Triage tents outside of the emergency department at Novant Health Forsyth Medical Center on Friday, March 13 in Winston-Salem. The tents are part of the hospitals response to the new coronavirus.

With the national total of COVID-19 cases exceeding 110,000 and the death toll rising above 1,800, Piedmont Triad-area health-care providers and officials are worried that hospitals could be overwhelmed with patients unless something is done to slow the spread of the disease.

There are at least 100 known cases of novel coronavirus in the Triad and more than 1,000 in North Carolina to date, according to state and local health departments. More COVID-19 cases have been diagnosed in the United States than in any other country in the world, including pandemic hot spots Italy and China.

The fears, primarily that there won’t be enough space in local hospitals to treat patients, are backed by a study of the nation’s COVID-19 readiness recently completed by the Harvard Global Health Institute. a Harvard University collective focused at tackling the world’s most unmanageable health challenges.

On Wednesday, Winston-Salem Mayor Allen Joines ordered city residents to stay at home in an effort to slow the transmission of COVID-19 in the area. Winston-Salem Assistant City Manager Damon Dequenne said Thursday that the decision to close nonessential businesses and ask residents to stay home is largely because the medical community asked the city to do so.

Julie Freischlag, the chief executive of Wake Forest Baptist Health, and Jeffrey Lindsay, the chief operating officer of Novant Health, wrote a letter to Forsyth County officials Wednesday in which they expressed how dire the situation may get.

“Our predictive models show that we have hours, not days, to help flatten the curve in a way that does not overwhelm critical services,” the health officials said.

If 20% of American adults contract COVID-19 over an 18-month period, about 95% of the nation’s hospital beds will be occupied, according to the Harvard study. Hospitals in New York City are already overwhelmed, The New York Times has reported.

Triad-area health-care providers have changed hospital procedures in order to free up bed space and are encouraging people to distance themselves from one another to help slow the spread of the virus that causes COVID-19. Most health-care systems in North Carolina have postponed all elective and non-essential surgeries in order to begin making space for potential COVID-19 patients.

“The Harvard Global Health Institute’s study shows the need for the public health measures we are asking everyone to take,” said Dr. Bruce Swords, the chief physician executive of Cone Health in Greensboro. “Social distancing, washing hands and staying away from others when we feel sick buys us time.”

In North Carolina, the state health department is urging people with mild symptoms to stay home, saying it is unlikely a person will be tested for COVID-19 unless they are severely ill.

“Testing is most important for people who are seriously ill, in the hospital, people in high-risk settings like nursing homes or long-term care facilities, health care workers and other first responders who are caring for those with COVID-19,” the state health department wrote in new guidance issued Thursday.

Most COVID-19 cases are mild and will not require hospitalization, said Dr. Lawrence Nycum, the chief clinical officer and senior vice president for Novant Health Forsyth Medical Center in Winston-Salem.

“Just because someone is diagnosed with COVID-19 doesn’t mean they need to be hospitalized or even go in for treatment,” Nycum said. “Many will recover at home without stepping foot in our facilities.”

Cities and counties in the region, including Winston-Salem, Clemmons, Greensboro, High Point, and Guilford and Forsyth counties have ordered residents to stay at home and practice social distancing in response to concerns from health-care providers.

Gov. Roy Cooper on Friday ordered North Carolinians to stay home as much as possible and travel only for essential activities, effective at 5 p.m. Monday.

The order drew praise from officials with health-care systems in the state, who thanked Cooper for doing his part to lessen any strain on medical facilities.

The data

As of 2018, there were 2,780 total hospital beds in the Winston-Salem area, with about 71% of them occupied at any given time, according to the American Hospital Association. The Greensboro area had 1,220 hospital beds, with about 70% of them considered occupied, and Hickory had 600 hospital beds,with about 57% occupied.

Published March 17, the Harvard researchers’ scenarios assume that each hospitalized COVID-19 patient will require 12 days of hospital care on average. Patients over the age of 65 are hospitalized at a significantly higher rate and are more likely to die from the virus, according to the U.S. Centers for Disease Control and Prevention.

