AUSTIN, Texas — As the number of patients hospitalized with the coronavirus has reached record highs 12 days in a row, Gov. Greg Abbott and other health officials have stressed that the state has “abundant” capacity to care for them.
Statewide, there were 14,260 available hospital beds and nearly 1,500 intensive care unit beds as of Tuesday.
But regionally, some hospital officials are reporting that intensive care units — for seriously ill patients, like those on ventilators — are near or over capacity, and local leaders have warned that hospitals could get overwhelmed if the number of infections keeps climbing.
In the hard-hit Houston region, hospitals have begun moving coronavirus patients from crowded ICUs to other facilities. A local children’s hospital said this week it is admitting transfer patients, with and without the virus, to help other facilities manage their capacity.
“We appear to be nearing the tipping point,” Dr. Marc Boom, head of the Houston Methodist hospital system, wrote in an email to employees Friday. “Should the number of new cases grow too rapidly, it will eventually challenge our ability to treat both COVID-19 and non-COVID 19 patients."
Elsewhere, counties like Travis and Harris, which includes Houston, have eyed local convention centers or stadiums as temporary hospital overflow facilities — reviving plans mapped out early in the pandemic that were largely abandoned due to lack of need at the time.
The number of patients hospitalized with the virus in Texas has more than doubled since the beginning of the month, reaching 4,092 Tuesday. The figure began rising in early June, a month after Abbott let a stay-at-home order expire and allowed businesses to begin reopening.
Total current hospitalizations
On April 6, the state started reporting the number of patients with positive tests who are hospitalized. The average number of hospitalizations reported over the past seven days shows how the situation has changed over time by deemphasizing daily swings
The governor struck a newly urgent tone Monday in a televised press conference to say COVID-19 was “spreading at an unacceptable rate” and that multiple metrics to gauge the virus’ spread and severity had significantly increased. Epidemiologists have attributed upticks in infections and hospitalizations to changes in behavior, including lax mask use and less social distancing.
Abbott spokesperson John Wittman said hospitals in Houston and Austin have been “emphatic” that beds will be available for coronavirus patients. He also said the governor has made clear that “he will utilize tools as necessary to ensure hospitals will provide beds for anyone who tests positive for COVID-19.”
“To be clear, in Houston, the percentage of beds occupied by COVID patients is currently 12.9%. In Austin, the percentage of beds occupied by COVID patients is 10.2%,” Wittman said.
Carrie Williams, a spokesperson for the Texas Hospital Association, also said Texas has enough hospital capacity, though she added that hospitalizations numbers are "definitely a concern."
“Right now we’re in good shape, but if this trend continues, it’s not sustainable,” she said.
Regional shortages
While large swaths of the state are not reporting surges in hospitalized coronavirus patients, health experts and local officials predict a coming crush in some urban areas if the growth in cases doesn’t slow down.
“What we had before was a ripple compared to what we're about to experience,” said Dr. David Persse, health authority for the Houston Health Department.
In the Houston region — which has seen one of the steepest increases in hospitalizations statewide — the Texas Medical Center anticipates intensive care unit capacity there could be surpassed in two weeks. Infectious disease expert Peter Hotez predicted over the weekend that Houston could become the “worst affected city” in the country and maybe rival Brazil, the world’s fastest-growing hot spot.
“We are stretched,” said Dr. Faisal Masud, director of the Critical Care Center at Houston Methodist. While the hospital is able to take COVID-19 patients from smaller facilities, if the upward trajectory continues, it, too, could become overwhelmed, Masud said.
“We were already quite full with people who need care, and now we’re adding big numbers of COVID-19 patients,” he said.
At Lyndon B. Johnson Hospital in Houston, ICU patients exceeded bed capacity, and patients were temporarily moved to other units or to other hospitals, said a Harris Health System spokesperson. At Ben Taub Hospital, also in Houston, 76% of ICU beds were full as of Monday. Patients have been transferred from both facilities to other Houston hospitals, including St. Joseph Medical Center, Houston Methodist Hospital and Texas Children’s Hospital, over the last week.
In Dallas County, where 470 coronavirus patients were in hospitals as of Tuesday, County Judge Clay Jenkins warned last week that “many more people will get sick and die in the coming weeks” if the numbers continue to rise.
