Gaps seen in health system's epidemic preparation

The coronavirus outbreak in the United States is revealing gaps in the health system's ability to respond to a major epidemic, forcing hospitals and doctors to improvise emergency plans daily, even as they remain uncertain how bad the outbreak will get.

As California announced its first coronavirus-linked fatality on Wednesday, bringing the U.S. death toll to 11, nursing homes were emerging as especially vulnerable to the virus, with more than 1 million residents, many of them frail.

But the care gaps are spread out across the country and affect medical facilities of all types.

In Rhode Island, where two cases have been detected, doctors in protective gear were testing patients with mild symptoms in a hospital parking lot rather than allowing them to enter the emergency room. Officials said the emergency measure was being wound down Tuesday as the state's testing capacity grows.

Officials in King County, Wash., this week said they were purchasing a motel to house patients who needed to be placed in isolation.

In rural areas of Texas and elsewhere, small hospitals do not have test kits, and central labs for testing samples are hours away.

"There's not anywhere near a sufficient number of kits to confirm or deny virus, or quarantine or control all these patients," said John Henderson, who heads the association for Texas's rural hospitals.

Ventilators and intensive care units, necessary to keep the most acutely ill patients alive, are largely limited to larger hospitals and academic medical centers in cities.

Front-line providers are dusting off old protocols for handling previous global health threats including severe acute respiratory syndrome [SARS], Middle East respiratory syndrome [MERS], H1N1 and Ebola. But the coronavirus is spreading and, with mild symptoms that mimic the flu, is difficult to detect.

"We just don't have the capacity in the hospitals and health systems to deal with a massive influx of patients and keep them isolated," said Gerard Anderson, a professor of health policy and management at Johns Hopkins University.

Despite weeks of preparations, health planners continue to fret about shortages of protective masks and gowns for hospital staff, as well as lifesaving mechanical respirators for patients with severe cases of the disease.

The World Health Organization warned Tuesday that panic-buying and hoarding was creating a dangerous global shortage of protective equipment. China, the origin of the virus outbreak, has stopped exports.

Budget-conscious health systems do not maintain large volumes of reserve supplies just for the possibility of a pandemic, said William Jaquis, president of the American College of Emergency Physicians. That leaves the system vulnerable.

Several of the deaths in the United States have been linked to the Life Care Center nursing home in Kirkland, Wash., and that has focused attention on the nation's more than 15,000 nursing homes and 20,000 residential care facilities.

At risk at both those kinds of facilities are more than 2 million Americans.

One of the particular challenges at nursing homes, aside from the vulnerability of residents, is one worker, if infected, can become a "super-spreader," said Lauren Ancel Meyers, a professor at the University of Texas at Austin who has studied infectious disease surveillance.

Advocates of the nursing home industry said the facilities are better prepared now because of new regulations in 2016 regarding emergency preparedness and infection control.

A separate analysis for Texas, published in 2017, showed that the state supply of ventilators would come up short in an extreme event.

The makers of ventilators said that, indeed, they have seen a dramatic uptick in demand.

"This is a rapidly evolving thing. In a matter of days you can go from 60 cases to many, many more," he said. Large hospitals are devising contingency plans for a growing epidemic, he said, but "we want to see that level of urgency at the federal level as well," he said.

A Section on 03/05/2020

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