.But the situation is worse than anticipated. Instead of at least 3,000 ventilators, Pennsylvania only has 2,000, state Health Department officials said this week. The state could need three times as many at the apex of the virus鈥 spread, according to a study from the Harvard Global Health Institute. (Laughlin and Ruderman, 3/24)

The number of confirmed coronavirus cases in California have nearly quadrupled in the past week, from 565 last Monday to more than 2,300 according to the latest counts from California health departments. (Stark, 3/24)

As the COVID-19 outbreak threatens to overwhelm hospitals in the U.S., many children's hospitals are united in the message: Don't send your adult patients here. That's the essence of guidelines the Children's Hospital Association, which represents 200 children's hospitals, made public Tuesday. After fielding questions from hospitals, governors and mayors about whether children's hospitals could take adult patients, the organization said adults can't safely be treated in children's hospitals, given the equipment and staff is centered around caring for kids. (Bannow, 3/24)

Federal health officials on Tuesday said they have awarded community health centers $100 million to help in their response efforts to the COVID-19 outbreak. The funding is part of the $8.3 billion emergency funding package signed into law by President Donald Trump on March 6. Funding will be allocated by the Health Resources and Services Administration with health centers receiving awards ranging from $50,000 to $320,000. (Johnson, 3/24)

Chicago officials are close to inking a deal to reopen a suburban hospital to provide more acute hospital care as coronavirus cases increase.MetroSouth Medical Center, a 314-bed hospital less than 20 miles from downtown Chicago closed last year amid dwindling patient volumes and rising operating costs, one of many community hospitals struggling to survive. Now the hospital could see new life as Chicago, like cities around the world, grapples with a potential surge in patients during the pandemic. (Quig and Goldberg, 3/24)

Health care workers are facing a serious shortage of critical equipment needed to treat the coronavirus. We spoke to the makers who are building innovative protective gear and ventilators for them. (3/24)

Former President Jimmy Carter is聽calling for donors to his nonprofit organization to redirect their contributions to local groups working to mitigate the spread of COVID-19. The聽former president, his wife, Rosalynn, and their grandson,聽Jason,聽who serves as聽chairman of The Carter Center鈥檚 board of trustees, asked those wishing to make a donation to the organization to 鈥渇orgo your next gift for the work of The Carter Center and direct it to a local group that is reducing the suffering caused by this pandemic.鈥 (Folley, 3/24)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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