As recently as a month ago, hospital leaders were unsure whether they could avoid being overwhelmed by acutely ill patients, as they saw happen at facilities in New York and northern Italy.
Since March, however, the region’s hospitals have dramatically expanded capacity, by adding thousands of beds and spending millions of dollars to collect gowns, masks and other equipment.
In the same period, elected leaders issued stay-at-home and social distancing orders that slowed transmission of the virus. That gave the hospitals valuable time to prepare for a peak projected to come between now and July.
“We feel very good here about where we are right now,” said Inova President J. Stephen Jones, whose system includes five Northern Virginia hospitals. “We have been able to keep comfortably under this region’s capability to handle the number of cases.”
Said Gabe Kelen, director of emergency medicine at Johns Hopkins Medicine, which includes five hospitals: “Maryland was a little bit lucky that we weren’t Washington [state] or New York, that we had several weeks to plan.”
But Kelen warned that the disease has not peaked.
“We’re predicting a new spike,” he said. “At first, it might be a little baby spike, three to six weeks after everything opens up. There could be a huge spike in early to late summer, depending on how much responsibility individuals choose to take and how rationally this region opens up.”
While hospital leaders are feeling more confident, problems remain. The supply chain for personal protective equipment (PPE) is vulnerable. Like the rest of the country, the region still has far to go before it is able to test residents for the virus in sufficient numbers, and then trace their contacts to identify and isolate those exposed.
Given those limitations, the region has benefited from the comparatively cautious approach taken so far by its top elected officials toward reopening the economy, according to hospital executives and academic experts.
Maryland Gov. Larry Hogan (R), Virginia Gov. Ralph Northam (D) and D.C. Mayor Muriel E. Bowser (D) have moved more slowly than much of the rest of the nation. Many states have begun opening businesses before meeting federal guidelines for doing so.
Lynn R. Goldman, dean of the School of Public Health at George Washington University, praised the region’s leaders for committing to delay reopening until health data deems it safe. She also applauded residents for generally obeying social distancing guidelines.
“It’s a more step-by-step, gradual approach [here],” Goldman said. “Obviously we’re not seeing that across the country. Our governors [and mayor] are different, but I think also our citizens are more trusting of government.”
She added: “I don’t think we’re ready yet with enough testing and contact tracing, but I do believe our hospitals are ready.”
Said Kristin Nickerson, executive director of the Northern Virginia Hospital Alliance, “We’ve been very pleased with how our local officials and Virginia as a whole have worked with us to flatten the curve and given the hospitals the critical time needed to prepare for the surge.”
Hospitals and public health authorities have taken drastic, expensive steps to get ready. They’ve reopened or converted buildings and rooms — and even used tents — to add beds and intensive care units. They’ve redeployed and retrained doctors, nurses and other staff to handle covid-19 patients. They’ve searched the planet for PPE in a market so tight that Maryland hospitals reported a seller asking for up to $15 apiece for gowns that would normally cost less than $1.
In hard-hit Prince George’s County, Doctors Community Hospital in Lanham has nearly doubled its potential capacity from its normal level of 200 beds. It did so after seeing projections in late March that it might have to deal with a surge of more than 500 patients needing beds.
That dire forecast has not materialized, and projections have now been lowered to a manageable peak demand of between 200 and 300 beds.
“The curve has flattened,” said Paul R. Grenaldo, president of Doctors Community Hospital. “It has everything to do with the social distancing and better safe practices that we see on the street every day.”
D.C. Hospital Association President Jacqueline D. Bowens said District hospitals have added 1,500 staffed beds to the normal total of 2,600.
“We are prepared when a surge occurs,” Bowens said.
The biggest constraint on hospitals is the continuing struggle to procure adequate supplies of PPE, but the shortages are less severe than a month ago.
“Because we have not seen the catastrophic surge [in patients] that we all were very worried about, we are in a much better position with regards to PPE today,” said Bruno Petinaux, chief medical officer at George Washington University Hospital.
Unions representing nurses and other front-line workers who use the masks and gowns confirmed that the situation has improved.
“All the institutions where we represent people are doing a much better job,” said Edward J. Smith, executive director of the D.C. Nurses Association.
Lisa M. Brown, executive vice president of 1199 SEIU, which represents 11,000 hospital and nursing home staff members in Maryland and the District, said PPE availability has “definitely” improved in hospitals, but “not so much” in nursing homes.
The liberal union leader offered rare praise for Hogan because of his stay-at-home orders.
“For a Republican I have to say, hats off to Governor Hogan,” Brown said. “We didn’t have the surges that were expected.”
The critical issue now is whether elected officials will continue to order — and the public continue to follow — safe practices.
Bob Atlas, president of the Maryland Hospital Association, said people cannot expect to return soon to daily life as it was before the pandemic.
“We do support the opening of the economy, [but] everything has to be subject to conditions,” Atlas said. “We can’t go back to the way we were.”
Said Boris D. Lushniak, a former acting U.S. surgeon general who is now the dean of the University of Maryland School of Public Health: “When it comes to the surge that we were expecting in the hospitals, overall this region has done very well. . . . We have not had the nightmarish scenarios of halls filled up with [sick] people.”
But, he added: “The reality is if we give up too soon, if we don’t follow the phased approach that the governors here are talking about, then we can still end up in trouble. Let’s not hold the victory parade yet, but let’s be optimistic.”