At the Helm

Map: How ready is your state to cope with a Covid-19 outbreak?

by Christopher Kerns, with analysis by Nick Hauger, Kyle Campbell, and Andrea Martin

By now, nearly every U.S. hospital and health system is knee-deep in preparing for a potential COVID-19 outbreak in their communities. Most executives I've spoken with are taking at least initial steps to ensure protocols designed for natural and other disasters are ready for execution should a local or regional outbreak occur.

Your top resources for coronavirus readiness

But pandemics aren't your typical disaster: They can persist for weeks or months, and they can initially strain quarantine resources (in space, labor, and crucial equipment), followed by spikes in overall admissions across an entire region.

Most organizations' leaders know what their facilities can handle (well, let's hope so at least; probably a good idea to get on that otherwise). But what about entire regions? If your hospital is at capacity, can your peer organizations pick up the slack?

How we analyzed hospitals' capacity to deal with COVID-19

To get a handle on this problem, we looked at current occupancy rates across the United States. We looked at not only inpatient occupancy, but also outpatient bed days and visits to get a sense of how many beds are likely to be occupied on any given day.

We've known for some time that, nationwide, U.S. hospital occupancy is quite low, in aggregate at 60.7%. This would suggest a lot of potential slack in the system (and has often been cited as a reason why health systems have tended to rely on price increases to sustain margins).

But this occupancy rate includes all hospitals—from the most sparsely populated rural regions to our densest metropolises. The rate for your region may be very different.

As I go through these numbers, keep in mind that I'm using the traditional heuristic of 80% occupancy as denoting "full occupancy" (because of daily variations in demand, at above 80% average occupancy, providers likely have to divert ambulance volumes due to lack of capacity).

The cities and states with the most (and least) spare hospital capacity

The charts below map occupancy rates by state and for the top 25 largest metropolitan statistical areas (MSAs):

 

Fortunately, no state is currently strained to capacity in aggregate—although New York state comes close, at 73.5%. In general, the more rural a state, the lower its occupancy rates: Wyoming, for instance, has the greatest amount of room to absorb demand, at 36.8%.

As expected, the occupancy rates for states as a whole are far lower than those of urban areas. Among the largest MSAs, Atlanta has the highest occupancy rate, at 77.4%, nearly straining total capacity. San Francisco holds the largest excess capacity, with occupancy at 55.1%.

What if a COVID-19 outbreak causes millions of new hospitalizations?

These numbers tell a story of what hospital capacity looks like today. But to any seasoned observer, these numbers are missing a critical factor: They don't show how many patients a moderate to severe outbreak might generate.

In 2017, HHS helpfully modeled out potential increases in nationwide hospitalizations for a flu pandemic ranging from a moderate scenario (1 million; based on the 1968 flu outbreak) to a severe one (9 million; the 1918 flu pandemic).

For this analysis, we started with HHS' estimates for new hospitalizations nationally, and allocated them proportionally to the three largest MSAs in the United States—New York, Los Angeles, and Chicago—based on their share of the U.S. total population, for illustrative purposes.

An important caveat: Overall infection and mortality rate estimates for COVID-19 vary widely. As such, this is by no means a prediction, but rather a what-if scenario to determine regional readiness for utilization increases in the event that COVID-19 behaves like historical flu outbreaks.

For the three largest American cities, a generalized outbreak could significantly strain resources under even a moderate scenario.

How likely are hospitals to see those levels of hospitalizations? It's hard to know. In some ways, China's experience gives us reason for hope: There are signs that, after an initially severe spike in infections and hospitalizations, the rate of new infections is slowing in China. But rates in other countries—including the United States—are rising on a near daily basis.

Some public health experts are hopeful countries can adopt lessons learned from China to stem new cases, and there's some evidence that moderate changes to handwashing could significantly slow the spread of COVID-19 in the United States—or at least reduce its incidence rate. I'll leave commentary on the epidemiology of the outbreak to public health experts.

But even a mild increase in utilization will strain resources if providers don't have the clinical labor to manage it—especially if they face potential infection and incapacitation of clinical staff.

Resources to support your response to COVID-19

We will continue explore ways in which organizations are building flexible capacity to manage clinical labor crunches, but in the meantime, we've curated links to recent work from Advisory Board and others on preparing for the worst:

Tracking the progression of COVID-19 in the U.S. and beyond

Learning from previous outbreaks and disasters

Managing clinical capacity

Your top resources for coronavirus readiness

book

You're no doubt being inundated with a ton of information on how to prepare for possible patients with the Novel Coronavirus (nCoV). To help you ensure the safety of your staff and patients, we pulled together the available resources on how to safely manage and prevent the spread of nCoV.

Access Now