The REAL reason you should care about COVID-19/Coronavirus. Hint - it is not about the actual virus itself!!!

As always, my friend is well informed, analytical and makes me think about issues from a completely different angle. This is the issue we have to focus on - not the virus itself! 

"I’ve been asked about coronavirus so many times recently, both because I work in healthcare and because I travel frequently. I’ve generally answered questions relatively non-committally, because, though I spend a lot of time with doctors, I’m not one. 

But, as I read reports coming out of Italy and elsewhere, it finally occurred to me that my area of expertise has actually become extremely relevant and important as people try to get their hands around the concept of “risk.” In my opinion, whether one gets the virus or not and/or how well they personally recover from it is only a minor consideration when assessing risk. In fact, it’s a whole different calculus that I think every person in America – even the very healthiest and heartiest among us! – need to be considering. Below I’ll try to explain why I believe this.

I’ve spent the better part of the last year studying and working to solve the challenges that hospitals have with placing admitted patients into hospital beds. Patients are generally admitted to the hospital from the emergency room, from operating rooms, from clinics and doctors’ offices, and sometimes from other hospitals. 

There are some key things that most people don’t know about hospitals that I think everyone should understand at least a little bit, in light of current events:

1) Hospital beds are only somewhat fungible (interchangeable). When you hear that a hospital “has 600 beds,” that doesn’t mean that they can properly serve just any 600 very sick patients. See, not every bed has the same characteristics in terms of level of care (for example, intensive care bed versus “regular” beds), equipment available (for example, telemetry), isolation capabilities (for example, negative pressure rooms), ability to accommodate patients with specific characteristics (for example, cribs for pediatric patients or larger entry doors for bariatric beds, etc.). Every patient that needs a hospital bed comes with a set of requirements that may only match a small number of the beds in a given facility, and there’s a small army of people at every hospital that tries really hard to figure out how to make a never-ending game of Tetris solve every single day (actually, every single hour!).

2) Doctors and nurses are only somewhat fungible. Though they certainly get some baseline set of common training in school, most doctors and nurses are at least somewhat specialized. A nurse who usually works on an orthopedic ward CAN care for patients who have had a stroke – but, that patient will be much better served by a nurse who has been trained to care for stroke patients. Conversely, a neurologist CAN set your broken bone, but you’d really rather have an orthopedist do that. All this is to say that just because there are people with MDs or nursing licenses available, that doesn’t mean that they are equipped to treat any condition that comes their way.

3) Some kinds of hospital beds are in very high demand even during “regular” times. Many, many (most?) large hospitals have a patient placement problem. At first glance, it often looks like a particular hospital has enough beds to serve the patients in line to be put into beds; but, in fact, the available beds are the wrong beds for the patients that need them or they are available at the wrong time. Nowhere is this more acute than in the relatively small subset of beds that are designated as Intensive Care (ICU) or Progressive Care units (“Progressive Care” units are a step-down from ICU, but the patients in these units still require more care and attention than those “on the floor” – which is hospital speak for “regular hospital bed.”). Those beds must be constantly turned over to ensure that there are always beds available for the patients that most critically need them. This means that patients are typically only in these units for a day or two. Sure, there are people who have to be in ICU or Progressive Care for longer, but they are the exception. In general, people go to these units to get stabilized or deal with an acute issue, and then they move “back to the floor” (a regular unit). If there are NOT enough ICU or Progressive Care beds available, nurses “on the floor” have to care for these patients. That means that their other patients get less care, since critical patients demand more one-on-one nursing and constant monitoring. It’s a lose/lose for both the critical patient stuck on a regular floor AND the patients who are in the right place, but end up getting less attentive care. 

So, why does all of this matter to you, especially if you are young and healthy and not likely to get really sick and end up in the ICU with coronavirus? Here's why:

The news out of Italy is that the patients that do need to be hospitalized are in pretty bad shape. In other words, they need ICU or Progressive Care unit beds. But, unlike the typical ICU/Progressive Care patient, they need these beds for WEEKS, not days. If a typical hospital’s number of ICU beds is ~15%, even most very large metro hospitals will have only 100-200 total ICU beds. And, as explained above, only a fraction of those will be “general med/surg,” or, beds that care for patients with all sorts of conditions. The rest will instead be staffed with nurses and doctors that have specific expertise in cardiac care, neurology, burns, etc. 

