When the surge of coronavirus hits the Manhattan area late next month, there will be no shortage of hospital beds, ventilators or equipment, hospital authorities here say.
The problem is pretty simple: Will there be enough respiratory therapists and other qualified staffers to run those ventilators? The hospital officials say that the answer is yes, if the public here helps to slow the spread of the virus.
In an hour-long interview with The Mercury Friday, local and state officials with Ascension Via Christi said that they projected the coronavirus pandemic would peak in the Manhattan area in late April or early May, based on current numbers and the rates of spread. They said the hospital here would lean on the national Ascension network for capacity and resources, and that there would be enough space in the hospitals in the Manhattan region to accommodate that surge.
“We feel we can handle Manhattan,” said Don King, senior vice president of Ascension and ministry market executive for Kansas. Via Christi is a member of the larger Ascension network that has hospitals in 14 markets in 12 states, including the hospitals in Manhattan and Wamego. “The thing that keeps me up at night for Kansas, the number one issue is human resources. It’s our people.”
King said the number of available beds and ventilators in the state would be plenty, unlike the current situation in New York City. That’s because of population density, he said.
But he and Bob Copple, president of Ascension Via Christi Hospital in Manhattan, emphasized repeatedly the importance of strong stay-at-home orders and compliance. In communities without such orders, the number of coronavirus infections doubles every two to three days. Strong stay-at-home practices can lengthen that doubling time to six days or longer, they said. Riley County issued a stay-at-home order Friday afternoon, effective Sunday morning. Gov. Laura Kelly issued a statewide stay-at-home order Saturday morning, effective Monday morning.
The estimated peak in this area of late April or early May is based on the current numbers, using data from elsewhere and estimates based on population density, Copple said.
Spreading out the surge of cases will not just “flatten the curve” of cases to be handled at the hospital. It also will protect the medical staff members from falling ill themselves from their movement around the community. Every respiratory therapist who gets sick, King said, could reduce the medical system’s capacity by the equivalent of four ventilators and several hospital beds. Ascension Via Christi anticipates shifting staff from one area to another as the peaks hit at different times around the country.
The math is like this, according to King: About 15% of the population tests positive for the virus. In Manhattan itself, with a population of about 50,000, that would mean about 7,500 confirmed cases. Of that total, about 10% would need to be hospitalized. That would mean roughly 750 people in the hospital. Those numbers shift some based on age and health demographics of a community, and, importantly, with how much people restrict their own interactions. They’re all just best-guesses.
Actual space at the local Via Christi hospital available to coronavirus patients started at about 40 beds, plus space for non-coronavirus patients. But the hospital has put off elective procedures and converted other space. With those changes, plus with other locations in the community, the total available space is “well over 100 beds,” Copple said.
In the larger Manhattan region, with 150,000 population, the math works out to 2,250 needing hospitalization. Hospital elsewhere — Geary Community, Irwin, Wamego, Onaga — would cover some of that need.
Copple and King said that it’s important to remember that not all the cases will hit at once under any scenario. Some of them also may end up “too sick for Manhattan,” as King put it, and would need to be transferred to Topeka or Kansas City. Ascension Via Christi has strong relationships with St. Francis in Topeka and KU Med and Adventist in Kansas City; those facilities have already shut down elective procedures to preserve capacity, too.
That’s why they say that the number of ventilators and beds “will not be our issue,” as King put it. “The limiting issue will be trained, licensed staff.”
Which is why the shelter-in-place regulations are, again, key: “We can’t have a bunch of them ill,” he said.
There are about 200 such staff members in Kansas, King said. In the Tulsa area, Ascension has “roughly another 200.” The patient surges are expected to hit at different times in Oklahoma and Kansas, so staffers will shift back and forth. Via Christi has been working to set that all up, King said.
The peak patient load in any one surge is expected to last 10-14 days in any one location. But these issues — as well as the calculations of health-care capacity — change “by the hour,” King said. For instance, in New York hospitals are putting two patients at a time on a single ventilator. Quicker testing turnaround also helps preserve the necessary personal protective equipment for staff.
“We want to instill a degree of confidence that we’re resourceful, we’re on this,” King said. “But there’s also no way for us to know exactly what’s coming our way. We still worry that we could hit our capacity in Kansas and it could throw us on our heels.
“I don’t want you to think that we’re not worried,” he said. “We don’t believe, with every predictive model we have, that we will have the kind of capacity issues that they have in New York, L.A. and Detroit. But that doesn’t mean it can’t happen. We are as prepared as any health care system could reasonably be prepared. Is it possible? It is possible. Is it likely? It is not likely.”