The study’s estimate of needed hospital beds is divided into six-, 12- and 18-month periods. The spread is meant to show how social distancing can lessen the strain on hospital resources both locally and nationally, by slowing and stopping the spread of the virus.

It’s estimated that between 20% and 60% of American adults will contract the COVID-19 virus, according to Marc Lipsitch, an infectious-disease professor at Harvard’s school of public health and the director of its Center for Communicable Disease Dynamics.

Following is the number of anticipated beds needed in Winston-Salem, Greensboro and Hickory as indicated by the study. The data includes an assumption that half of all hospital beds currently occupied could be made available if needed. (Note: High Point adults area adults are split into the Greensboro and Winston-Salem hospital areas, according to the study’s data.)

At 20% infection rate, only Winston-Salem-area hospitals would have enough beds to treat the expected number of cases requiring hospitalization should the infections all occur within a six-month period. Should the infections be spread out over 12 or 18 months, all area hospitals would have sufficient, if not strained, bed space.

Winston-Salem: If 20% of Winston-Salem-area adults are infected over the next six months, 88% of all area hospital beds, or 2,530, would be needed to treat COVID-19 patients.

If the outbreak were spread over 12 months, about 44% of area hospital beds would be needed. The number goes even lower if the infection is spread out over 18 months, with only 29% of beds being needed.

Greensboro: Should 20% of Greensboro-area adults become infected in the next six months, estimates show those area hospitals do not have enough beds to treat potential patients. Area hospitals would need to increase their bed count by about 15%, or 183 beds total, on top of the current 1,224 beds in the region.

Again, if the number of patients is spread out over 12 months or 18 months, hospitals in the Greensboro-area would have enough beds to treat patients, requiring 58% and 38% of total beds.

Hickory: Hickory-area hospitals are also ill equipped to handle a six-month outbreak of just 20% of adults in the area, with the hospitals needing 43 additional beds on top of their 603 beds.

Like Winston-Salem and Greensboro, if the number of patients is spread out over 12 or 18 months, there are enough beds to treat patients.

At a 40% infection rate, all regional hospitals would be overwhelmed with patients in a six-month time span. The Greensboro and Hickory hospitals would still not have enough beds if the contraction period is extended to a 12-month period. All three areas would have enough beds should the infection period spread over 18 months, though Greensboro and Hickory hospitals would be at two-thirds capacity.

Winston-Salem: Should 40% of area adults contract COVID-19 in a six-month period, area hospitals would need 5,059 beds, or a 76% increase to treat the expected number of patients.

Should the viral outbreak be spread out over 12 months, 88% of hospital beds, or 2,530, would be needed. The number becomes much more manageable if the virus outbreak is spread over 18 months — with only 57%, or 1,650 beds, being needed.

Greensboro: If 40% of adults in the Greensboro-area became infected over six months, the hospital systems would be overwhelmed. It’s estimated that hospitals would need to increase their bed count by 130%, or 1,593 to meet the needs.

If the virus is spread out over 12 months, hospitals would need to increase their bed count by about 15%, or 183 beds to treat the expected amount of patients. Should the virus be spread out over 18 months, 75% of area hospital beds would be needed.

Hickory: Should 40% of area adults be infected in a six-month period, Hickory-area hospitals would need to increase their bed count by 114%, or 689 beds, to treat the expected number of patients.

If spread over 12 months, area hospitals only need 43 additional beds to treat the expected number of patients. Again, if viral contraction is spread over 18 months, the hospital system needs to utilize 421 of its 603 beds to treat expected COVID-19 patients.

At a 60% infection rate, none of the area hospitals would have enough beds to treat potential COVID-19 patients, whether its over a six months or 12 months. A 60% infection rate is considered to be the worst-case scenario.

Hospitals in the Winston-Salem, Greensboro and Hickory areas would need to add thousands of beds within six months if the worst-case scenario occurs. The number of needed beds is still significantly above capacity should the viral outbreak be spread over 12 months. Only Winston-Salem-area hospitals would theoretically have enough beds should the outbreak be spread over 18 months.



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