AUSTIN, Texas — The front lines of Texas’ health care workforce are preparing for the possibility of widespread COVID-19 infection — and sounding the alarm about the state’s limited number of hospital beds.
Some hospitals are restricting who may visit and screening outsiders for fever. Some are asking doctors and nurses to work longer hours. Others are building drive-through testing sites, temporary triage centers and fever clinics in anticipation of high patient volumes.
And all of them are urging Texans to stay as isolated as possible in order to slow the spread of the new coronavirus because there aren’t enough hospital beds to care for critical patients if too many people get sick at once.
“If we can get people to stay out of crowds, stay out of crowded environments to slow down the transmission of this virus from person to person, we should be able to stretch our resources to the point where we can take care of the entire population that needs hospitalized care,” said Craig Rhyne, the Lubbock-based regional chief medical officer for Covenant Health.
The Texas Tribune interviewed more than a dozen doctors, nurses and other health care workers about how ready the state’s health care system is for an expected spike in coronavirus cases. Most spoke on the condition of anonymity because their employers did not allow them to talk to reporters.
Because COVID-19 is a respiratory disease that attacks the lungs, some doctors worried that they would run short on ventilators, machines that provide oxygen to patients who become so sick they cannot breathe on their own.
“Capacity is a big problem if this thing continues to continue to prove to be a nasty bug,” said one emergency room doctor who works at multiple suburban and rural hospitals in North Texas. “The doomsday scenario that we’re worrying about is what does a relatively small hospital do when we’re using all four or five of our ventilators.”
At a Tuesday press conference, Gov. Greg Abbott said he was confident that Texas hospitals have enough ventilators to handle the situation.
"We feel comfortable with ... the information that we received with regard to ventilators," Abbott said. "Some [hospitals] had numbers larger than what I anticipated, and so there is no great urgency about that right now, but we want to be prepared and make sure we have as many as we could possibly need."
Texas’ hospital capacity — the number of beds available per person in the general population — is about 2.9 beds per 1,000 Texans, according to state regulators. The U.S. rate is about 2.8 beds per 1,000 people.
That’s less than the capacity of other countries that have already seen widespread transmission of coronavirus. Italy — where more than 2,100 people have died from COVID-19 and the nation’s hospital system has been overwhelmed — has 3.2 beds per 1,000 people, according to the Organization for Economic Cooperation and Development. European media reported that Italian doctors were prioritizing ventilators for the patients considered most likely to survive, and the country ordered manufacturers to ramp up ventilator production.
South Korea, where the government has aggressively tested its population for the virus and the number of new infections has leveled off, has more than 12 hospital beds per 1,000 people — roughly four times more than Texas. The country reported 75 deaths from COVID-19 as of Monday and has seen the daily rate of new cases fall from more than 900 in late February to less than 100 this week.
Texas health care workers say those figures underscore the need to slow the number of new infections so that hospitals can keep up.
“We need to do the best we can to try to slow down the virus so that our hospital systems are not overwhelmed,” said Mary Dale Peterson, president of the American Society of Anesthesiologists and chief operating officer of the Driscoll Health System in Corpus Christi.
Other health care workers expressed fears that supplies of personal protective equipment, such as N95 respirator masks, could quickly run out.
“Literally, [my boss] told me to hide them,” said Allen, an X-ray technician at a Central Texas clinic who keeps the masks under lock and key. Many patients he sees get X-rays to check for pneumonia or other respiratory conditions.
Allen was able to place a limited order for masks last week, he said, but a backlog of orders kept the manufacturer from fulfilling the complete request. He estimated his clinic had enough protective equipment to last roughly three months under normal conditions and said he had been told to reuse masks as long as the patients they came into contact with hadn’t tested positive for COVID-19.
“I’ve heard from some of our members that they’re struggling just to get the disposable surgical gowns that they would use in the operating room and are having to resort back to cloth gowns that they would have to launder and sterilize,” said Serena Bumpus, director of practice for the Texas Nurses Association.
In the eyes of Peter Hotez, the ability to protect health care workers from becoming sick is “our weakest link right now in our U.S. response to COVID-19.”
Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, told CNN this week that keeping workers safe will be paramount in ensuring the health care system can handle an influx of sick patients.
“If we have multiple front-line health care workers, ER physicians, nurses go down in this epidemic, a situation where we have colleagues taking care of colleagues in the intensive care unit, there’s nothing more destabilizing for the United States, and we have to make this our highest priority,” he said.
Two emergency room doctors were reported to be in critical condition this week from coronavirus infection, one in New Jersey and the other in Washington. And on Monday, the U.S. Centers for Disease Control and Prevention announced that one of its employees had tested positive for COVID-19.
Texas reported its first coronavirus-related death, a Matagorda County man in his late 90s, late Monday.
For Peterson, the Corpus Christi anesthesiologist, a main concern is the lack of testing, which can limit hospitals’ ability to perform effective triage, or sorting of patients based on how immediately they need care.
One nurse at MD Anderson Cancer Center in Houston said the hospital had begun building a temporary structure in an ambulance bay to serve as a triage space. Brette Peyton, a hospital spokesperson, said it was one of "numerous proactive measures aimed at minimizing risk to our particularly vulnerable patient population."
And Jacqueline, a nurse at Parkland Health and Hospital System in Dallas, said her hospital was assigning some nurses to focus solely on patients who had tested positive for coronavirus.
“In my years of experience in nursing, that’s absolutely unheard of because we just don’t have the staff for that,” she said. “I’m grateful, though, because that’s really what needs to be done.”
Other nurses were being asked to prepare healthier patients to be discharged more quickly, she said, “because they don’t want them exposed to anything in the hospital and because we may need that bed.”
A Parkland spokesperson did not respond to emailed questions.
This story originally appeared in the Texas Tribune.