In a worst-case scenario, Arizona may not have enough hospital beds for an onslaught of very sick patients.

It may not have enough health-care workers to treat those infected by the new coronavirus.

It may not have enough specialized equipment to keep people breathing.

That's why public health leaders and other government officials are working to buy time and prevent an unmanageable surge of COVID-19 patients.

Health leaders face much of the same scenario in every state. The number of U.S. hospital beds is 2.4 per 1,000 people, a 2018 Kaiser Family Foundation analysis shows. That analysis puts Arizona's rate, 1.9 beds per 1,000 people, in the bottom 10 states.

While Arizona ranks 14th in the U.S. in population, the state is No. 32 in its rate of active physicians per 100,000 people, 2019 data from the Association of American Medical Colleges says.

And Arizona ranks 44th of 50 states in its rate of total active primary care physicians per 100,000 population, a 2019 policy brief by the University of Arizona's Center for Rural Health says.

In hard-hit Italy, one of the problems with treating coronavirus patients has been a shortage of ventilators, according to media reports. Health experts have said that could be an issue in the United States as well.

Arizona has contingency plans to create beds and increase the number of health care professionals. And all the social distancing efforts in recent days could help slow the spread of the virus to make it more manageable.

Not having enough hospital beds is a "worst-case scenario," Arizona Department of Health Services director Dr. Cara Christ emphasized in her remarks March 11, the day Arizona declared a public health emergency. "But we always keep it, in public health, in the back of our mind."

Arizona has 16,000 licensed inpatient hospital beds. During an emergency situation, the state is authorized to waive licensing fees to open up other beds for use in facilities not normally used for inpatients, such as outpatient clinics and ambulatory surgery centers.

A NATIONAL LOOK:U.S. hospitals will run out of beds if coronavirus cases spike

Some experts are predicting 40% to 70% of Americans will get infected with the new coronavirus over the next 12 to 18 months.

If that's true, not everyone will need hospitalization. Based on evidence from the Chinese Center for Disease Control and Prevention, 81% of the people who become infected will have mild symptoms.

Nearly 5% will be critically ill, the data says.

But having enough hospital beds alone is not enough to treat a large number of critically ill patients.

Phrase to remember: 'Flatten the curve'

For a bad flu season or an outbreak of another contagious disease like the new coronavirus, three components are needed to successfully handle a sudden swell of patients needing hospitalization, said Will Humble, executive director of the Arizona Public Health Association and former director of the Arizona Department of Health Services.

Those are enough beds; enough staff to manage patients and provide the right kind of treatment; and enough equipment like ventilators and masks, Humble said.

He led the state health department during the H1N1 flu pandemic in 2009. There are some similarities between the H1N1 pandemic and the new coronavirus pandemic, but there are crucial differences, too.

The new coronavirus is hitting older people much harder than H1N1, which disproportionately affected younger people; there were antivirals that were proven effective in treating H1N1; and partway through the H1N1 pandemic, a vaccine was developed to prevent it.

"That flu pandemic turned out to be much less lethal or pathogenic than we had feared," Interim Pima County Health Department Director Dr. Bob England wrote in an email Saturday, adding he expects the coronavirus pandemic to be worse.

There's no vaccine for the new coronavirus, and no known effective treatment, either. So far the mortality rate appears to be much higher than for any seasonal flu.

The way to prevent a patient capacity that exceeds what Arizona hospitals are able to handle is to "flatten the curve."

"Flatten the curve" is a basic principle of disaster medicine. It refers to lowering the peak of the surge of patient demand that's expected to hit health care providers. And it's to buy time, too, in hopes a vaccine and effective treatment can be developed.

"If everyone shows up in the hospital or ER at the same time, the system becomes overwhelmed and we cannot take care of them all. This leads to bad outcomes," wrote Arizona Rep. Dr. Amish Shah, D-Phoenix, who works as an emergency room doctor.

His comments were made in a Facebook post Friday.

"In Italy, a surge in patients meant there were not enough ventilators to serve patients in need, and people died unnecessarily. We can’t let that happen here."

Here are things we know about Arizona's pandemic preparation plans and challenges when it comes to hospitals:

Your elective surgery may get delayed

The Chicago-based American College of Surgeons on Friday recommended that hospitals, health systems and surgeons enact plans to "minimize, postpone or cancel elective operations" until it's certain that the health care infrastructure is able to support a "potentially rapid and overwhelming uptick in critical patient needs."

ERs could become chaotic and dangerous

Health care facilities need to plan for additional security during a pandemic, according to Arizona's pandemic influenza plan, which the state health department would use as a guide in the event of a swell of coronavirus patients here.

Increased demand for services, long wait time for care and triage of treatment decisions may leave people feeling like they aren't receiving the level of care they think they require, the plan says.

"Hospital staff need to be reminded of potential crimes within the facility that may be committed during times of overcrowded conditions and staff distractions."

Health providers could come out of retirement to help

If medical providers become infected with the new coronavirus and have to stay home, a shortage of patient caregivers could result.

Gov. Doug Ducey's emergency public health declaration gives the Arizona Department of Health Services the authority to waive the licensing requirements of health providers on a case-by-case basis during heightened demand. That could include anything from waiving licensing requirements for continuing medical education to asking providers to come out of retirement to help.

"We will need every available doctor, nurse and health care worker to get through this crisis," Shah wrote in his Facebook post.

"Given my work in the ER and the risk to the other elected officials, I will no longer be able to attend the Arizona House of Representatives in person in 2020.

"I have informed Democratic and Republican leadership of my decision. I hope to be able to resume as soon as possible. I will continue to fully participate by telephone or conferencing as much as I can."

Hospitals may start putting up tents

In other parts of the country, hospitals are setting up large triage tents outside their emergency departments as screening areas for patients with respiratory symptoms.

Italy's civil protection service has put up more than 500 triage tents across the country to handle its surge of COVID-19 patients, the Associated Press reported Friday.

It's not just up to the state and the hospitals

It's up to all of us. What's encouraging — and different from the H1N1 pandemic — is the public's reaction to the coronavirus outbreak, Humble said.

"The decisions that individuals and private organizations are making is profound," he said. "Canceling the NBA season, canceling these very large medical conferences, Disneyland — in my whole life I don't think I've seen people making the decisions they are now."

Individual social distancing decisions such as working from home and avoiding large gatherings will make an impact, Humble said. Whether it's enough to ensure hospitals can handle a surge in patients and flatten the pandemic's epidemiological curve is still unknown.

"People are really stepping it up with handwashing. They are really taking it seriously. They didn't take it that seriously in H1N1," he said. "Hopefully we don't end up with a surge problem. That's really the main thing. That's the purpose of all these interventions, to push down that peak to where it can be handled."

Reach health care reporter Stephanie Innes at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on Twitter @stephanieinnes

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