bugs that live in the hospital In the hardest hit areas of China and Italy, entire wings or even entire hospitals are set

On the other hand, PPE is intended to protect patients from each other — not just COVID-19 but also MRSA and E.coli and all the other bugs that live in the hospital. In the hardest hit areas of China and Italy, entire wings or even entire hospitals are set up or being converted to care for only coronavirus patients. In an effort to conserve PPE, providers are wearing the same gown and mask for the entire shift — not even taking them off to use the bathroom. In theory, this seems appropriate since all the patients are COVID-19 positive so they won’t infect each other — but other infectious agents are free to travel between patients. Such practices may become necessary even here in the US due to shortages of PPE. This raises the risk both to providers — imagine the viral contamination on a gown as you take it off after an 8-hour shift and to other patients.

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PPE is intended to be single-use and disposed of between patients. Let me re-iterate that hospitals around the country are already feeling the pressure. Different hospitals have issued restrictions on when masks may be used, or rations on how many masks each provider has access to. Others are being forced to use bleach to clean and reuse equipment intended to be single-use only. We have to do a better job protecting our providers on the front line.
Much of the world’s supply is manufactured in China. The US emergency stockpile is only 12 million N95 masks and 30 million surgical masks. We will need far more than that. We need the President to invoke the Defense Production Act to surge production of PPE.
The front-line health care providers
The third point to raise is the availability of health care workers to treat these patients. Two issues immediately come to mind. The first and most obvious is what if the doctors and nurses are exposed and ultimately infected? This is happening in Italy and elsewhere at a staggering rate. In some areas of Italy, 20% of the hospital staff have become infected — not only must they self-quarantine, others are becoming patients themselves in the hospitals where they served. The current guidelines at most institutions are that providers exposed to a COVID-19 patient may continue to work with a mask as long as they remain asymptomatic. Herein we return to the critical need for a streamlined mechanism to test all suspected cases. Asymptomatic spread of COVID-19 is real — and it may be even more dangerous when it is healthcare workers who are spreading the virus. We MUST have fever clinics, separate areas of emergency rooms, or drive through testing sites. We NEED to know if an inpatient who develops respiratory symptoms is a carrier so that we can take the appropriate precautions.
The second and more subtle consideration is the effect of school closures on availability of staff. Closing schools poses a significant hardship in terms of childcare. What are these families supposed to do with a child who is now stuck at home? Finding an outside babysitter — especially if shared with other families — undermines the efficacy of social distancing. Trump suggested one way to get around staffing issue is to relax licensing requirements between states so that providers in another state can assist in areas of need. Maybe. But when this is a nationwide crisis — this is like your whole house is on fire and being told that you can use a fire extinguisher in any room you want. It doesn’t really solve the problem.
Conclusions
With the confluence of overcrowding in hospitals, high ICU and ventilator utilization, inadequate PPE for staff, and staffing shortages due to infected health care workers, you get a healthcare system in crisis. Hospitals will have to deviate from normal standards of practice and quality suffers — not just for COVID-19 patients, but for any patient that otherwise might require urgent medical care. In this way, it is dangerous not just for the elderly — anyone that gets into a car accident or has a stroke is now receiving subpar care. This explains how the mortality rate climbs quickly from the 1–2% into the 5–10% range. Future analyses of all-cause mortality and outcomes in cardiac arrest or strokes in the affected regions will shed light on the effect of the COVID-19 surge on the larger healthcare system as a whole.