As I explained above, finding an available ICU bed can be challenging even when there’s not anything interesting going on in the medical world. It always gets a little more challenging during flu season (which we are in now). When you imagine a world where even only a very, very, very small percentage of those infected with coronavirus are sick enough to need an ICU bed, there’s still suddenly an *entirely new category* of people who need these beds…and they may need them for WEEKS at a time.

This means that a few things will happen:

1) Patients will increasingly have to be placed in units that are not best equipped to handle them. Yes, a nurse in a Burn ICU CAN treat a coronavirus patient (or a patient coming out of hip surgery or who had a stroke), but that is not their specialty (and, it may have been literally years since that nurse reviewed the very specific care protocols that are needed to care for those patients). 

2) Patients will eventually be unable to get into ANY critical care units. They will be placed “on the floor” instead, which means less appropriate care for them AND what is effectively a reduction in care for ALL patients on that floor, due to a nurse needing to spend more time with that single patient (even though it will still not be as much as that patient needs).

3) Patients who need very specific types of rooms (even if they aren’t in need of critical care) will find it harder to get the proper placement in a room with the proper equipment, tended to by the proper medical service and nursing staff.

4) When there are literally no rooms available (which already happens now, even during NON-flu season!), patients will stack up as they are “boarded” in Emergency Rooms – not only in rooms and behind curtains, but in hallways and any other space that a stretcher can fit. This means there won’t be a place to care for patients coming into the ER and wait times will mushroom.

5) Surgeries will be delayed or cancelled, because the PACU (Post-Anesthesia Care Unit) will be completely packed with patients who are ready to move to a bed in the hospital…but there are none available 

Note that I didn’t say that “coronavirus patients” will experience these things. It’s true, they will, but that’s not the point here. **ALL patients will experience these things.** This includes:

- The healthy 25YO who is in an automobile accident and needs to go to the ICU…but there’s no bed available

- The 50YO health nut who experiences a heart attack while on the treadmill at the gym and needs intensive cardiac care...but, the cardiac ICU is full of patients who couldn’t be accommodated in the ICU they needed to be in, so they took the last ICU beds available, even though they were the “wrong type”

- The healthy child that falls off of the monkey bars and ends up with a head injury or compound fracture, but can’t be cared for in a pediatric unit or orthopedic unit, because people are being housed there since there was literally no other place to put them

- The college kid who has an unfortunate encounter with a car while biking to campus and ends up in the Burn ICU instead of the Neuro ICU, even though she has a traumatic brain injury

- The woman who gets an appendicitis - completely out of the blue! - but can’t get seen in the ER for hours because there’s literally no place or person to treat her

The list goes on and on and on. EVERY SINGLE PERSON who needs care that would ideally be provided in an Emergency Room or hospital setting – even those who can beat coronavirus in their sleep with one hand tied behind their back! - will be impacted. If one looks at the number of beds, by type, in a typical American hospital, it becomes scarily clear that this doesn’t have to get “really bad” in order to BE really bad for *ANYONE* that needs care in an ER or hospital…not because of THEY are infected by coronavirus, but because so many other people are! 

It is this reality that I wish the news would focus on. Instead, we see a lot of talk about coronavirus itself (which really is easy to dismiss if you’re young-ish and relatively healthy) and some talk about “overwhelmed health systems” (what does that even mean?). I wish they’d spend more time really laying things out in the sort of detail I have above to help the typical, healthy, normal-immune-system person out there realize why this whole “coronavirus thing” really DOES matter to them – in a real sense that’s more concrete than in a “you should care about others” way.

In short, if there’s ANY chance that you or someone you love might need a hospital for ANY reason over the next couple of months, I think you need to care about what’s happening. Even if there’s no one in your life that is elderly or immunocompromised, the risk is real that the emergency/critical health care that you expect to be available to you when you need it…well, it might not be.

I am not taking a position on how or when people should prepare for coronavirus or what actions that government or private entities should take or not take at this juncture. But, I do hope that, as each of you makes your own decisions on these things, you’ll think more broadly about the concept of “risk” – and realize that what we are facing right now is only peripherally about “the virus” itself."