Beds, Ventilators, and Epidemiological Models

by James A. Bacon

The Richmond Times-Dispatch is getting frustrated with the lack of hard information about the COVID-19 epidemic forthcoming from the Northam administration. Reporter Bridget Balch has been trying to track down data on the number of ventilators in the state to treat patients stricken with respiratory afflictions. Frustration with the Northam administration’s lack of responsiveness is leaking into her news coverage.

Virginia, with a population of 8.6 million, has 2,000 ventilators on hand, Balch quotes Cotton Puryear, spokesman for the Virginia COVID-19 Unified Command Joint Information Center, as saying Friday. That’s the first time I’ve seen that number. Balch’s article pointedly says that the newspaper had been asking for the number since March 16.

Virginia public health authorities have not released any own internal forecasts of expected demand for ventilators, But the state has requested an additional 350 ventilators from the national stockpile, Puryear said.

Also, regional groups comprising the Virginia Healthcare Management Program “have ventilators that can be deployed to hospitals,” said Julian Walker, spokesman for the Virginia Hospitals and Healthcare Association in a statement. But is not clear if those ventilators are included in, or in addition to, Puryear’s 2,000-ventilator number.

While state officials say they are planning for the epidemic peak, writes Balch, “they have kept those plans mostly under wraps.”

While other state officials, like those in New York, have publicly discussed projections of how many intensive care beds and ventilators will be needed depending on how many people are infected by the virus, Virginia has not released that information.

In news briefings, Northam and Health Secretary Daniel Carey have stopped short of giving specific numbers on current available resources or projections, instead saying that state officials are in the process of planning ….

At Friday’s briefing, Carey addressed questions from reporters about bed capacity and projections, saying that state officials are aware of different projections and are involved in helping health systems implement their emergency plans and working to call in backup from the Federal Emergency Management Agency, the Army Corps of Engineers and the Virginia National Guard.

Balch notes that the state still does not have its own epidemiological model to help with decision-making. She quotes projections from the Institute for Health Metrics and Evaluation, based in the University of Washington in Seattle, which suggests that Virginia will need 512 intensive care units beds — 183 more than the 329 predicted to be available — when the virus peaks in the state on May 2. If the administration has its own estimates, it has not made them public.

State epidemiologist Lilian Peak has said that state officials are, in Balch’s words, “looking to different entities, such as the University of Virginia and individual hospital systems, that are doing scientific modeling to project possible numbers of infected people and needed resource, but that the state does not have one model it’s relying on.”

Presumably, Peake is referring to an initiative of the University of Virginia Biocomplexity Institute, which, according to UVAToday, is “using powerful computing resources for studying and understanding the spread of infectious diseases.” Said Madhav Marathe, a professor of computer science and biocomplexity:

We also are using our computer expertise and artificial intelligence capabilities to develop epidemic dynamics simulations and decision-support tools for planning and response. Much of this involves curating, synthesizing, wrangling and organizing data for use by the larger academic community to further develop models and decision-support tools.

The UVAToday article did not say if the Institute’s model generated data that would be of use to state health officials. At the time of the article’s publication, March 2, the Institute appeared to have global focus. Said Marathe: “Through our dashboards, we have curated multiple data sources to provide global and detailed perspectives into the confirmed cases.”

If the Institute has generated any Virginia-specific forecasts, it has yet to release them.

Bacon’s bottom line: Either state officials in charge of the COVID-19 response still lack basic information about the health system’s capacity to treat victims of the virus or they aren’t willing to share the information. Neither is acceptable. Kudos to Balch for pushing hard on the Northam administration. The media need to push even harder.

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21 responses to “Beds, Ventilators, and Epidemiological Models

  1. Richmond should partner with VT & UVA to begin work on these…..
    A Ventilator System Built For Rapid Deployment:

    Prepare for all contingencies

  2. Jim,
    You really need to give credit where credit’s due. The Virginia Mercury was the first media outlet to question how many ventilators the state has. I raised the same issue in my Style Weekly story a out a week ago. You are giving too much credit to the RTD.

  3. For better or worse, Cuomo has set a standard for the State communicating on the coronavirus and I see few other states coming close to his performance, including, of course, Virginia.

    And Northam probably can be dinged for not “enough” but it’s not like there has not been information coming out at all – it’s that people want more and the State is in the position of not having guaranteed dead-on correct up to date info in an environment where things are in flux.

    The news cycle has gone at all of this on a 24/7 basis – has taken it’s lead from what Cuomo has focused in on. He has essentially set a standard and the thing is this is the Superbowl of pandemics and not all the players on the field are Superbowl quality.

    They are what they are – and it brings to mind this ditty:

  4. Why do you want hard facts when the chief executive provides you aspirational statements?

    BTW, that’s ass-pirational, as in respirations from an arse.

