/Older Coronavirus Patients Face Looming ICU Bed Shortage

Older Coronavirus Patients Face Looming ICU Bed Shortage

The need for intensive-care beds for older Americans, the population hardest hit by Covid-19, may outstrip the supply in some regions of the U.S., a Wall Street Journal analysis shows.

The Journal examined the number of beds in intensive-care units available for every 100,000 people aged 60 and older in 306 U.S. health regions. Although the national average is 116 ICU beds per 100,000 people 60 and older, nearly one in five regions have fewer than 75, and six have fewer than 50. The analysis was based on data from the Centers for Medicare and Medicaid Services and the U.S. Census Bureau.

New data from the Centers for Disease Control and Prevention show those 60 and older have so far accounted for about three-fifths of Covid-19 ICU patients in the U.S., while just one-fifth of the country’s population is in that age group.

The Journal’s analysis suggests that hospitals in some communities likely won’t have enough beds available for the sickest patients of any age if the pandemic spreads more widely.

ICU beds per 100,000 people aged 60 and older, by hospital referral region

Sioux Falls, S.D.

58 beds

ICU beds per 100,000 people aged 60 and older, by hospital referral region

Sioux Falls, S.D.

58 beds

ICU beds per 100,000 people aged 60 and older, by hospital referral region

Sioux Falls, S.D.

58 beds

ICU beds per 100,000 people aged 60 and

older, by hospital referral region

Sioux Falls, S.D.

58 beds

New York Gov. Andrew Cuomo said Tuesday morning that the state, currently the epicenter of the country’s Covid-19 outbreak, soon could need 40,000 ICU beds given the trajectory of infections. “Those are troubling and astronomical numbers,” he said.

The Journal analysis shows that the state has about 3,800 beds, or 96 per 100,000 older residents, putting it slightly below the national average. The Manhattan health region, which includes Brooklyn, Staten Island and part of Queens, had about 1,100 ICU beds before the crisis.

Areas ranking near the bottom in ICU beds per older resident in the Journal analysis include the Hackensack, N.J., Fort Myers, Fla., and Santa Cruz, Calif., regions.

“We are working nonstop to protect our elderly,” said Florida’s top hospital official, Mary Mayhew, secretary of the state’s Agency for Health Care Administration. She said the state is working with hospitals to convert surgical beds to work as ICU beds, and has sent out guidance for hospitals to test every symptomatic elderly person to keep those infected from returning to senior homes.

What happens if New York hospitals run out of ventilators? State officials are considering different options to help in that grim scenario. WSJ’s Jason Bellini spoke to experts familiar with the discussions. Photo: Ronald Bon/DPA/Zuma Press

Hospital association and state officials in New Jersey and California said expansion efforts would add thousands of beds overall.

The findings also show vulnerabilities in areas that have both low levels of ICU beds and higher levels of older people with underlying health conditions such as asthma and diabetes, which are associated with higher risk from the coronavirus.

Hackensack, currently a Covid-19 hot spot, had a higher rate of hospital visits for diabetes than 74% of the regions, but had just 64 ICU beds per 100,000 older residents, well below the national average.

The Binghamton, N.Y., region ranks well below the national average in ICU beds per older resident, but had a higher rate of hospital admissions for asthma and chronic obstructive pulmonary disease among 65-to-74-year-olds than 80% of all U.S. hospital regions.

Hackensack, N.J., currently a Covid-19 hot spot, had just 64 ICU beds per 100,000 older residents, well below the national average.



Photo:

eduardo munoz/Reuters

A spike in coronavirus patients where too few ICU beds exist could result in otherwise preventable deaths among the elderly, health experts said. “It’s pretty ominous,” said David Wallace, a researcher on hospital capacity at the University of Pittsburgh and a physician in the transplant intensive-care unit at UPMC Montefiore, one of 42 hospitals operated by the Pittsburgh-based system.

Many hospitals are trying to expand numbers of ICU beds, clearing room for more critically ill patients by sending home those who can be cared for elsewhere and canceling procedures that can wait. State and federal aid efforts are also adding beds in tents and other temporary locations. Those factors could help address some of the shortcomings revealed by the Journal’s analysis.

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The CDC analyzed 2,449 Covid-19 patients with known age in the U.S. through March 16. Although many hospitalizations and ICU admissions involved those younger than 55, the rates sharply increased with patient age, with a majority of ICU admissions and more than 80% of deaths among those 65 and older.

Using the CDC data, the Journal calculated that Covid-19 patients aged 60 and older were more than twice as likely to be admitted to the ICU than those in younger age groups.

Critical Conditions

The average hospital region in the U.S. has 116 intensive-care beds per 100,000 residents who are aged 60 or older, but many regions fall well short of that mark. These 10 regions, each of which has at least a half million residents, show the wide variation in the number of ICU beds available to confront the Covid-19 pandemic.

