Dr. Mitchell Levy in the Rhode Island Hospital intensive care unit with nurse Robin Mercier. [Lifespan photo/Bill Murphy] ▲ A look inside the medical intensive care unit at Rhode Island Hospital [Lifespan photo/Bill Murphy] ▲ Dr. Mitchell M Levy [Lifespan photo/Bill Murphy] ▲ A look inside the command roomm for medical staff at the Lifespan field hospital in the Rhode Island Convention Center. [The Providence Journal / Sandor Bodo] ▲ A bed inside the Lifespan field hospital at the Rhode Island Convention Center. [The Providence Journal / Sandor Bodo] ▲

PROVIDENCE – Rhode Island's transition to social distancing, which came earlier than most other states' and has been strictly practiced by most residents, has significantly mitigated the impact of coronavirus disease here, one of the local and national leaders in the fight against the pandemic told The Journal on Tuesday.

And that, said Dr. Mitchell Levy of Lifespan and Brown University, means the state will need fewer ventilators and intensive-care unit beds for COVID-19 patients than was once envisioned.

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"The beds and ventilators likely to be needed now," Levy said, "are within easy reach of the resources we already have in the state."

Awareness of the pandemic before it enveloped America and local planning for potentially catastrophic consequences have paid off, said Levy, medical director of Rhode Island Hospital's Medical Intensive Care Unit and professor and chief of the Division Critical Care, Pulmonary, and Sleep Medicine at Brown's Warren Alpert Medical School.

Like others, Levy watched the emergence of the novel coronavirus in Wuhan, China, in 2019. But it was hearing from critical-care specialists in Europe, he said, that raised alarm early this year. Those ties turned out to be Rhode Island's good fortune, said Levy, a past president of the Society for Critical Care Medicine, which has members in more than 100 countries.

"Because of my international connections and relationships, I have a very, very good friend in Milan," one of the first cities outside China to devastated by COVID-19, Levy said. Dr. Maurizio Ceccioni is president-elect of the European Society of Intensive Care Medicine.

"He started emailing me early on saying this is horrible," Levy said, "and it was somehow hearing a friend describe the depths to which they were descending in the hospitals that it no longer felt far away. I really felt like, 'Wow, this is at our doorstep.' So it was then I started thinking: we need to start thinking about what we're going to do when it comes here."

Levy began working with colleagues at Lifespan and elsewhere in the state, along with the Rhode Island Department of Health, "to develop the 'what-ifs.' "

What if, for example, Rhode Island became a hot zone like New York City, where confirmed cases rose from the first, reported on March 1, to more than 30,000 cases and deaths approaching 1,000 by the end of that month?

"How do we increase the number of ICU beds? How many ventilators will we need?" were two of the questions requiring answer. A protocol for care of COVID-19 patients had to be written, and Levy wrote it, sharing it with professionals at Lifespan and around the state.

Levy also worked with a panel of American doctors, statisticians and others to develop guidelines for care of coronavirus patients in the United States. Approved by the National Institutes of Health last week, "these guidelines, intended for healthcare providers, are based on published and preliminary data and the clinical expertise of the panelists, many of whom are front-line clinicians caring for patients during the rapidly evolving pandemic," according to the NIH.

At Rhode Island Hospital, Levy organized a succession of intensive-care units to supplement those in existence before the pandemic. Lacking the staff in his division for all of the new personnel required, he has recruited surgeons, neurologists and cardiologists to operate them with respiratory therapists and nurses, trained in the use of ventilators. He has worked closely with anesthesiologists, who intubate patients, place invasive lines, and perform other critical tasks.

"All four units are done under the supervision of the Pulmonary Critical Care Division, as has been the case in Spain, in Italy, in Washington state and in New York," Levy said.

Weeks ago, no one in Rhode Island could predict with any surety which "what-if" would become reality. Fears of a possible Italy-style nightmare prompted Gov. Gina Raimondo, working with Health Department head Dr. Nicole Alexander-Scott and their staffs, to declare a state of emergency on March 9 just in case.

"What has characterized this illness is the predictions of the large number of ICU beds and ventilators" that would be needed, Levy said.

"As recently as her April 16 press conference, Gov. Raimondo predicted, accurately at the time, that we would need almost 1,000 ICU beds and about 900 ventilators," Levy said. "We're now seeing that we're probably not going to need more than 100 to 150 ventilators and probably 250 ICU beds at the most."

Those will be available, Levy said.

"That's good that we prepared and who knows what's around the corner?" Levy said.

But the curve appears to have been flattened, Levy said.

"We had one admission in the last 24 hours to a COVID critical care unit," Levy said. "Three-quarters of the admissions to the intensive care units in the last 10 days have come from the wards, meaning patients with COVID who deteriorated. A much smaller percentage is new patients coming into the emergency department."

Levy credits the public's compliance with orders to stay at home, practice social distancing and other containment measures for keeping deaths and hospitalizations relatively low in comparison to other states and regions.

"No one understood the profound impact that social distancing was going to have on the illness and on the pandemic," Levy said. "It's pretty clear from the models that are being prepared for the Department of Health that we have passed the surge."

gwmiller@providencejournal.com

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On Twitter: @gwaynemiller