Hospitals Unprepared for Pandemic Surge

"Clearly when planning for this, we are no longer talking about surge capacity," Toner said. "Rather, I believe we are talking about surge strategies or capabilities."

More often than not, these strategies would involve keeping many patients out of hospitals altogether -- not only to make the most of scarce resources, but also to keep additional patients from getting sick.

"Hospitals are not designed necessarily to reduce contagiousness," said Dr. John Bartlett, chief of the division of infectious diseases at Johns Hopkins University School of Medicine. "And in SARS and other epidemics they are infectious disease amplifiers."

A Pandemic Scenario: New York City

Dr. Michael Tapper is an epidemiologist and director of the division of infectious diseases at New York City's Lenox Hill Hospital, which has 650 to 700 beds. Tapper says that the capacity of his hospital would be quickly outstripped in the event of a pandemic infection.

But the bigger problem, he says, is that the same thing would be happening all around the city. And densely populated areas like New York could bear the brunt of the patient surge problem.

"New York City has done a survey and surge capacity, and in the city, our surge capacity is very low because most of our beds are fully occupied most of the time," Tapper said.

He added that the shortage of hospital space would not be the only problem. Rather, finding the staff necessary to treat patients would present a special challenge. He said this includes nurses, who are already in short supply, and respiratory therapists.

Bartlett said conditions created by the flu itself could further intensify the strain on the available workforce.

"Thirty percent of the health care workers in a given hospital will be out with the flu," he said. "Others will have kids to take care of because of school closures."

In order to take the strain off of medical facilities, non-traditional clinics could be set up in schools, civic centers and other public buildings. But in all likelihood, these temporary facilities would not provide medical care -- only food, water and a place for New York's displaced patients to sleep.

Preparing for a 'Diminished Standard of Care'

In the surge scenario described above, it is easy to see how those seeking medical care would likely have to accept what infectious disease experts call a "diminished standard of care."

This would involve triage and rationing of service and supplies in order to milk the full potential of every resource.

And it could mean that the role of hospitals could be shifted away from saving every patient, and toward leveraging resources to save those patients who can still be saved.

Bartlett said this could be a difficult notion for the public at large to swallow. But he added that absent a major preparation effort, such a situation may present itselfif a major pandemic strikes.

"Nobody can deal with the surge thing," he said. "It's beyond reach, I think."

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