by Bryant Furlow, New Mexico In Depth, New Mexico In Depth
March 13, 2020
Two days after Gov. Michelle Lujan Grisham declared a statewide emergency to marshal public health resources against a global pandemic, and as President Trump announced a national emergency Friday, it was unclear how prepared New Mexico hospitals would be for a surge of seriously-ill patients.
A spike in caseloads would require sufficient intensive care unit (ICU) beds, negative-pressure isolation rooms, mechanical ventilators to help patients breathe, and personal protection equipment like masks, gowns and gloves. Officials at UNM and Presbyterian hospitals report having enough masks, gowns and gloves on hand. But unknown is how many ICU beds and ventilators might be needed for a surge of COVID-19 patients.
In Italy, both ICU beds and medical ventilators have been in short supply as COVID-19 patients overwhelmed hospitals.
Currently, the great majority of New Mexico’s ICU beds are occupied. Just 54 of 344 state-licensed ICU beds are vacant.
But that number changes day to day, said David Morgan, a spokesman for the New Mexico Department of Health (DOH). In the event of a surge, the state could convert some of the additional 3,000 hospital beds in the state to care for infected patients, said Jodi McGinnis Porter, spokesperson for the state’s Human Services Department. And the 344 figure does not include ICU beds at the state’s five federally administered Indian Health Service hospitals or the Veteran Affairs hospital in Albuquerque, which the state does not license or regulate.
Ventilators help patients who are in acute respiratory distress to breathe. But one unknown in New Mexico is how many mechanical ventilators hospitals have.
“The number of ventilators in the state is a challenging number to capture,” Morgan said. “Acute care hospitals, long-term care and skilled nursing facilities, EMS, and other provider types all have ventilators. If the need in the state exceeds our capabilities, there are additional resources available to us if needed, including the Federal Strategic National Stockpile.”
On Friday morning, state officials reported 10 cases of COVID-19 in New Mexico. Two of those patients were hospitalized. One in an undisclosed ICU, according to DOH Medical Epidemiologist Chad Smelser, MD.
The DOH activated its emergency operations center to prepare for COVID-19 cases, as had several Albuquerque-area hospitals, including UNM Hospital, the US Veterans Affairs Medical Center, Lovelace Westside Hospital, and Sandoval Regional Medical Center.
“We have sufficient personal protective equipment and N-95 masks for employees and are following CDC and New Mexico Department of Health guidelines,” UNM Hospital spokesman Mark Rudi told New Mexico In Depth. Rudi did not volunteer details of the hospital’s pandemic influenza response plan or answer how many patients have been tested.
Some other hospitals in New Mexico and El Paso, Texas were reporting limited ICU bed and emergency department space on Friday morning, due to seasonal illnesses unrelated to COVID-19.
Center for Disease Control and Prevention guidelines recommend that patients arriving at hospitals with respiratory symptoms wear masks and that those with risk factors like recent travel to Italy or China or exposure to people recently returning from those places, be placed in isolation rooms, noted Jeff Salvon-Harman, MD, chief patient safety officer and medical director of infection control for Presbyterian Healthcare Services.
It is unclear how many New Mexico hospitals could comply if a sudden influx of cases occurs.
Presbyterian Hospital in Albuquerque is following the CDC guidelines, according to Dr. Salvon-Harman.
Like Presbyterian, the San Juan Regional Medical Center in Farmington, which has 14 licensed ICU beds, plans to place suspected COVID-19 patients in negative-pressure isolation rooms, spokeswoman Laura Werbner said in an email. But she did not immediately respond to a question asking how many of those rooms were available.
Thanks to seasonal flu and other respiratory infections, ICU beds are frequently in limited supply this time of year, even without a pandemic. Some New Mexico communities, like Santa Rosa, have no hospital ICU beds at all. The DOH and hospitals are coordinating overflow and plans for transferring patients to hospitals with available ICU beds.
“This virus will not be isolated to only one region of the state,” noted Guadalupe County Hospital administrator Christina Campos, in Santa Rosa. “But if we contain or mitigate it through preventative efforts, perhaps we can slow the progress and ensure that the demand for intensive care doesn’t outweigh the resources at any given time.”
Guadalupe County Hospital has three ventilator machines and three isolation rooms, including one in the ER, Campos said.
By closing schools around the state, banning large public gatherings, and calling on sick individuals to self-isolate, state officials hope to slow the spread of COVID-19 and “flatten the curve” – to reduce spikes in new cases that could overwhelm local hospitals.
COVID-19 symptoms include fever, dry cough and difficulty breathing. New Mexico residents can call the DOH Coronavirus hotline (855-600-3453) to be assessed by a nurse. A call to that number at 1 p.m. on Friday prompted a message that all nurses were busy with other calls at that time and a call-back option.
Patients should call local healthcare facilities before arriving for COVID-19 testing, Dr. Salvon-Harman added.