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Copyright © 2020 Albuquerque Journal

Only a small fraction of New Mexico’s nearly 60 coronavirus patients were hospitalized as of Saturday. But the possibility of hundreds of such hospitalizations to treat the respiratory virus spurred the state’s biggest hospitals to set up emergency command centers weeks ago.

Nurses are being recruited from Canada. Critical supplies are being stockpiled. State, hospital and city leaders are eyeing in-house offices and out-of-hospital settings, such as at Balloon Fiesta Park, for treatment sites if the demand exceeds available bed space.

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“Part of being a hospital is to be prepared for a disaster,” state Human Services Secretary Dr. David Scrase told the Journal on Friday.

States hit hard as the coronavirus spreads are planning to open MASH-style field medical units or convert hotels to treat the sick. In Italy, overwhelmed hospitals are having to choose which severely ill coronavirus patients get mechanical breathing machines to stay alive.

“I think New Mexico has done a much better of job jumping ahead of this, imposing social isolation so we are really hoping we are flattening the curve (of new coronavirus cases that could stress hospitals),” he said.

Scrase is Gov. Michelle Lujan Grisham’s go-to medical official overseeing plans to ensure adequate hospital space and supplies. Last week, he also fielded questions about COVID-19 during webinars for some 1,250 New Mexico physicians.

He has also been meeting with officials from New Mexico’s largest hospitals in Albuquerque, which have developed plans to handle a potential surge of patients. A state hospital association official has warned about a limited “excess capacity” of beds in New Mexico.

“These hospitals have had their incident command centers, their emergency command centers up and running for weeks now,” Scrase said.

Scrase also said the hospitals assured the governor and her staff they had an adequate supply of ventilators for acute care of virus patients with respiratory problems.

But, he said, “the hospitals are concerned about their personal protective equipment for medical workers who come into contact with patients suspected of having contracted the virus.”

He said the state is aggressively purchasing such equipment and wants to ensure it receives its fair share promised by the federal government.

“So far we’ve received 25% of our share of the federal stockpile, and we are actively seeking other places to purchase the masks and the gloves to prepare us for a surge,” Scrase said.

Another concern from hospitals is the adequacy of the blood supply.

There’s been a dramatic drop-off in blood donations throughout the country, which is to be expected given that people don’t want to travel outside, he said. Blood banks in the state are actively seeking donations, and “we’re thinking of ways of doing blood drives that don’t involve people all sitting in a room or in a line.”

Meanwhile, the New Mexico Medical Board is reviewing how to speed up licensing of new providers.

Take precautions

As of Saturday afternoon, the governor’s office reported 57 cases, with three people hospitalized.

Scrase said about 80% of COVID-19 cases are very mild forms of the disease. About 14% are more severe, and 6% of patients require life support.

Though hospitals are taking steps to be ready, guidelines for social distancing and isolation recommended by the governor and the state Department of Health offer the best remedy to ensure hospitals aren’t overwhelmed, he said.

Scrase said the best thing for people who fear they will contract the virus and be without a needed hospital bed is prevention.

“I would tell them to stay at home and practice social isolation, wash your hands frequently if that’s really what you’re worried about,” he said.

Those 65 and over should stay indoors, even if it means asking others to bring them groceries.

“That’s the best way to protect yourself from the eventuality of being in the hospital with COVID-19,” he said.

Capacity issue

New Mexico has fewer hospital beds per capita than the national average and has had a severe shortage of physicians in recent years.

The Kaiser Family Foundation reported that New Mexico had 1.8 beds per 1,000 people, compared to 2.4 nationally in 2018, the most recent year for which data was available.

New Mexico Hospital Association President and CEO Jeff Dye said in an op-ed column submitted to the Albuquerque Journal that hospitals have little excess capacity with many running at 90% occupancy. Dye’s op-ed column can be found on Page A-11 of today’s Journal.

“If the inevitable surge cannot be mitigated, it will be overwhelming to our already stressed health-care system,” he said.

Dye said New Mexico has 46 hospitals and currently has 4,434 licensed beds statewide.

According to an analysis published last week by USA Today, New Mexico would be among 11 states, most of them in the West, that could have the most severe shortages if the virus spikes.

A separate analysis by ProPublica based on information modeled by the Harvard Global Health Institute also raised concerns. “Intensive care units (in New Mexico) would be especially overwhelmed and require additional capacity,” the report said.

The report said that as of 2018, Albuquerque had 2,910 total hospital beds, of which about 62% were occupied. The bed count included 380 beds in intensive care units, ProPublica reported. Its data came from the American Hospital Association and the American Hospital Directory.

Both Scrase and Dye emphasized that in addition to adding capacity and developing contingency plans, the public must follow precautions. Hopefully, that will head off a surge that floods the system.

Scrase said New Mexico is a rural state and “we have some hospitals that really can’t care for COVID patients in respiratory failure for a prolonged period of time. That’s why we’re working hard now to build a network of hospital systems so our larger hospitals with more intensive care unit capacity can reach out and help smaller hospitals.”

Conserving resources

Scrase said hospitals have been canceling elective surgeries to free up bed space.

“Many of the systems have gone to every single room they have in their system, including outpatient examination rooms and office buildings and identified actual numbers in every facility that could be converted to hospital beds or rooms if needed,” he said.

Albuquerque Mayor Tim Keller told the Journal last week that one of the first potential sites for temporary hospital facilities would be at Balloon Fiesta Park. “We actually have a cascade of city buildings that can be deployed for this ranging from everything from the convention center to every single community center and other public facilities.”

And, Scrase said, “We are looking at allowing people from other states to come in and treat … as long as they aren’t at risk of infection.”

One impediment to recruiting nurses from Canada is that “right now flying in an airplane is a risk factor.”

Lovelace Health System spokeswoman Whitney Marquez said the system’s hospitals have 50 critical care beds in Albuquerque and could expand to 90 by using other hospital units as needed. Lovelace also has an alternative triage area and emergency room set aside for respiratory patients in order to avoid contact with other patients.

At Presbyterian Healthcare Services, Dr. Jason Mitchell, chief medical officer, said Presbyterian can double its ICU capacity in the Albuquerque metropolitan area by canceling elective surgeries and flexing some clinical positions, such as anesthesiologists, to expand the critical care workforce. Presbyterian also said it plans to expand its telehealth service.

University of New Mexico Hospital, the state’s only Level One trauma center, said in an email that it is operating under its pandemic influenza plan and is prepared.

“As part of this plan, we are discussing different triage areas that can be set up in the event of a patient surge,” said spokesman Mark Rudi. “UNM currently has personal protective equipment for personnel and we do not have any concerns of running out at this time.”

Sandoval Regional Medical Center is also part of the University of New Mexico Health System.

The New Mexico Hospital Association’s website states that flexibility is the key.

“Most hospitals in the state are not holding beds open for possible COVID-19 patients. However, this is not a static situation. If beds are reserved before a need arises, that could mean delays in care for people who need services now,” the website states.

“The public should understand that most cases of COVID-19 will not mean hospitalization, or even a trip to the emergency room,” the website stated.

“Hospital care is a precious resource that needs to be reserved for those with the most serious symptoms.”

Journal staff writer Jessica Dyer contributed to this report.