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March 11, 2020

What America can learn from the global fight against the coronavirus

Daily Briefing

    As the new coronavirus spreads in the United States, health care providers are treating a growing number of cases of COVID-19, the disease caused by the virus. Here's what providers in other countries have learned from their experience treating the disease.

    Our analysis: The 'recurring themes' of disease outbreaks

    About the COVID-19 epidemic

    Reports of the new coronavirus first surfaced in early December 2019 in Wuhan, China. As of Wednesday morning, officials reported more than 121,800 cases of COVID-19 globally. Officials said as of Wednesday morning there had been at least 4,381 deaths linked to the new coronavirus, and all but 1,219 occurred in mainland China.

    In China, the number of newly reported cases of COVID-19 has slowed. Chinese officials on Wednesday reported a total of 24 new cases of COVID-19 and said 10 of those cases occurred among patients who had contracted the virus abroad.

    But the number of newly reported infections from the new coronavirus has been surging in other countries. For example, in the United States, state and federal officials as of Wednesday morning reported 1,015 confirmed or presumed positive cases of COVID-19, up from 231 on Friday. So far, 31 U.S. deaths have been linked to the new coronavirus.

    Here's what providers around the world have learned from their experience treating COVID-19.

    Takeaways from China's response

    While China saw cases surge earlier this winter, in recent weeks, the country has managed to slow the growth and reduce the number of new cases.

    China was able to slow the rate of new COVID-19 cases in part by diagnosing suspected cases rapidly and treating confirmed cases quickly. To help with these efforts, officials set up makeshift hospitals and launched teams to diagnose patients.

    Still, Du Bin, director of intensive care unit for internal medicine at Peking Union Medical College Hospital, in retrospect said Chinese officials could have improved the country's response to the outbreak. For example, he said public health authorities could have had their ICU team members collaborate more closely to establish best practices for providing care to infected patients in critical condition.

    Du also said officials could have encouraged providers to use more aggressive treatment methods for patients in critical condition. For instance, he said providers could have treated patients experiencing respiratory failure or low levels of blood oxygen, called hypoxemia, with invasive mechanical ventilation.

    According to Du, the most important step providers in other countries can take to prepare for the new coronavirus is to establish a response plan. "You must have a plan to provide not only space but also supplies such as personal protective equipment for all the health care workers involved," he said.

    Takeaways from Britain's response

    In Britain, providers and public health experts have said the country's National Health Service (NHS) is ill-prepared to handle an influx in COVID-19 cases.

    On the one hand, Britain's health care system so far has been able to provide 18,000 Britons with no-cost testing for the new coronavirus, and a national helpline has ensured patients with less serious cases stay out of the country's hospitals with limited capacity.

    But physicians and public health experts are concerned steps the British government has taken to slow the national health care system's spending growth will negatively impact the country's response to an outbreak. Over the years, cost-cutting measures have resulted in health care worker and bed shortages. For instance, since the late 1980s, the number of hospital beds in Britain has decreased by about 160,000, presenting a unique challenge for providers responsible for treating infected patients.

    Chris Whitty, Britain's CMO, has acknowledged an outbreak would "put very high pressure on the NHS." One possible solution the British government has considered might be to create an additional 5,000 intensive care beds, treat patients using at-home ventilators, or recruit retired physicians to help.

    In the meantime, providers are trying their best to respond to an influx of patients.

    Nick Scriven, a specialist in urgent conditions in Halifax, England, and the former president of the Society for Acute Medicine, said, "We're already at maximum capacity and clearing out beds as best we can." Scriven said he estimates hundreds of people in Halifax could become infected and need respiratory support, but his unit only has 17 ICU beds. He noted that providers could use about 18 other ventilators stationed in the hospital's ORs, but outside of those options, "We're talking about people squeezing bags."

    Meanwhile, hospitals and administrators are taking a number of steps to prepare for a potential outbreak. For instance, they are beginning to check whether they have the appropriate number of ventilators and oxygen in stock. They're also determining whether their hospitals have properly trained providers on staff and supplies to respond to an outbreak.

    Takeaways from Italy's response

    In Italy, hospitals are facing provider shortages as more people become infected with the virus. Health care providers in interviews with the Washington Post said they feel as though the country's health care system is being "stretched to its limits."

    Last week, providers at a hospital in Milan said they were treating the outbreak, which has been exacerbated by provider shortages, like a "mass-casualty event."

    Enrico Storti, head of emergency and intensive care at the hospital, said, "This hospital managed to stand in a very complex situation." Storti noted that "[p]hysicians, nurses, technicians are also infected, so they were forced to stay home."

    Italy has taken steps to mitigate the provider shortage. For example, officials are graduating nurses early and calling health care providers out of retirement. In areas hardest-hit by the virus, hospitals are delaying nonessential surgeries and scrambling to find ways to add 50% more ICU beds, the Post reports.

    In addition, Italy has been providing extensive testing for COVID-19, including testing patients who do not show symptoms of the disease (Bloomberg News, 3/5; Mueller, New York Times, 3/6; Morris, Washington Post, 3/3; Fassihi/Kirkpatrick, New York Times, 3/4; Alaei/Alaei, New York Times, 3/6; New York Times, 3/11; Neuman, "Goats and Soda," NPR, 3/11; Smith et al., New York Times, 3/11).

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