TUPELO • As the number of COVID-19 cases continues to climb sharply in Mississippi, a state which already struggles with rural healthcare gaps, chronic illness and poverty-driven inequities, now potentially faces a crippling drain on medical supplies and hospital space.
The collision course between finite healthcare capacity and the relentless spread of the new coronavirus pandemic has proven a global challenge. Hard hit foreign nations like Italy and China saw a surge of patients overwhelm hospitals, depleting intensive care space, ventilators and other essentials.
This threat is very much front of mind for Mississippi’s healthcare professionals deeply involved in the state’s COVID-19 response.
“We are ramping up all our contingency planning for the tidal wave of patients that we know we are about to see,” said Dr. Alex Jones, Department of Emergency Medicine chairman at the University of Mississippi Medical Center.
Whether or not this tidal wave can be absorbed has significant implications for healthcare throughout the state, Jones emphasized last week in a conference call with reporters.
The new coronavirus that causes COVID-19 is more deadly than the flu, with most recent estimated death around 1 percent. The new coronavirus is more lethal for older patients and anyone with underlying health conditions.
But from the standpoint of the healthcare system, the hospitalization and intensive care rates are perhaps even more worrisome than the rate at which the pandemic kills people.
Analysis has found that as many as 15 to 20 percent of cases in China were severe, a much higher number than the fatality rate. As many as 5 percent required intensive care, according to some preliminary analysis. These numbers in Italy are higher.
Across 103 hospitals, there were 10,891 acute care hospital beds in Mississippi in 2018, according to information provided by the state Health Department. More recent data has not yet been reported, the state said.
This number includes ICU beds, but no specific breakdown of those beds was available, according to a health department spokesperson. This number excludes beds for psychiatric care, chemical dependency and other non-acute care purposes.
Models for how many Americans will ultimately become sick of the new coronavirus and of how many of those will require hospitalization vary widely. If a quarter of Mississippi’s population were to become infected, and if 5 percent of the infected were to require hospitalization, then more than 39,000 Mississippians could eventually require hospitalization.
Even far more conservative calculations of both infection rates and hospitalization rates yield patient totals that either outstrip or significantly consume the state’s total share of all hospital beds.
And of course, those hospital beds are not just sitting empty.
The Health Department’s 2015 report of hospital statistics reported a 43 percent occupancy rate for 11,060 acute care beds across 104 hospitals.
The much discussed need to “flatten the curve” describes an effort to extend the time span over which cases are contracted, thereby reducing the rates of infection and hospitalization to a number that the healthcare system can absorb.
And if social distancing measures don’t work at flattening the curve, it won’t only be coronavirus patients who suffer from an overburdened system. The influx of coronavirus patients requiring hospitalization could take up resources used for other procedures.
“If we don’t do these things then we will have a situation where the ability for us to care for any patients will be hampered,” said Jones, the emergency medicine chairman at UMMC.
North Mississippi Health Services reports as of Saturday that it has five presumptive COVID-19 patients hospitalized. According to data released by the Health Department, at least 24 percent of patients identified as presumptive positive have been hospitalized, 67 percent are not hospitalized, and 8 percent are unknown.
The more immediate concern most frequently raised in recent days concerns personal protective equipment, or PPE, as medical professionals refer to it. This equipment includes masks, gloves, face shields and gowns. This equipment helps keep doctors and nurses safe from infection and helps prevent a depletion of critically needed medical personnel due to illness or quarantine.
“We are taking aggressive efforts to preserve PPE,” said LouAnn Woodward, the vice chancellor and dean at UMMC. “That is critically important. We have all been in touch with our peers across the country. The top concern that they all expressed was the supply chain and the availability of PPE.”
In order to preserve the on-hand stocks of masks, gloves and other protective equipment, some rationing decisions are already being made.
“We have canceled many of our elective surgeries, many of our routine clinical exams,” Woodward said.
That trend is likely to only accelerate.
“Pretty soon, elective healthcare will be shut down, we believe,” Jones said.
Shortages of PPE have potentially widespread impacts, and could hit rural areas hard. State Sen. Chad McMahan, a Guntown Republican who represents part of Lee County, told the Daily Journal he’s already been contacted by some smaller clinics struggling with supply issues.
This concerns McMahan, because if these clinics can’t see their patients, those patients will be forced elsewhere. This put more strain on larger hospitals and potentially expose more people to illness.
“It’s important that these clinics remain open so people don’t have to go to the ER,” McMahan said.
The Mississippi State Health Department has also sounded the alarm.
“The Department of Health has a small supply of PPE and we plan to give that out by the first of next week, but it’s a paltry amount compared to the need,” State Medical Officer Dr. Thomas Dobbs told reporters last week.
In communication late last week with legislators in the chamber he leads, Speaker of the House Phillip Gunn emphasized that concerns over medical supplies, especially PPE, have dominated his briefings with the state’s top officials handling public health and disaster response.
In a letter, Gunn told state House members the federal government is redirecting most PPE into its own national stockpile for redistribution throughout the country as needed. Distribution decisions are made by the Department of Health and Human Services, with the consultation of FEMA.
In the meantime, hospitals in Mississippi already face pending shortages.
“Because Mississippi is a lower population state, we don’t get as many supplies as other states. Therefore, there is a critical shortage of certain components,” Gunn wrote, referring to PPE. “Hospitals are having difficulty ordering these supplies through the normal supply chain, because the federal government has confiscated the normal supply for the national stockpile.”
Gunn said that MEMA has begun releasing some of its own stockpile throughout the state, and there is hope that FEMA will distribute additional PPE to Mississippi within a week.
The list of exhaustible resources could go on: ventilators, negative pressure rooms, and testing resources.
“I think everyone everywhere is just overwhelmed by the magnitude of all this,” said sate Sen. Hob Bryan, an Amory Democrat.
A long-serving legislator, Bryan chairs the Senate Public Health and Welfare committee. Bryan said he remains in contact with his counterpart in the state House about potential legislation that could be of use to healthcare workers.
Even as lawmakers and state officials scramble to respond, state Rep. Jerry Turner, a Baldwyn Republican, said a great deal of uncertainty remains about how to prepare and react in the coming months.
“In a lifetime, I’ve not seen anything like this,” Turner said. “There’s so much uncertainty about it. A disaster like a storm, a flood, a hurricane, you’ve dealt with that before and gained wisdom and knowledge.”
But this is something different.
“Right now,” Turner said, “everything seems to be upside down.”