SEATTLE >> With the due date fast approaching, Kelly McCarty packed a nursing bag, a coat, slippers and granola tights. Ultrasound last week, he said, showed “this baby is upside down and ready to go.”
But the new coronavirus has thrown him a curveball, bouncing it with about 140 other expectant mothers from their first hospital in another 30 minutes away. The birth unit of the Edmonds Hospital, Washington, is required for COVID-19.
With the ability to stretch thin, US hospitals are rushing to bed for an upcoming flood of patients, opening older closed hospitals, turning single rooms into doubles and re-pushing other medical buildings.
Louisiana is contracting hotels to provide additional hospital beds and has converted three state parks into isolation for patients unable to go home. Illinois will reopen a 314-bed suburban Chicago hospital that closed in September. In Seattle, Harborview Medical Center is turning a homeless shelter into a 45-bed coronavirus recovery center.
In New York, the city’s convention center will become a temporary hospital. At Mount Sinai Morningside Hospital, heart surgeons, cardiologists and cardiovascular nurses now care for coronary heart patients in a converted cardiac unit. The floating hospital from the U.S. Navy is heading to Los Angeles and, eventually, New York. Mobile military hospitals are promising in Washington state.
Simple math is leading hospital leaders to prepare. With the total US case doubling to three  days, the intensive care unit beds required by the estimated 5% of patients will be filled quickly.
American hospitals reported operating 74,000 ICU beds in 2018, with 64% filled by patients on a typical day. But the available ICU beds are not exactly distributed, according to an Associated Press analysis of federal hospital data that provided a Medicare cost report in fiscal year 2018.
The AP found more than 7 million people age 60 and older – those most at risk for severe COVID-19 disease – live in counties without ICU beds. AP included ICU beds in cardiovascular units, surgical units and burn units in the county.
“Better to be over-prepared than to react at this time,” said Melissa Short, who heads women’s health for Seattle’s Swedish Medical Center, which is using data from China and Italy as he is trying to double his capacity to 2,000 beds.
In South Korea, some die at home waiting for a hospital bed. In northern Italy, an explosion could invade the hospital system. Videos and photos from two Spanish hospitals showed patients, many hooked up in oxygen tanks, trapped corridors and emergency rooms.
About 10 days ago, Dr. Tanya Sorensen received a call from the doctor leading the response to the Washington State virus at Swedish Medical Center. How could the system consolidate its birth services to maintain the health of rescuing mothers?
“It took me mad,” said Sorensen, medical director for women’s services at the hospital. “It has brought home the fact that we will face a huge surge in COVID cases very soon.”
The Swedish Edmonds facility – where McCarty planned to deliver – announced Saturday it will close its 7th-floor temporary birth center, taking 35 beds for the expected crowd. McCarty will go instead to an affiliated hospital in Everett.
“They need more beds. If they can open up a whole floor, I understand, “said McCarty, a public school teacher who handles coaching about online learning during state shutdown.
For most people, coronavirus causes mild or moderate symptoms, such as fever and clear cough in two to three weeks. For some, especially the elderly and people with existing health problems, it can lead to more serious illnesses, including pneumonia, and death.
If other countries have similar experience in China, 15% to 20% of COVID-19 patients will have serious illness. About 5% might get sick enough to require intensive care.
Equipment is a challenge. About 20% of American hospitals said they do not have enough breathing machines for patients and 97% have reused or maintained other N95 masks, according to a survey conducted last week by hospital groups buying Premier Organizations.
Who will employ the ICU bed needed to keep leaders in American hospitals awake at night.
In western Massachusetts, Nancy Shendell-Falik, a hospital-run nurse, is planning Baystate Health’s response. The Community Hospital System and Ship Hospital in Springfield will find space for an additional 500 beds, including 140 ICU beds.
He asks himself: Do cross-training of staff and teamwork help nurses to handle a surge of patients in need of machine respiration? Will there be enough masks, gowns and face shields? She was also concerned about fatigue, burnout and falling ill nurses.
“Beds don’t take care of patients. We need staff to do that,” he said.
During 9/11, she worked as a chief nurse in a hospital eight miles from the Twin Towers. He also worked at a Boston hospital that crashed in the 2013 marathon bombing.
“Things changed our world forever, but they were very time-limited activities. What’s scary about this,” he said, is “we don’t know the duration.”
This weekend, McCarty and her husband plan to drive to Everett Hospital, a trial run for when she goes to work. When her contraction begins, her father will be called to stay with his 4-year-old daughter. McCarty is taking it to stride, knowing the depth of the need.
“If it was my first child, I think it would be a little more difficult,” McCarty said of adjusting his birth plan for COVID-19. “I know what it’s like and I’ve been to it before. Where I deliver is not necessarily that big of a deal. I’m happy to be forced.”