  5. Yeah. Northam is bad at his job because he isn’t sharing his feelings and speculations.

    Meanwhile the President is a good businessman that gets it for suggesting that we all go to church on Easter Sunday.

    Surely the same people on this board who declared that the pandemic was over under a week ago aren’t losing patience?

    • “Surely the same people on this board who declared that the pandemic was over….”

      And who might that be?

      • the usual suspects?

      • Go all the way back to…5 days ago.

        March 25th “Governor Northam don’t destroy the state” (Or something like that). Reader sentiment (comments) was that the estimates were grossly exaggerated and that Democratic governors were all opportunists destroying the economy for political gain (as if that makes sense). Young people should return to work (and to Liberty University I guess). Easter was a fine date for everything g to reopen.

        Around the same time you, James, were cautiously (cautiously to your credit) optimistic that Virginia would be spared (based on two days of data and in spite of the fact of every epidemiologist was staying that the infection rate wouldn’t peak for another month).

  6. That’s cute, Naive Nancy can think up cutting little sleights about President Trump in every comment response. Useful? No. Helping in any way? No. In any way related to a blog about Virginia issues? Again, no. Unfortunately, just because the federal government or President Trump fails or performs badly at things, doesn’t mean we as a state have to follow suit. Didn’t voters put in the blue wave to be better? Governors of both parties have performed better, or in some cases, worse than Trump. Turning a discussion about Virginia’s issues, or Northam’s successes or failures, to Trump serves no positive benefit. But hey keep doing you and we can all continue to be amazed by your snarky intellect and useless observations.

    • re:; ” just because the federal government or President Trump fails or performs badly at things, doesn’t mean we as a state have to follow suit”

      not true.

      If the Feds fails at their part of the partnership with states, then states fail too. This is the problem with the testing.

      If the states were counting on the Feds to supply testing kits and PPE and masks from a National Stockpile – and they do not get it and are told to go find it on their own on the world market – then it has impacts and a lot of what we are seeing right now has at it’s roots the initial Fed response which said in essence that they were not responsible.

      Virtually every single governor has come on TV begging for help from the Feds – help that they thought the Feds was supposed to provide.

      Don’t blame Northam unless you want to blame virtually every other Governor including Cuomo who has begged and cajoled Trump to do what he should have done to start with.

  7. I have come across a graphic that nicely expresses my philosophy for civil discourse on the Bacon’s Rebellion blog.

    The well-chosen insult or witticism can be entertaining, I do confess, but we aspire to the top three levels of this pyramid.

  8. yes… very good.. excellent in fact, but I bet you get disagreement here…

    and sometimes “explicitly refuting the central point” leads directly to name-calling… eh?

    Would suggest, that every time things get out of hand that you submit this graphic as a comment and encourage folks to do better.

    I do claim my share of falling short sometimes but I’ve always felt that it’s
    the argument – not the person – don’t personalize it.

  9. Here are opening paragraphs of today’s Johns Hopkins article titled The Increasing Demand for Critical Care Beds— Recommendations for Bridging RN Staffing Gap, by Tener Goodwin Veenema, PhD, MPH, MS, RN; Christopher R. Friese, PhD, RN, AOCN; and Diane Meyer, RN, MPH | March 30, 2020

    There are more than 3.8 million registered nurses nationwide, making them one of the largest components of the healthcare workforce.1 With their clinical roles and scope of practice, they are critical contributors to national health security. They are vital in the ongoing response to the COVID-19 outbreak, where nurses across the United States are currently or likely will be involved in identifying, triaging, isolating, and treating suspected and confirmed cases. However, the United States is already witnessing a shortage of critical care nurses in the COVID-19 response. In this post, we discuss potential ways to bridge this staffing gap.

    The rapid surge in COVID-19 cases over the past 2 weeks highlights that, despite concerted efforts in the field, our healthcare system will be strained beyond imaginable expectations. Currently, health systems in Washington State, California, New York, and the greater Boston area are exceeding their critical care bed capacity and face shortfalls in ventilators and personal protective equipment (PPE). The Italian experience portends what the US is already beginning to see: seriously ill patients requiring care in a healthcare system that has no additional capacity, critical equipment shortages, and the real risk of a depleted healthcare workforce due to employment-acquired COVID-19.2 Sadly, earlier this month, New York nurse Kious Kelly died of COVID-19 amid reports that his hospital had run out of protective equipment and had resorted to trash bags as gowns.3 Difficult, painful decisions may potentially lie ahead regarding allocation of scarce resources. We are in the “acceleration phase” of the COVID-19 pandemic in the United States. We recognize the fluidity of the current situation, the urgent needs, and the absence of high-quality evidence on many essential topics …” End Quote

    What is Virginia, and its hospitals, doing to close this deadly gap in critical care nurses?

    For more of John’s Hopkin’s article, see:

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