Dr. David Dausey: America, brace for impact - TribLIVE

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If Italy is any guide, in the upcoming days and weeks America will face a health care crisis like we have not seen in this country in many years in response to covid-19.

While the country has recently taken admirable steps to contain covid-19, some measures were taken too late. The mantra for pandemic preparedness is early detection, early response. Our country failed on both counts.

What does this mean in real terms for ordinary Americans? Here are some predictions.

The health care systems in some parts of the country will exceed their capacity. The total number of hospital beds in the U.S. is significantly below many other countries in the world. Therefore, our health care system has limited surge capacity. In the upcoming days, you are likely to see hospitals working with community partners to increase surge capacity by using gymnasiums, shelters and other spaces to house sick patients.

While we are likely to find surge in space, we won’t be so lucky in finding surge with critical hospital equipment needed to treat the severely ill. In particular, hospitals are likely to run out of mechanical ventilators needed to treat people facing severe acute respiratory distress. Even areas that don’t run out of ventilators will struggle to find the health care personnel (including respiratory therapists) needed to treat patients using these ventilators. There is a possibility that the greater Pittsburgh region will experience some of these challenges in the near future.

The virus will spread in health care settings and among health care workers. There is a national shortage of face masks for health care workers. This shortage can be felt in the greater Pittsburgh area where many health care workers are practicing without face masks. The U.S. has a Strategic National Stockpile that is designed to be tapped when the nation faces an emergency like this one. Unfortunately, face masks have not been substantially replenished in this system since 2009.

The lack of face masks for health care workers is equivalent to the Titanic not having enough lifeboats. People will die as a result. Our health care workers are our front line for dealing with any public health threat. Their protection is our protection. Therefore, if you have face masks (specifically N95 masks) in your house, consider donating them to organizations in your local area that are collecting them for health care workers. The health care workers need them more than you do at this time.

Significantly more people will be identified as sick. Pennsylvania now has more than 600 confirmed cases of covid-19. The number of cases identified in Pennsylvania will likely grow now that the FDA has cleared a rapid-test for covid-19. This means we will be testing more people and identifying more people with the virus.

In order to identify those who are truly sick, the U.S. will ramp up efforts to do rapid testing with drive-thru testing sites around the country. Test sites are already popping up across the country. Not everyone identified as having the virus will be able to receive immediate health care attention. Priority will likely be given to those who are the sickest and those who are at the greatest risk of mortality. If and when a vaccine is developed or a drug is demonstrated to be effective for prophylaxis, it will be given to health care workers first.

Reported deaths will continue to increase over time. As more people are identified as sick, and as they report to our health care system for urgent care, more will succumb to the virus. This is incredibly tragic but is unavoidable.

There is no vaccine for covid-19, and we don’t have proven treatments for the disease. A vaccine will likely take at least 12-18 months before it is ready for mass distribution. Many existing and new drugs will be rapidly tested for treatment and/or prophylaxis. However, many that have initial promise will be shown to be ineffective as has already happened. The reality is that we can only do so much to help people even if we had a fully functioning health care system. Elderly men with comorbid illness are at the greatest risk and will likely have the highest fatality rates when the dust settles.

Many states will extend social distancing orders. Covid-19 can now be found in every state in the nation. States around the country have implemented stay-at-home orders. Many of these states will extend their social distancing orders into April or longer.

The reality is that the total number of detected cases in the U.S. is simply the ice we can see above the water for the iceberg that is covid-19. The majority of cases in the country are undetected. The majority of deaths are yet to occur.

Americans have shown great resilience throughout the evolving saga with covid-19. That resilience will be tested more in the days ahead. The most important thing that we can all do at this point to follow the guidance of federal, state and local authorities and to treat each other with care and compassion.

David Dausey, Ph.D., is provost and vice president of academic affairs at Duquesne University and a professor in Duquesne’s John G. Rangos School of Health Science. He is also a distinguished service professor of health policy at Carnegie Mellon University.

Categories: Coronavirus | Opinion