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We all saw the horror that played out in Italy when hospitals were overrun and the bodies of coronavirus victims piled up.
Avoiding that kind of tragedy was why the world enacted drastic restrictions, shutting down huge swaths of the economy, churches, schools and social gatherings.
Now, as Utah gradually eases those restrictions, moving from what the governor calls the “red” phase to the “orange” one, more people will be out and about, though it’s far from a return to normal life.
Experts expect the number of infections to rise. It will be crucial to protect our hospitals’ ability to care for these people. With that in mind, I spoke with Dr. Michael Good, the CEO of University of Utah Health Care and the dean of the School of Medicine, to get an idea of what he anticipates in the coming weeks and months.
Here are excerpts of our discussion, edited some for length and clarity (mostly to make sense of my long, rambling questions).
Gehrke: A few weeks ago you gave a presentation that used a model showing the current outbreak peaking on July 21, with the demand for hospital beds scraping right up against your maximum capacity. As we ease the restrictions, do we run the risk of pushing that peak higher and overwhelming our hospital capacity?
Good: I think at that time we had three projections. I’ve since had a fourth projection. [Previous projections showed] that really tall peak, the 3,000 [beds needed], the next one at 900, the third one at 600 [our maximum capacity].
But now there is a fourth one … and it was at 400. And that’s where I became supportive of moving from red to orange, because that was below our bed capacity.
When the bed projections came down to 400, we still would have to put into play our so-called surge plans. But we could still take care of the community.
This graph shows the anticipated hospital bed needs for the University of Utah Health System. The demand has been reduced over time as social distancing and other measures have flattened the curve. They also have pushed out the expected peak of the disease until August 4.
We’re comfortable that we’ve got this buffer right now. We obviously have to watch the number of new cases, the number of hospitalizations. We also have our epidemiologist measure the transmission rate. Remember when we started in March it was three-to-one, every person was infecting three others. We did get it to one for about half a week. Now it’s been hovering at 1.1, 1.2., 1.3, but close to one.
As we have more activity in the community I suspect we will have more cases of COVID, but I do think we’re able to handle them and we’ll be watching closely to make sure that’s indeed what happens.
Gehrke: Looking back over the past two to three months, what has been the most surprising or striking thing you’ve learned from this experience?
Good: Nothing like this has happened in my career. We’ve had bird flu, SARS, and to some degree HIV but their impact on the community and the things we needed to do as a community and as a health system were in retrospect so much smaller in size and scope than the things we needed to do to slow down coronavirus.
I could have never imagined a pathogen that was so strong and could move so fast through a community. If you talk with my colleagues and particularly in New York City, Detroit, New Orleans, other places, the virus moved so fast that they were overwhelmed. And people who needed care were not able to get care and had unfortunate outcomes because of that. But a point of pride is how quickly our state came together, made hard and difficult decisions that really slowed the virus down.
So on the negative side is the power and speed this virus can move, the positive side was the equally impressive speed that our community leaders and our health system came together to fight it with the basic tools we had. We’re still in this fight. We’re learning to live with coronavirus and it’s a formidable foe, but for the moment we’re holding it off and we just need to keep doing all the things we’re doing … and work to balance the health care components with the economic impacts of COVID and find that right balance.
Gehrke: You have a firsthand view of the way doctors and nurses are responding to this outbreak. What sticks out in your mind about the work they’re doing?
Good: Some of the stories are so inspiring. Particularly in our effort to slow the spread of the virus in the hospital, we’ve had to restrict visitors. In my 35 years in medicine I’ve never ever been unable to have family members with their patients in the hospital.
I was just reviewing a note that said, “You’re taking care of my husband. If you offer him a blanket, he’ll say he’s not cold. Give him one anyway. He’ll say he’s not thirsty but make him drink.” … There were a couple other instructions. The last one — I’m getting a little teary thinking about it — is: “Tell him his wife thinks he’s hot and please take good care of him. He’s all I’ve got.”
Just the human connection and the human bond between caregivers and patients suffering from disease and families trying to make sense of all of this, there’s just so many wonderful stories.
Gehrke: As a medical professional, what do you want people to understand about this transition period?
Good: I don’t want moving from red to orange to be overly confused with open for business the old-fashioned way. There are a lot of nuances. Also really as a community we need to pay attention to high-risk individuals. If we can help the high-risk individuals stay healthy that will really knock down the spread of the virus in the community at large.
It comes down to not letting the virus run rampant through our community. As I mentioned, it’s a highly infectious virus. With the [warmer] weather, being outside is wonderful. The virus doesn’t do well, particularly in bright Utah sunshine, so being outside is great. But we need to keep that physical distance. I’m a big believer in wearing masks. That helps slow those respiratory secretions.
