Indianapolis-area hospital officials girding for what could be an onslaught of coronavirus patients say they hope they are prepared to handle what may come even if it means some dramatic changes, such as severe visitor restrictions, placing the healthiest patients in hallways and opening field hospitals.

How bad things could get in Indianapolis is difficult to predict, an uncertainty that Marion County Public Health Director Virginia A. Caine cited Thursday as one of the reasons that government officials have closed schools and limited public gatherings to fewer than 250 people to help deter the spread of the virus.

Franciscan Health already has been “continually stressed” during the current flu season, said Dr. Christopher Doehring, vice president of medical affairs. COVID-19 could force the health system to consider additional measures, such as postponing elective surgeries, reconfiguring hospital space, and relying more on telehealth.

“We have largely operated 'business as usual,' even under very challenging circumstances,” he said. “A COVID-19-related surge could push our capacity over the edge.”

A recent USA Today report estimated that there could be as many six seriously ill patients for every available hospital bed in the worst case scenario of a coronavirus outbreak that sweeps the nation. Indiana would have an estimated 14 to 20 seriously ill patients for every hospital bed, the analysis found.

Hospitals in larger cities may be called upon to absorb patients from rural hospitals that do not have the same capabilities to handle the most severely ill patients.

Preparing for a coronavirus outbreak

Indianapolishospital officials acknowledge that the coronavirus may lead to some changes but say they at least hope they are prepared for what an outbreak would mean here.

Over the past three months as China and then Italy has seen a surge of illnesses and deaths, hospitals here have been reviewing pandemic preparation plans developed during other crises such as the H1N1 flu, which lasted from 2009 through 2010.

“I think in general we’re in good shape,” said Dr. Douglas Webb, medical director for infection control for Indiana University Health. “We have all been trying to do the same thing to prepare, to shore up our processes on how we would evaluate patients, isolate patients, how we would manage a surge of patients, how we would try to look at supplies and work together.”

Starting Friday area hospitals instituted tighter visitor restrictions than those already in place for the flu season, many limiting visitors and screening any potential visitors for signs of COVID-19.

Community Health Network, for instance, said that no visitors would be allowed at its three Indianapolis hospitals, Community Heart and Vascular Hospital, and Community Behavioral Health. Patients being admitted would be allowed one visitor during the admission period.

Other exceptions of one visitor per patient included NICU, labor and delivery, pediatrics, an outpatient provider appointment, emergency department, inpatient surgery for the day of surgery, behavioral health treatment, outpatient surgery, discharge planning and end of life situations. No visitors under age 18 will be allowed.

Many more changes could be on the way for area hospitals, officials say.

Field hospitals and isolation rooms

Franciscan Health’s Doehring said that in the past the MESH (Managed Emergency Surge for Healthcare Coalition), a nonprofit entity that coordinates local hospitals’ emergency response, has discussed opening a temporary field hospital in the area to handle a surge in patients too large for the current hospitals to handle because of an epidemic or other disaster.

For now, IU Health hospitals are considering setting aside a special isolation wing for patients with COVID-19, Webb said.

“We are going through some different scenarios where if in fact we had a surge of 10 ICU patients with COVD-19, I think we would try to cohort them as best we can to limit the number of health care workers who would take care of them,” he said.

Recently, the Centers for Disease Control and Prevention changed their guidance as studies have suggested that the coronavirus is not an airborne disease but is transmitted by respiratory droplets. This means that patients no longer need to be isolated in special negative pressures rooms, though procedures such as an intubation in which a tube is inserted in a patient's airway will still be done in such spaces, Webb said.

Limited number of hospital rooms

Franciscan Health is considering other ways to handle an influx of patients, Doehring said, such as having patients close to discharge wait in a bed in the hallway, freeing up a room. The Indiana State Department of Health does not usually allow that but waives the ban during states of emergency.

Other solutions could consist of turning private rooms into semi-private rooms or converting administrative or surgical spaces into patient rooms, Doehring said.

“There are a lot of different things you could do if you got into a real crunch,” he said. “They’re not easy things, not things we would do as first trigger things, but if things spun out of control, these are things that can be considered.”

Another measure might involve emergency credentialing of physicians and providers who have not gone through the typical credentialing procedure to work at the hospital, Doehring said. Such doctors could fill in for regular staff, who might be ill themselves or need backup.

Extensive pandemic preparation plans exist on paper, but Indianapolis has not had to put them to the test — yet.

“The key thing is that there is ongoing modeling of this sort of thing and simulation so these are scenarios that have been contemplated,” Doehring said. “They just haven’t been reality."

Contact IndyStar reporter Shari Rudavsky at 317-444-6354 or shari.rudavsky@indystar.com. Follow her on Facebook and on Twitter: @srudavsky.