Houston health care leaders are urgently putting together contingency plans — from repurposing hospital beds not currently in use to creating a makeshift facility at NRG Stadium — to prevent an expected surge of COVID-19 patients from overwhelming area hospitals.

The plans, assembled by leaders from the Texas Medical Center, the city of Houston, Harris County and the region, stress fluidity and flexibility because the extent of the surge, projected to peak in the next two to four weeks, is so maddeningly unknowable.

“It’s like we’re waiting on a very, very slow moving hurricane that has been sitting off the Gulf of Mexico for three weeks,” said Dr. James McDeavitt, dean of clinical affairs for Baylor College of Medicine. “We don’t know if the eye’s going to hit us or we’re going to be hit by the outer bands. We have to be ready for both.”

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Dr. Umair Shah, executive director of Harris County County Public Health, said officials are “looking at numerous contingency plans, putting all the pieces together.” He said regional leaders hope they don’t have to execute the plan or at least all of its phases, but must think steps ahead.

A number of officials emphasized that Houston doesn’t want to “be in (the same situation as) New York” — a reference to the nightmare blow the coronavirus has inflicted on that city. As leaders and residents there braced for matters to get even worse, New York City’s death toll neared 1,400 Wednesday afternoon.

To avert such a situation here, Shah said Houston and Harris County public officials are focusing now on the NRG Stadium option. Under that plan NRG would be staffed by a mix of doctors, nurses and other employees provided by a private company and as well as those in the medical center who have had their jobs or work curtailed or shelved in anticipation of the coming surge.

Shah says the stadium idea would only be executed if patient volumes cannot be handled through contingency plans already in place at hospitals. That involves not just repurposing beds but rapidly making available beds not currently in use.

Houston-area hospitals should be able to create at least 3,500 more beds by such creative rearranging, estimates Darrell Pile, CEO of the Southeast Texas Regional Advisory Council, a state group that coordinates the emergency response to disasters in a 25-county area centered in Houston.

For now, those improvisations haven’t been necessary in Houston. Pile estimates an average hospital occupancy rate of roughly 60 percent in the area — the Harris Health System is close to 90 percent, CHI St. Luke’s is 47 percent — partly thanks to its suspension of most elective surgeries nearly two weeks ago. In a city with roughly 14,000 beds, that will accommodate quite a few COVID-19 patients.

But the number of hospitalized COVID-19 patients are definitely picking up. In SETRAC’s area, for instance, the number of hospitalizations grew more than 40 percent — 729 to 1,031 — from March 26 to March 30.

Last weekend, Methodist began moving some of its sickest patients into a second intensive care unit, a neurosurgery suite recently converted to house COVID-19 patients.

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“The next couple of weeks are going to be very telling,” said Methodist President Dr. Marc Boom. “If the curve flattens over the next two or three weeks, we’ll manage well. The real question is, what if, over the next two or three weeks, it doesn’t flatten?”

Boom noted that in mid-March, Methodist had three or four COVID-19 patients, all travel-related. Now it is has more than 100 throughout its system. So does Memorial Hermann.

In all, more than 840 people in Harris County are now hospitalized with either COVID-19 or suspected COVID-19, according to data collected by SETRAC.

Beds alone don’t tell the whole story. Some 40 percent of the COVID-19 patients at both Methodist and Memorial Hermann have had to be admitted to the ICU, officials said.

That’s consistent with statistics out of China and Italy. Those statistics also found such patients spend significantly longer in the ICU, on ventilators and recovering upon returning to a regular hospital bed.

“These patients do not have rapid stays,” said Dr. Bela Patel, executive medical director of critical care for Memorial Hermann’s hospital in the medical center. “They can get very sick very quickly, which demands high expertise and skill levels in the ICU.”

Such longer stays make the hospital less able to take on new patients, said Patel, also a UTHealth physician.

An adequate number of ventilators has proved a problem in many locations, but Pile said the Houston area supply is currently good — as of Sunday, 667 ventilators were available for use in a nine-county area. Patel said that Memorial Hermann has one for every one of its more than 500 ICU beds.

The real shortage may be ECMO (extracorporeal membrane oxygenation) devices, which replace the function of the person’s lungs and are used, sparingly, when ventilators fail. Patel estimates there are only about 50 of the devices in Houston.

The existing contingency planning includes discharging eligible patients to home, to nursing homes and to long-term acute care hospitals as early as possible; opening beds in parts of the hospital that may have been closed for a period of time’ and repurposing beds in recovery rooms and other areas not normally used for inpatient care.

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Pile said such actions, in addition to the suspension of elective surgeries, can provide hospitals more than 20 percent additional capacity in the event of an emergency.

Shah said the hope is that such contingency efforts, in place at every hospital, will suffice. He said the uncertainty requires officials to maintain a fine balance — between taking all steps necessary to be ready for a worst-case scenario, such as laying the groundwork for a hospital, and not getting too far ahead of an evolving situation.

Dr. Paul Klotman, president of Baylor, said Houston has some advantages on New York. Houston started social distancing sooner; the virus may not thrive as well in this hotter, more humid climate; and the fact that the area is not as densely populated, he said.

The key, he says, is for Houston to take advantage of such natural advantages.

“The more aggressive we are about maintaining our social distance, the better our chances of maintaining our current infection rate, 2 [percent] to 3 percent, which is much lower than New York,” said Klotman. “Do that, and we should be able to squeak by when the peak hits in four weeks.

“But if we lower our guard and the infection rate rises significantly, the peak will come four weeks later and patient demand will far exceed hospital capacity and we’ll need field hospitals.”

Lisa Gray contributed to this report.

todd.ackerman@chron.com