Hospitals are finding innovative ways to re-use personal protective equipment and convert other medical machines into ventilators in preparation for a potential surge of coronavirus patients by mid- to late April.
Dr. Dennis Blankenship, senior associate dean of academic affairs OSU College of Osteopathic Medicine in Tulsa, on Monday said he thinks the health care system in Tulsa or Oklahoma could reach capacity in many facilities before April ends. He called it a “reasonable time frame” to expect by the third week in April that the state should be at a point where, if hospitals aren’t already overwhelmed, they are approaching that point.
Blankenship said he’s studied data here and infection curves in other states. He participates in daily COVID-19 briefings that involve Kayse Shrum, who is president of OSU Center for Health Sciences and the state’s secretary of science and innovation.
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Oklahoma’s peak, Blankenship said, could strike perhaps at the eight-week range — or late May. He said that is a conservative outlook, meaning the high point could come sooner.
“Over the next two to three weeks I think we’ll see a sharp increase,” Blankenship said. “The hope is that what we’re doing is really going to mitigate that — the measures that have been put in place — but also with just the difference in populations in Oklahoma as compared to New York and some of these larger metropolitan areas. We have a much better ability to isolate.”
Mayor G.T. Bynum imposed a shelter-in-place order Saturday that applies to all residents to prohibit social gatherings, enforceable by police officers. The mayor offered a scenario in which 20,000 people in the Tulsa metro might need hospitalization for COVID-19 in the next two months.
Blankenship is a practicing emergency room physician at OSU Medical Center. He said rationing and re-using personal protective equipment, as well as developing ways to retrofit other medical equipment to serve as ventilators, is preparing the state in advance of that pending influx of coronavirus patients.
Gov. Kevin Stitt implemented an effort March 24 to preserve medical supplies, with a 14-day suspension of elective surgeries, minor procedures and nonemergency dental work.
The stock of PPE on hand has improved statewide since the state began tracking the inventory March 19 through an executive order requiring hospitals and physician clinics to report data daily. There was an average of 8.8 days worth of PPE available at facilities then, growing to a high of 11.1 days on Friday before dipping a bit to 10.6 days on Monday.
Tulsa and Oklahoma counties have made significant gains. Initially, each county’s facilities reported a median of about two days of PPE on hand. Tulsa County had risen to a median of eight days on Monday, with Oklahoma County moving up to 4.5 days.
“I think that is one of the most concerning needs obviously as we see what’s happened in the states that were hit first and hit hard — that they ran out of PPE,” Blankenship said. “It’s a tough number to gauge.”
He explained the figures tracked daily by the state are a conservative snapshot of a fluid metric. Baked into the calculation is an increase in PPE burn rate during the coming days as the disease hospitalizes more people, he said.
The anticipated “drastic need” is prompting medical providers to extend the lives of disposable N-95 masks beyond just one patient, he said. There are cleaning techniques with ozone or UV rays, with some doctors also letting the protective equipment sit for five days between uses because of the lifespan of the virus on solid surfaces.
Blankenship noted that many businesses are donating masks and some schools are using 3D printers to make visors or face shields.
“That’s been very reassuring and makes you feel good about the community and their involvement and their willingness to help us protect ourselves,” he said.
Another factor Blankenship anticipates will help build PPE reserves is increased testing capacity mated with swifter turnaround times. There are companies creating tests that can be done in minutes, not hours or days, he said.
Fewer inpatients awaiting test results means less hospital PPE is used caring for them, especially with so many eventually returned as negative for COVID-19, he said.
“You don’t want to put them back into the normal population, you want to make sure that they’re isolated. You’re using up a lot of your PPE and you don’t know the results of the test,” Blankenship said. “Even on discharge, how do you manage those patients on discharge if they have to go back to a care facility. So I think the turnaround time on the testing as those become more available this week I think is going to be very, very crucial.”
Efforts aren’t solely focused on medical personnel’s own protection.
Hospitals here are learning and adopting plans for techniques born of desperate circumstances to care for coronavirus patients in hot zones elsewhere in the country and world. Blankenship said Oklahoma hasn’t retrofitted other machines to serve as ventilators yet, but that last-ditch effort is a valid contingency.
“We’re seeing inventive ways of not only just finding them the bed space, but also finding ways to use ventilators and other machines that can function as ventilators,” Blankenship said. “There are BiPAP machines that are not invasive ventilation machines that have been found to be useful and converted to be used as ventilators. We’re seeing anesthesia machines have the possibility to be used as ventilators. There are methods of even splitting ventilators where you can ventilate multiple patients with one ventilator.
“All of these things obviously aren’t ideal, and you wouldn’t want to do them unless that’s the only resource that you have.”
Bottom line, Blankenship said, there is some level of surge capacity beyond typical use of beds or equipment. But an outbreak or outbreaks in certain spots could hit hard.
“When you look at these ICU beds and percentages and different things, you can anticipate a couple of clusters in just the right place — whether that be nursing facilities or other places — could impact that pretty quickly,” Blankenship said. “I think we also have just a little bit of reserve that is outside of the strict ventilator and ICU bed numbers that give us a little bit of a surge capacity above that.”
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Tulsa Mayor G.T. Bynum and Dr. Gerard Clancy answer reader questions in a Tulsa World “Let’s Talk” virtual forum, sponsored by the George Kaiser Family Foundation and the University of Tulsa.
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