As the number of cases and deaths from the coronavirus continues to increase in the U.S., hospitals are finding it difficult to prepare.
More than 100 cases have been confirmed as of Tuesday, according to the Centers for Disease Control and Prevention, with six deaths reported in Washington state and 60 infections across 12 states.
Northwell Health in New York recently opened its emergency operations center as the threat of a surge in COVID-19 cases has grown in its home state, said Dr. Mark Jarrett, the system's chief quality officer. New York has reported two cases.
Jarrett said Northwell is focusing on patient triage and how to quickly detect infections.
But the system is also ramping up its long-term planning in light of the continued rise in cases and the estimated timeline for a vaccine—currently about a year.
System officials are deciding where to place patients once hospitals run out of infection isolation rooms and how to manage the supply of essential medical devices and protective equipment.
Jarrett said real-time tracking will help manage supplies while policies have been put into place to address any shortages of N95 respirator face masks. Providers are competing with consumers for face masks even though experts say healthy individuals do not need to wear the masks.
Dr. Shira Doron, an infectious disease physician and hospital epidemiologist at Tufts Medical Center in Boston, said her hospital has had thefts of respirator masks and other essential protective equipment in lobbies and other high-traffic areas.
Jarrett said Northwell plans to follow the CDC's guidelines for extended use and re-use of respirators if supplies get too low. But the lack of supplies could force providers like Northwell, Tufts and others throughout the country to make hard decisions on what patients are most likelty to survive if an outbreak becomes severe.
Supplies to keep healthcare workers safe became easier to come by this week.
The Food and Drug and Administration gave healthcare workers approval to use an industrial type of respirator mask designed to protect construction workers from dust and debris.
A major challenge of any infectious disease outbreak is accurately gauging supply inventory.
But scientists are currently still learning much about the virus, such as its transmissibility from asymptomatic patients or how long they might still be infectious as they are recovering. A Chinese patient who was treated and discharged recently became ill again.
"It makes it much more difficult to make plans because you're basing it on assumptions," Jarrett said. "We're trying to be flexible with this, so we don't get into trouble."
Some clinicians are using their experience in the 2014 Ebola crisis to manage expectations.
Still, Doron said Tufts conducted training sessions for 1,200 clinicians to get them re-accustomed to proper methods of using protective equipment and removing it safely.
Jarrett believes it's likely hospitals will have to eventually depend on the National Strategic Stockpile to replenish a portion of their medical supplies. But there are concerns that the stockpile does not have enough supplies to handle a major sustained outbreak.
In a Senate health committee hearing held Tuesday, Dr. Robert Kadlec, HHS assistant secretary for preparedness and response, said the stockpile's supply of medical equipment such as respirators was approximately 10% of what would be needed in the event of a full-blown pandemic.
"That's an area where I have been most concerned that it strikes me that we should have substantially more than 10%," said Sen. Mitt Romney (R-Utah) during the hearing.
Lawmakers also expressed skepticism about U.S. health officials' claims that testing for the new virus should be widely available by the end of the week. Authorities have said labs across the country should have the capacity to run as many as 1 million tests by then.
Northwell on Tuesday announced it will begin testing for the coronavirus within a week, starting manual testing that Jarret said will yield results in about six hours.
The system will be able to conduct automated diagnostics of patients suspected to have Covid-19, which will enable them to test thousands a day.
In addition, FDA Commissioner Dr. Stephen Hahn said the agency has been working with a private company to get as many as 2,500 test kits out to labs by the end of the week. Each kit should be able to allow a lab to run about 500 tests, he said. But health officials were careful about making hard promises.
"I am optimistic, but I want to remain humble," said Dr. Anne Schuchat, principal deputy director of the CDC.
The Associated Press contributed to this report.
