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Bucks County prepares for COVID-19 arrival

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How prepared is Bucks County for the inevitable rise in infections of the novel coronavirus? Two confirmed cases in Bucks County were announced Tuesday.

How do we find the reasonable middle ground between panic and complacency, and what actions can we take here in this county to maintain health in a practical yet effective way?

In a series of future articles, the Herald will attempt to answer those questions. But before we can address a response to the problem, a candid view of the situation is needed.

One has only to look at Italy to see the reality of what many argue we are under-prepared for. As of this writing, 10,149 people in Italy have been infected, and 631 have died, including 168 in the past 24 hours. And while Italy is in partial lockdown over 4,300 miles away, the first “containment zone” in the United States has been created just 70 miles away in New Rochelle, N.Y.

A quick glance at any map, such as at Arcgis.com, shows that political boundaries and geographic barriers have been largely permeable to this virus. COVID-19 is now in 115 countries and on every continent on earth except Antarctica.

A sobering document leaked from a webinar hosted by the American Hospital Association described a pandemic tsunami that may be expected to hit the United States.

Released by Business Insider, the slide reflects the “best guess” estimate of Dr. James Lawler, a board-certified infectious disease expert at the University of Nebraska Medical School and director of clinical and biodefense research at the National Strategic Research Institute.

Lawler’s numbers include an R-zero value of 2.5, meaning that each single infected person will in turn infect an average of 2½ others, doubling transmission every 7-10 days with community epidemic waves expected in two months. He puts the community attack rate at 30-40 percent with 5 percent requiring hospitalization, 1-2 percent requiring ICU care, 1 percent needing ventilatory support and a case fatality rate of 0.5 percent.

Those rates translate to a disease burden 10 times greater than a severe flu season, which can threaten to overwhelm current hospital capacity.

When the rates are converted to raw numbers, Lawler said that we can expect 96 million cases in this country – a full third of U.S. citizens. Of those, 4.8 million can be expected to flood the hospitals as admissions. That is six times more than the number of staffed beds at community hospitals, of which only a fraction would be available due to other hospitalized illnesses and conditions such as cancer and heart disease.

A simple linear regression of Lawler’s numbers could mean that Bucks County might see almost 185,000 COVID-19 cases with over 9,200 hospital admissions. There are only 978 staffed hospital beds among the six community hospitals in Bucks County, however. The challenge, assuming Lawler is correct and no significant variables in the linear analysis exist, is quite clear.

Adding to that concern are infection rates among front-line hospital workers, which could further decrease health care system capacity with ill or quarantined staff.

Dr. Ron Goren, an infectious disease specialist with St. Mary Medical Center in Langhorne and Nazareth Hospital in Philadelphia, said that we’ve dealt with similar viruses with varied contagion and pathogenicity. “The coronavirus got our attention because of all the people showing up at hospitals in a fairly high death rate,” Goren said.

Goren stated that hospitals are concerned with panic visits overloading resources. He said that a strategy they may adopt is to direct people with mild to moderate fever and cough to self-quarantine and take precautions to prevent spread.

He explained that limited testing capability and no on-site testing currently hampers hospitals as they try to grapple with the epidemic. “We have a bottleneck in testing, which I hope is going to expand over the next few weeks,” adding that clinical similarities with a concurrent wave of influenza complicates the matter further.

Goren then stated some positives. He said that new point-of-care viral pneumonia diagnostics capability is being acquired by many hospitals, allowing accurate on-the-spot emergency room diagnoses within two hours. COVID-19 viral assays are being rapidly developed for those systems.

And despite the serious nature of COVID-19, Goren expressed optimism.

“Most people are not going to get very sick with this,” he said. “Don’t panic. The reason people are buying toilet paper and stealing masks is because they’re panicking. And they shouldn’t panic. The overwhelming majority of people aren’t going to get very ill.”

He then paused and reflected, “Am I painting too negative a picture or too rosy a picture? It’s hard for me to say. I’m trying to look at all the information and parse out how we’re going to handle this.”

Next Week: Understanding COVID-2 and the best ways to protect from it.


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