Over the coming weeks, how many Americans die from covid-19 will depend largely on the capacity of our hospitals to treat critically ill patients. As hospitals try to increase their surge capacity, each of us can take steps to reduce the burden on the health-care system.
On most normal days, hospitals are usually at, or near, capacity. That limits their ability to pivot to emergency footing. So we all have to do what we can to help them treat the people who need it most.
The federal government's projections show that, in a moderate disease outbreak, 200,000 people will need intensive care. Today, there are fewer than 100,000 ICU beds in the United States, and most of them are already occupied. If hospitals are inundated with critically ill patients all at once, clinicians will be forced to ration scarce resources such as ventilators and ICU beds. (Doctors in Italy and China have faced this untenable situation over the past few months, and patients have been denied care and have died as a result.)
This is why public health experts talk about "flattening the curve," or slowing down the rate of transmission so that even if many people still get infected, the infections disperse over many months. Ideally, the delay could help us get to the point where a vaccine can be widely distributed. And even if it doesn't, spreading out the rate of infection would avoid the worst-case scenario of overwhelming hospitals in a concentrated period of time.
In the past week, we have seen aggressive actions by state and local officials to restrict mass gatherings, close schools and urge people to work from home. These social distancing measures are our best chance to flatten the curve. The novel coronavirus is transmitted by person-to-person contact. Without contact, the virus can't spread.
Those who are especially vulnerable — the elderly and those with underlying medical conditions — should be the first to reduce their exposure, but the young and healthy should also do their part. No one should be blasé about getting the virus — even if someone recovers without difficulty, they could have infected many others. Everyone should minimize social contact, in addition to practicing good hand and face hygiene and taking other preventive measures.
Starting now, everyone should try to avoid going to the ER. My emergency medicine colleagues around the country report that their waiting rooms are already being inundated with the so-called worried well. These are patients with cold and flu symptoms who are in the ER to be checked out for covid-19.
In such cases, going to the ER will not help you — but it will place additional strain on our medical infrastructure. There aren't enough covid-19 tests as it is and, besides, at the moment, you are unlikely to receive a test in the ER. Depending on the availability of tests in your area, you'll probably be told to go home, self-isolate and treat your symptoms with fluids, rest and over-the-counter medications.
In trying to meet the demands of worried patients and reduce the burden to ERs, many doctors are ramping up telemedicine consultations. Some hospitals and local health departments have hotlines for those who have symptoms. Eventually, there will be separate clinics and drive-throughs to get covid-19 testing. Use these virtual and outpatient settings, and reserve the ER and inpatient care for patients who really need acute care services. You shouldn't go to the ER if you otherwise wouldn't have gone but for concern over covid-19.
In the meantime, hospitals are putting into place their pandemic preparedness plans to increase surge capacity. They are reducing elective procedures and looking into constructing makeshift facilities. In time, the federal government may call upon the military to build field hospitals. Still, in a worst-case scenario, 21 million people in the United States could require hospitalization — an unfathomable number given the fewer than 1 million staffed hospitals beds our country has on hand.
Of course, the United States should not be in this situation, so far into a pandemic, where we don't have tests for everyone who needs one or wants one. When this is over, we will need to address that misstep as well as our inability to provide sufficient care for even a moderate outbreak of a virus such as this.
But we can all play a role in the meantime. Our individual actions can change the trajectory of this disease, reduce strain on our health-care system and save lives.
Leana S. Wen is an emergency physician and visiting professor at George Washington University Milken Institute School of Public Health. Previously, she served as Baltimore's health commissioner.