As hospitals swell with COVID-19 patients, Alabama officials are exploring “pop-up hospitals,” temporary facilities that experts describe as a last resort.
Alabama state Health Officer Dr. Scott Harris revealed those contingency plans during a news conference Wednesday in Montgomery. He said the Alabama National Guard was scouting possible locations across the state.
Guard officials referred questions to the Alabama State Department of Public Health, which declined to provide specifics.
“As part of planning, alternative or additional care sites continue to be reviewed in order to reduce the burden on hospitals rendering care to patients who have COVID 19,” Assistant state Health Officer Dr. Karen Landers said in a statement to FOX10 News. “Hospitals continue to exercise their surge plans within their facilities and develop a number of strategies to ensure the best care for patients.”
Landers added that the department will partner with communities and hospitals to secure federal funds to pay for alternative sites, although she declined to identify which ones have sought funding.
Temporary hospitals – including a Navy medical ship – helped hospitals deal with the influx of patients during the peak of the outbreak in New York City. But Alabama and most other places have avoided that step so far.
Dr. Don Williamson, president of the Alabama Hospital Association, told FOX10 News that it would be best to avoid having to do that.
“In general, if you can avoid taking care off your campus, it is better for the delivery of the care because once you move off of your hospital campus, you run into two problems,” he said. “One, you don’t have some of the infrastructure, such as pharmacy. The other is staff becomes much, much harder to staff a satellite location than it does to staff your main hospital.”
Williamson said temporary off-site medical facilities have been used in Alabama following some hurricanes, but he said he could not recall one in recent years.
Creating more space within hospitals
More common is shifting internal operations to create more space within hospitals, Williamson said. That has been done during severe flu seasons, and Williamson said some state hospitals – including in Mobile – have taken that step during the current pandemic.
Such maneuvering allows hospitals to increase intensive care unit beds.
Williamson said at a certain point, though, pop-up facilities might become necessary. He said it would take about two weeks to set up such a facility and that locations like convention and civic centers would be likely spots.
Beds are not the problem. The problem is staffing.
If that is done, Williamson said, those temporary facilities most likely would take on non-coronavirus patients needing less care to free up more space for ICU units inside hospitals.
On Thursday, Alabama hospitals reported 1,595 COVID-19 patients. Williamson said that including all hospitalizations for any reason, about 6,300 of 9,000 adult medical beds statewide are occupied. All but about 190 intensive care unit beds are filled, as well.
Dr. Jeanne Marrazzo, director the Division of Infectious Diseases at the University of Alabama at Birmingham, said Thursday that tight ICU capacity does more than constrain the ability of hospitals to keep up with a surge in infections. She said it also reduces the ability of hospitals to handle other emergencies unrelated to the virus.
“Right now, we’re having approximately the same number of patients admitted to our hospital who are discharged, which is a balance that is scary, but it is at least sustainable,” she said during a Facebook session organized by Sen. Doug Jones (D-Mountain Brook). “If that starts to tilt, and you have double the patients admitted – half the patients being discharged because the patients are sicker and sicker and sicker, and you have more and more of them – then that’s going to be something that we’re going to have to look at.”
Cutting back on elective surgeries?
Another potential step is to cut back on elective surgeries. Alabama Gov. Kay Ivey canceled them in the early days of the pandemic, but they resumed after a feared surge in patients failed to materialize. With hospital admissions now rising, Williamson said space could be made that way. But he added it likely would be done by individual hospitals, rather than a blanket statewide order.
Perhaps, Williamson said, some facilities would allow only procedures less likely to need ICU space or result in hospital admissions, why delaying other operations. He said the reason why officials postponed all elective procedures in the beginning was partially due to a concern about shortages of masks and gloves. He said the state is in much better shape in that regard and also has about 790 available mechanical ventilators.
But Williamson said supplies and hospital space are not his biggest concerns.
“Beds are not the problem. The problem is staffing,” he said. “Talking with hospitals yesterday, the overwhelming problem that we’re facing is a serious nursing shortage. COVID patients require more intensive care that do some other types of patients.”
If a nurse typically would handle about six patients, the ratio is closer to 1-to-4 for COVID-19.
“They’re out working long hours, multiple shifts,” he said. “They’re emotionally exhausted, they’re physically exhausted. And a significant percentage of our cases have been health care workers.”
Williamson said hospitals are trying to recruit nurses and hire temporary health care workers. But he added that the state is competing against many other hard-hit states.
Marrazzo said there might be signs that community transmission is leveling off in some of the most impacted states. But she cautioned that it is too soon to say Alabama will not need pop-up facilities.
“The availability of those beds right now is threatened,” she said. “It’s not compromised yet. But again, I want to get back to this concept of if we don’t get our hands around this and continue to really take care, it could be compromised, and it really is very worrisome.”