An old photo of a community event helps us illustrate a point. Based on modeling, 87 people will need an ICU bed to survive a covid-19 infection. Over half will not find a bed because we don't have the capacity. It is a national problem - but will come home to us in a very personal way.
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A window of opportunity and the need to act

A new website made the rounds this weekend on social media – it uses data and modeling to predict the final window of opportunity that local governments have to flatten the curve and avoid swamping their healthcare system with COVID-19 patients. 

For Arizona, that window is March 29 through April 3.

What would it look like for our healthcare system to be overwhelmed? Here in the Globe-Miami area, we depend on Cobre Valley Regional Medical Center, a 25-bed hospital that serves more than 20,000 residents in the communities of Globe-Miami, Superior, Hayden-Winkleman, and Roosevelt. 

For complete details visit: https://covidactnow.org/state/AZ
CovidActNow.org was created by a team of data scientists, engineers, and designers in partnership with epidemiologists, public health officials, and political leaders to help understand how the COVID-19 pandemic will affect their region. This tool is built to enable political leaders to quickly make decisions in their Coronavirus response informed by best available data and modeling

 

As far as rural communities go, we are lucky to have CVRMC. In Arizona, rural hospitals in Florence, Douglas, and Kingman have closed within the last ten years. In the same period, our hospital has expanded and continued to add equipment to better meet the needs of our region, including the recent addition of a state-of-the-art Halcyon radiation unit that will enable patients needing radiation treatments to get them here, rather than drive into the Valley. 

But our hospital, our community, and our healthcare providers have never faced a threat like COVID-19. It is a novel virus that we know very little about. It spreads easily – lying in wait on surfaces, fabrics, and hands for days before finding a host. It infects people of all ages (although those over 60 are at higher risk of severe symptoms and death). It kills those who get seriously ill, unless they are given a fighting chance in ICU with care of trained medical personnel – and ventilators. 

That’s where the numbers get important. 

A projection based on population numbers for Globe-Miami, Superior, Hayden, Winkelman, and Roosevelt shows the challenge we face in caring for those infected with a virulent virus that has already taken more than 15,000 lives. (The US is reporting 64 new deaths since yesterday)

Based on modeling of worldwide and USA communities, the data suggests that we can expect 10% of our population will get infected, with 20% of those (1 out of 5) needing hospital beds. 

And of that number, around 20% will need an ICU bed. 

These percentages are best estimates. We won’t know the true numbers until after the crisis has passed. But we have to act now.

If we don’t act aggressively, it means we could be facing a situation where 87 people in our community may desperately need one of 4  ICU beds. Although we don’t know how long the ‘crunch’ will last, estimates suggest three to four weeks. Using three weeks, we have enough ICU beds to treat 28 over that time period.

Leaving 59 people without ICU care during the same period.

This is why it is so critical to bring down the curve and give our hospital and healthcare system the ability to keep up. 

What do you think we should tell the those 59 seriously sick people who won’t get a bed in ICU? What should we tell their families?

 

This chart is based on available numbers and data. The hospital has doubled the number of beds by adding bed counts from other facilities which they will draw on as the need increases. NOTE:  Update from the hospital. They have 15 beds they can use for ICU, but this number would include utilizing some of the 50 beds noted here for that purpose. We will be updating this information on Monday, 30th.

FLATTENING THE CURVE is our responsibility.

We are not acting yet in sufficient ways to flatten the curve and avoid this scenario.

While we have closed schools and asked people to self-isolate, I talked to over a dozen people, this weekend, who had taken advantage of our beautiful spring weather to take a road trip and come to Globe. Along the way they made stops at a bar, or restaurant or local shop. They were all from the Valley, where bars and restaurants have been closed since March 18th (except for take out)  and they were of the mind that this talk of a virus was mostly hype about a flu virus. 

We’re Americans, so we like to say “To each their own.” And yet we must ask now, because it affects us:

Were they concerned that they might be infecting others? No.

They, of course, are not the only ones who think this way, and that’s a problem for those 59 people who will  get seriously sick, and will have no place to go. It’s a problem for our front line healthcare workers, from doctors and nurses to CNAs and EMTs, who report they do not have enough protective gear (PPEs and masks) for the task ahead of them. It’s a problem for a hospital that was built to manage a steady stream of healthcare needs, from heart attacks, cancer treatments and diabetes to newborn babies and knee replacements – not an out-of-control public health crisis.  

The chart above models the numbers for our hospital system if it only handled COVID-19 cases.

But of course, that’s unrealistic. There will still be car wrecks and babies to deliver. 

Testing for COVID-19 in Arizona is in the lower 25th percentile of all testing in the United States. In a state with a population of 7 million plus, we have managed just 521 tests, with 152 of those coming back positive. (That’s a 29% infection rate). However,   we are not testing asymptomatic people – who could be carrying the virus and not know it. We are not testing people who have asked to be tested because they think they might be ill. Here in our area, the hospital has 19 test kits, and local physician offices have 5 or less. Decisions have to be made.

Dr. Chad Campbell, with Hope Family Care Clinic, outlined the difficulties of deciding who gets a test and who doesn’t in his clinic on a recent You Tube video. Testing guidelines are being restricted to those who have symptoms PLUS either have a known contact with COVID-19, or have traveled to China, or live in congregate housing (like nursing homes), or are in healthcare. 

And even with that restrictive list, healthcare providers still do not have enough test kits.

As the virus has progressed, a report in Bloomberg News addresses what we have come to know through news stories: asymptomatic people can test positive for COVID-19. So unless we broaden our testing protocols and strengthen our quarantines, there will continue to be people who circulate in the general population, passing the virus on to others. 

Case in point: Rand Paul, a Senator from Kentucky, who after being tested, went ahead and had meetings, went to the gym and had private lunches, while waiting for the results. Which came back positive. Then he went into quarantine. After the damage has been done, is too late.

The graph above that shows the window of opportunity in our state to significantly lessen the impact on their healthcare system is a wake-up call for leaders to act upon. 

Let’s support them in taking those actions. 

You can do your part by washing your hands frequently and staying home.

As professor RayHugh Montgomery said in a video interview on Twitter put it, “

Please just remember the best chance we can give to the people who do fall ill….
is if we have enough beds, enough staff and enough kit to be there for you. And if you are irresponsible enough to think that you don’t mind if you get the flu, remember it is not about you. It is about everyone else.”

 

 

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