Oregon Risks Chaos Without An Emergency Plan, former Gov. John Kitzhaber Says
No one knows what will happen in Oregon, but if the exponential spread of the coronavirus isn’t stopped, the picture won’t be pretty.
The state could face 75,000 cases by mid-May, according to Dr. Dean Sidelinger, the state epidemiologist. Perhaps 15% would need hospitalization, judging from rates in other countries. Maybe 5% would need intensive care treatment.
If they all had to be hospitalized at the same time, Oregon would need 11,250 hospital beds, including 3,750 beds for ICU patients. That’s far more than the current capacity of 6,600 hospital beds, including nearly 1,060 intensive care bed but some of those are specialized for cardiac and neonatal patients, according to the Oregon Association of Hospitals and Hospital Systems.
“There’s a potential point here where we cross between demand and capacity,” former Oregon Gov. John Kitzhaber told The Lund Report. “Maybe we don't get there, but every day that we don’t plan for that, increases the likelihood that we could have a real train wreck.”
Even Gov. Kate Brown acknowledged the need for more hospital beds in a conference call with reporters on Monday, saying “the only thing we know to do is slow the transmission through social distancing and expand and preserve hospital capacity to support the sick.”
She said she’ll release more information about hospital capacity on Monday afternoon.
Kitzhaber, a former emergency room physician and three-term Oregon governor, said the state needs an emergency response team, staffed with public health officials, coordinated care executives, emergency room specialists and medical ethicists to devise a plan to manage and coordinate resources related to the pandemic.
“That needs to start like yesterday,” Kitzhaber said. “If we reach a point where we've got more people who need ventilators than we have ICU beds, what are we going to do?”
Gov. Kate Brown said in a conference call with reporters on Monday that she has an emergency response team but did not give any details. In late February, she convened a coronavirus response team composed of leaders from 12 state agencies, including the Oregon Health Authority, the Department of Human Services and the Office of Emergency Management, tasked with coordinating the state and local response. But Brown has not indicated that the group is planning for a worst case scenario to avoid the kind of situation that authorities, for example, in Italy face.
Northern Italy has a well-funded health care system, but hospitals there are overflowing, and physicians are being forced to make life-and-death decisions about a patient’s fate, according to news reports.
Italy has tested thousands more people than the U.S., which has lacked tests. But Brown said during the call on Monday with White House authorities that the testing logjam is ending.
“Private labs will have capacity to do 1 million test this week, 2 million next week and 5 million the week after and that’s good news,” Brown told reporters.
Experts say expanding testing will help, but more than 400 practicing physicians signed an open letter Brown last week, asking her to step up the state’s response to the outbreak. The letter was written by Dr. Smitha Chadaga, a Legacy Health internal physician, and Dr. Maxine Dexter, a Kaiser Permanente critical care specialist and candidate for a state House seat; it was signed by physicians across the spectrum, including emergency room doctors like Dr. Mary Tanski, the head of the emergency department at Oregon Health & Science University. The recommendations included a call for a team of medical and public experts to coordinate the state’s response to the outbreak, the creation of shelters to house people with and without COVID-19, expanded testing and tracking of quarantined people and supplies.
“I think they’re spot on,” Kitzhaber said. “In fact, I think we might need to be even more aggressive.”
He said the state should plan for a triage of resources, inventory supplies and give first responders and frontline workers priority on protective gear.
On their own, hospitals have already started to plan. For example, OHSU will cancel all non-urgent surgeries starting March 23, according to an internal posting obtained by The Lund Report, and Kaiser Permanente is postponing non-urgent medical and dental procedures, according to a release on Monday. Information from other hospital systems was not immediately available.
Oregon only has 688 ventilators and 510 negative pressure isolation hospital rooms which prevent contaminated air from infecting other people.
Brown has appealed to Vice President Mike Pence for additional supplies, asking for 400,000 N-95 respirators, 600,000 surgical or procedural masks, and other equipment. Federal authorities said they could only provide 36,855 N-95 respirators, 87,795 masks, 16,718 face shields and 13,700 surgical gowns, according to a notice that Oregon Health Authority officials received from a U.S. Department of Health and Human Services official. The Washington Post reported Monday that the White House told governors they need to find ventilators on their own instead of waiting for federal authorities to supply them.
Kitzhaber said emergency planners could stretch resources, for example by collecting breathing devices, called CPAP, from people who suffer from mild sleep apnea.
“It's not as good as a ventilator, but they have continuous, positive airway pressure,” Kitzhaber said.
He said the state could expand bed capacity by identifying a few smaller hospitals that could be ready in a short time to treat COVID-19 patients. He suggested PeaceHealth Sacred Heart Medical Center University District in Eugene - with 104 beds - and Tuality Hospital in Hillsboro, with 215.
He also suggested the state consider housing people in the vacant Wapato Jail in Portland
“Fundraising efforts are underway to open three of the nine wings at the Wapato Jail facility for people experiencing homelessness,” he said. “What would it take to use these wings to expand capacity for managing those with coronavirus who need inpatient care, but not ICU care?”
Kitzhaber is also worried about the sense of panic that’s evident in grocery stores swept clean of toilet paper.
Some of the buying might be for people who are in quarantine or who intend to self-isolate, but much of it stems from uncertainty, Kitzhaber said. He called on the state to prevent panic, hoarding and blame.
Everyone needs to work together, he said, a sentiment that was emphasized by Brown on Monday.
"We must work together and support each other to get through this," Brown said.
The media call was cut short, leaving many reporters with unanswered questions.
Kitzhaber suggested that the state deploy a network of advisory bodies and councils that have deep roots in the community to carry a calming message, letting the public know that the state might not have all the answers but that it’s aware of the questions and is working on solutions.
The alternative, he warned, is frightening.
“Potentially we could have some real chaos,” Kitzhaber said.
Mar 16 2020