ICU beds per 100,000 residents aged 60+

     = 5 beds

Percentage

of population

aged 60+

ICU beds per 100,000 residents aged 60+

     = 5 beds

Percentage

of population

aged 60+

ICU beds per 100,000 residents aged 60+

     = 5 beds

Percentage

of population

aged 60+

ICU beds per 100,000

residents aged 60+

     = 5 beds

Percentage

of population

aged 60+

Cities and states are racing to add hospital beds. California is moving to open as many as four temporary hospitals. Florida and Washington have appealed for federal aid for about 6,000 total additional beds, and New York City is converting nursing homes into hospitals, officials said.

A Harvard Global Health Institute data analysis released last week looked at several scenarios to estimate how hospitals in each of the U.S. health regions could cope with a surge of Covid-19 patients. It focused on all adults, while adjusting for likely higher admission rates for the elderly. The regions it showed might have the biggest shortfall in ICU capacity were consistent with those in the Journal’s analysis.

The Journal analysis used a broad definition for ICU beds, including units usually used for burn, surgical and coronary patients. The 306 health regions used by the Journal were created by the Dartmouth Atlas Project, which groups hospitals according to where their patients generally come from.

A patient arrives at WellStar Kennestone Hospital in Marietta, Ga.



Photo:

Curtis Compton/Atlanta Journal-Constitution/Associated Press

Several regions of Florida, home to a large elderly population, are among those with the fewest ICU beds per elderly resident, the Journal analysis showed. The most populous of those areas is Fort Myers, with about 470,000 residents over 60, and 268 ICU beds.

Lee Health, the largest hospital chain in the Fort Myers area, has 60 additional beds that could be converted to ICU-type beds, and “we are very confident of our ability to meet the needs of our community in these unprecedented times,” a spokeswoman said.

The region around Santa Cruz, Calif., has 22 ICU beds serving an area with nearly 300,000 people, about 20% of them age 60 or older, giving it one of the lowest ICU-capacity rankings in the Journal analysis.

A spokeswoman for the largest hospital in the area, Dignity Health Dominican Hospital, said it currently has the equipment and supplies to manage any Covid-19 patients, and is updating its “surge capacity policies” that could include triage tents, using other space inside the hospital or transferring patients to nearby health systems.

If the number of Covid-19 patients exceeds bed capacity, the hospital spokeswoman said, Santa Cruz County would be responsible for taking action in coordination with state and federal officials. A county health spokesman said it has a mobile hospital that could be deployed, “but nobody has adequate beds for this.”

Seattle and New York hospitals already were nearing capacity over the weekend as cases surged, even after they moved aggressively to empty beds.

“Our ERs are full,” said Rebecca Bartles, an epidemiologist and executive director of infection prevention for Providence, which has eight hospitals in the Seattle area. “Our beds are full.”

The hospital system, one of the largest in the U.S., with 51 hospitals across seven states, prepared for an influx by clearing out entire hospital units to dedicate for treatment of coronavirus patients, she said. “That strategy was great, initially,” she said. “But the demand is exceeding that as well.”

Washington’s outbreak is so far the deadliest in the U.S., with 35 of 74 total deaths in Seattle and King County tied to one nursing home. The Journal analysis shows ICU capacity in the Seattle area is close to the national average.

Medical equipment arrives at the Jacob K. Javits Convention Center in New York, which is slated to become a hospital.



Photo:

Angus Mordant/Bloomberg News

Despite the expected shortfalls, the U.S. has more ICU beds per capita than most other nations. The U.S. has about 78,000 beds, or 24 beds per 100,000 inhabitants of all ages, according to the Journal analysis. That compares with about 29.2 in Germany, 12.5 in Italy and 3.6 in China, according to academic studies.

Measures of beds don’t account for how many beds are typically full, which can fluctuate by time of day or season, according to researchers and hospital executives. The Journal analysis showed that the average annual ICU-usage rate before the coronavirus struck was 64% in the U.S.

ICU patients in the U.S. stay an average of 3.3 days, according to a 2014 study. Covid-19 patients who survive often stay in the ICU for 20 to 25 days or more, said Paolo Pelosi, director of the intensive-care unit and anesthesia at a 1,600-bed hospital in Genoa in Italy, which has tripled its ICU capacity to cope with a surge of seriously ill people.

“When patients are admitted to the ICU, the duration is very long,” Dr. Pelosi said, “and it is very difficult to discharge the patients.”

Write to Tom McGinty at tom.mcginty@wsj.com, Mark Maremont at mark.maremont@wsj.com and Melanie Evans at Melanie.Evans@wsj.com

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