Experts at the University of Texas Southwestern Medical Center forecast a coming wave of hospitalizations in North Texas before July 4. Hospitals in the North Texas region had more than 5,000 beds available as of late last week and can surge to around 8,500, according to Stephen Love, head of the Dallas-Fort Worth Hospital Council.
Meanwhile, the former county judge of Travis County said in an email obtained by The Texas Tribune that she hasn’t been able to get an answer on the capacity of the local private hospitals.
“Documentation from every major metropolitan area in the state shows an overall surge in cases since the Governor relaxed personal and business adaptations and removed almost all enforcement powers,” Sarah Eckhardt, an adviser to Travis County Judge Sam Biscoe, wrote in an email to Austin-area hospital officials. “We must plan for the increasing probability that more Central Texans will need hospital treatment than we have the current capacity to care for. Planning requires numbers. What is your capacity?”
“Pre-surge state”
As the outbreak began in March, Abbott directed hospitals to pause elective procedures and suspended regulations that limit how many beds can be in each room. The steps were taken to accommodate a potential surge in COVID-19 patients. But instead, some hospitals saw little traffic for weeks. Without lucrative elective procedures, revenue plummeted. Medical staff members were furloughed.
By late April, when there were less than half the hospitalized patients as there are now, Abbott allowed hospitals to resume elective procedures as long as 15% of beds were reserved for coronavirus patients.
Some hospitals now have more than 15% of beds filled by COVID-19 patients. The state’s tally of hospitalized people is likely an undercount because the state only includes lab-confirmed coronavirus cases and not patients suspected of having the virus.
Abbott said he “was assured and reassured consistently” by hospital executives across the state that “they had the capability and the flexibility” to treat all coronavirus patients. “They know how to ratchet back on the number of people who are being admitted for nonessential surgical procedures, to make sure that beds are going to be available for anybody who tests positive for COVID-19.”
Texas officials said Monday that all hospitals are in a “pre-surge state” — still using their staffed beds and not yet turning to emergency expansion plans — and that the state stands ready to assist them. A plan categorizing how hospitals will respond to shrinking capacity shows them doubling up patients in rooms, using nontraditional care areas to treat coronavirus patients and then expanding to nearby buildings. In the most extreme circumstances, they may stand up alternate care sites, like pop-up hospitals.
The number of available beds statewide, which is updated daily by the Department of State Health Services, included on Monday 1,303 pediatric beds and 380 psychiatric beds housed in general hospitals, said agency spokesperson Chris Van Deusen. The available bed numbers don’t include beds at psychiatric facilities, alternate care sites or those that “could be brought online but aren’t actually staffed yet,” he said.
Staff shortages, too
Hospital capacity varies markedly by region.
When Amarillo had a recent outbreak at a meatpacking plant, for example, it filled up ICU capacity in less than five days, said Dr. Robert Hancock, an emergency room physician practicing in the Panhandle city and in the Dallas-Fort Worth region.
“It can happen quick in these areas that have limited ICU availability,” he said. “Dallas, Fort Worth, Austin, Houston have such huge hospital systems that it could happen, but it would take a lot to overwhelm the entire ICU capacities.”
Hospitals are also seeing the return of patients who postponed care during the start of the pandemic, said Hancock, who is president-elect of the Texas College of Emergency Physicians. Those patients may have delayed care because they were heeding official warnings to stay home or were fearful of contracting the virus at the hospital.
“We saw just a rash of people that came in for relatively treatable conditions that had just waited to the point that it deteriorated,” Hancock said. “That’s kind of added to the ICU stress on top of just having the COVID patients.”
Coronavirus patients who go on ventilators can stay on them for weeks, he said, tying up ICU resources.
Facilities treating coronavirus patients could face challenges that go beyond bed space — like staffing shortages.
Some hospitals have already turned to contract nurses or extended employees’ hours, in part because of a rising number of staff members in quarantine after possible exposure to the virus, said Maureen Milligan, president and chief executive officer of the Teaching Hospitals of Texas. There’s burnout among some employees, including medical staff, she said.
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Disclosure: The Texas Hospital Association, Texas Children’s Hospital, St. Joseph Medical Center, UT Southwestern Medical Center and the Texas College of Emergency Physicians have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.