We’ve been trapped inside for three weeks. The number of diagnosed coronavirus cases in the state is still climbing, by nearly 1,000 cases a day. But the peak of the disease—the time at which the most Massachusetts residents will be hospitalized for COVID-19—is still on its way. Yesterday, Governor Charlie Baker announced that new models predict that this surge in cases could potentially arrive between April 10-20, just a little over a week from today. As headlines about equipment shortages and shrinking capacity at hospitals swirl, we have to wonder—how can a hospital possibly ready itself for something like this?
When it comes to battling COVID-19, the number of intensive care unit beds can literally make a life or death difference. Because of the havoc the mysterious disease can wreak on a sick person’s lungs with very little warning, it’s critical that there be sufficient room for those people to be admitted to the ICU to receive potentially lifesaving treatment when it matters most. But finding physical space for the number of ICU units necessary, not to mention staffing and equipping those units, is no small feat.
“As we prepare for the surge, we know ICU is going to be the limiting factor,” says Nick Duncan, Director of Emergency Management at Tufts Medical Center.
Tufts Medical has 58 traditional ICUs that cover a range of specializations. Those ICUs are now being “flipped,” Duncan says, into COVID units, to care for patients with confirmed cases or cases that are highly suspected to be coronavirus. Tufts is also evaluating other areas of the hospital, like medical surge floors, that could be converted into ICUs with additional capabilities.
Of course, a switch-up to this degree presents some challenges. First of all, building additional ICU units doesn’t just require wheeling in more equipment and beds—it’s also critical that there be enough staff to care for the added patients. Under normal circumstances, even staffing all 58 of Tufts’ traditional ICU units can be a stressor on the hospital’s system. To compensate, some of the hospital’s health care workers from other departments who have ICU experience are being trained to staff the new ICU units. These staffers undergo a rigorous training program, and will then work under experienced ICU nurses to expand the number of hands caring for the COVID-19 patients. “It’s a force multiplier for our staff,” Duncan says.
In the Boston area, there will perhaps be no other ICU unit under more strain than the one at Mass General Hospital. As the region’s major quaternary care hospital, Mass General already receives numerous transfers from other institutions when patients reach a level of care that smaller hospitals cannot meet. “We anticipate using all of our ICU units,” Theresa Gallivan, an associate chief nurse at Mass General, says. Mass General set up its first COVID-dedicated unit on March 17, and has since transitioned 220 of its beds to COVID-19 care. However, that’s not enough given the predicted volume of patients. Mass General’s recovery rooms are already being used for ICU level care, Gallivan says, and as of Friday, 64 of the hospital’s general care beds have been upgraded to ICU level care as well. The hospital’s burn, plastics, cardiac, pediatric, and other general units are in the process of being converted next. Once all of those beds are full, patients will be housed in procedural suites, and after that, potentially conference rooms and other nonclinical spaces.
Another sticking point is that, due to the nature of COVID-19, not all of the beds at Mass General can be used at once. Because the disease is so contagious, healthcare providers must take the utmost pains to ensure that COVID-19 positive patients are isolated from patients who have not tested positive. Many of Mass General’s beds are in double rooms, and are therefore only usable by two patients when both patients have confirmed cases of the disease.
Right now, that’s less of a problem—Mass General, which is typically close to full, is currently operating at a quiet 65 percent occupancy. But that will likely all change soon. “We are anticipating and planning for far exceeding our capacity,” Gallivan says.
As hospitals scramble to find space within their walls, the Baker administration is working to find bed space outside of them. Field hospitals are in the works across the state, with sites like the Seaport’s Boston Convention and Exhibition Center, the DCU Center in Worcester, and Dorchester’s Carney Hospital being outfitted to host patients. These spaces, meant for patients who require less serious care than at the ICU, are designed to help relieve some of the burden on hospitals like Mass General and Tufts.
On top of that, Baker reported this week that the federal government swiftly approved his request for 1,000 ventilators, and that they are due to arrive next week. One million N95 respirator masks also arrived in the state Thursday via the Patriots’ red white and blue 767. The pieces, or as many as we can assemble ahead of time, are falling into place.
There’s no hiding that the next few weeks will be difficult and at times terrifying. Even with all of this planning, Baker said at a press conference this week, he still expects “our medical system will be stretched.” Even after hospitals execute their surge plans, models estimate that there will be a remaining gap in ICU capacity of more than 500 beds. An arena at Fitchburg State University has been designated as a temporary morgue if necessary. But area hospitals have put everything on hold to focus their efforts on preparation—and those familiar with the plans are as optimistic as they can be in the face of a world-altering pandemic.
“I will make no bones about it—this is a challenge like we have never before seen,” says Gallivan. “But given the plan that we have and the capability and the commitment, I’m confident as anyone can be.”
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