U.S. Healthcare Delivery System Not Ready for Virus Battle
March 1, 2020 (EIRNS)—the number of U.S. hospitals has been in steady decline for the last few decades, according to the American Hospital Association (AHA), which says there are now 6,146. But in 2015 the AHA reported 5,534 active hospitals, and that number improbably shot up to 6,200 (the mid-1990s level). According to the Definitive Healthcare blog, AHA shifted its hospital classification, rather than new facilities opening. The present number of 6,146 hospitals includes the entire range of types of hospitals, including 1,486 psychiatric and rehabilitation hospitals. The decline in clinical hospitals, from the 1975 level of 7,100 to the 2015 level of 5,534, was a collapse of 22%, while the U.S. population had increased by 100 million, nearly a third.
U.S. hospital beds (staffed) per capita are presently at about 2.3 per 1,000 people, according to the World Bank and the World Health Organization. That is about half the 4.5 per 1,000 (5.5 per 1,000 in rural areas) mandated in 1946 by the Hill-Burton Act. By comparison, China has about 4.3 hospital beds per 1,000. The U.S.A. has, however, 8.6 nurses per 1,000 people, and 2.45 physicians per 1,000. (In China, nurses are 2.7/1,000 and physicians are 1.49/1,000). The total number of hospital beds available in the U.S.A. presently are estimated at 746,000, about half of the 1.4 million beds the U.S. had in 1975.
To get a sense of what those 746,000 beds would mean in the midst of a COVID-19 epidemic, Harvard Professor of Epidemiology Marc Lipsitch has said that 40% or more of the world could be infected by COVID-19, as in previous “great waves” of influenza. For the current U.S. population of 327 million, that would be about 130 million infected. Using the statistics from China, serious cases (cases which would require some sort of hospitalization and life support systems) were at about 10%, although that spiked to nearly 15% on certain days. Of course, only a fraction of those 13 million cases would be hospitalized at the same time, but still far more than the 746,000 total beds. And many will require mechanical ventilators, dialysis and extracorporeal membrane oxygenation.
All of these cases would also require isolation rooms with negative pressure and special ventilation systems. Raw data on the total number of relevant isolation rooms in hospitals is difficult to find, but for example, University California San Francisco Health has 40 of these types of rooms, with more capable of being adapted. UCSF has about 796 beds in total, so it could put between 5% and 10% of all its patients in isolation rooms. If that could be done across the hospital system, 37,000 could be accommodated that way.
HHS Secretary Alex Azar has said we would need 300 million N95 masks in the event of a breakout of COVID-19; we presently have 30 million. As for the defective COVID-19 testing kits, Vice President Mike Pence said March 1 that CDC is shipping 15,000 replacements out to medical labs. Until that shipment, there have been less than 100 labs capable of processing the tests.