Maryland lawmakers were briefed Wednesday on an ambitious plan that appears to be the backbone of the state’s response to an expected explosion of patients requiring hospitalization as the result of the COVID-19 pandemic.
The plan, outlined in a wide-ranging 20-minute briefing by Health Secretary Robert “Bobby” Neall to the General Assembly’s Joint Committee on COVID-19, includes the construction of modular hospital facilities as well as the use of hotels and college dormitories.
The success of it likely hinges on the availability of resources including, most importantly, ventilators and help from the federal government that has been slow to come to Maryland and controlling what Neall called an “incursion” of potential cases from Virginia and the District of Columbia.
“I think the next three or four weeks is going to determine how Maryland is going to come through this,” said Neall. “If we’re well-prepared and get our plans done, a lot of people, their lives are going to be saved. We know what the mission is. We know what the job is and we’re doing our level best.”
The legislative work group was formed nearly a week ago. The meeting Wednesday morning was its first.
The video conference was not open to the public but audio of the meeting was published later on the General Assembly’s website. The work group, established in a press release rather than by statute, is not technically subject to the state’s Open Meetings Act though legislative leaders vowed to work through technical issues to make it more accessible to the public.
As of Wednesday, the state had confirmed 423 COVID-19 cases.
It’s a number that officials, including Gov. Larry Hogan and Neall, said they expect to continue to rise as testing becomes more widely available.
So far, health department officials have been hesitant to publicly discuss the number of confirmed COVID-19 cases that are hospitalized.
Neall told lawmakers that nationally 25 percent of those hospitalized because of the virus “require intensive care, which means a ventilator and extra staffing.”
On Wednesday, Deputy Health Secretary Fran Phillips told reporters that the state is currently not in a crisis for beds.
Neall’s comments to lawmakers in the video conference call with lawmakers suggest the state is planning for a sharp increase.
Hogan has called for finding an additional 6,000 beds using existing and closed hospital facilities.
Additionally, state officials are planning to turn the Baltimore Convention Center and nearby hotel into a facility for patients who do not require intensive care. Neall said the facility, operated jointly by Johns Hopkins and the University Of Maryland Medical System, will make use of a federal medical station, what he referred to as “hospitals-in-a-box that we can deploy at the convention center.”
“We’ll use that as sort of a test place to see what we need to learn,” said Neall.
But Neall told lawmakers Wednesday that they are looking at other outside-the-box alternatives.
Currently, there are just under 400 intensive care beds available in the state and another nearly 2,100 adult acute treatment beds available, according to Neall.
“That number is large because we’ve started to eliminate elective surgeries and whatnot and hospitals are losing census in order to get ready for what’s to come,” said Neall.
Alternatives discussed by Neall include the construction of modular buildings — some on the parking lots of existing hospitals — that can house up to 30 patients each.
Neall said he is in discussions with modular builders and a team of “20 medical planners and architects we borrowed from anybody we could find” to focus on modular planning and site evaluation.
The state is planning to construct up to 100 modular facilities at a cost of $100,000 each plus another $100,000 to equip them for hospital use. Mercy Hospital in Baltimore recently received emergency state approval to reopen a floor with 30 beds. That facility is estimated to be ready in less than three months at an estimated cost of $12.5 million.
“We could do 100 of those and that would cost $20 million, which for hospital construction is dirt cheap,” said Neall. “Put them on the parking lots of hospitals so they are an integral part of the hospital and it would give them some surge space.”
The plan, however, could hinge on acquiring some of the hardest-to-find medical devices in the country.
“We’re probably going to have to use a good many of the beds in our community hospitals as intensive care beds and use our alternative sites like college dorms and hotels and portable buildings as the lower intensity in care,” said Neall. “But that’s where the rubber is really going to hit the road, and that’s why the ventilators are critical to the success of this plan.”
State officials have been hesitant to discuss the number of ventilators on hand. On Wednesday at a news conference, Gov. Larry Hogan told reporters he’d rather not make that number public.
Neall, in his briefing to the committee, said there are 1,040 ventilators in the state.
“I’d sleep better at night if we had twice that many. And we’re doing everything we can to acquire more whenever and wherever we can,” said Neall.
The health secretary said he is also in conversations with neighboring jurisdictions in an attempt to prevent Maryland hospitals from being overwhelmed by out-of-state patients.
“I’m very concerned that in the Washington suburbs that we may have an incursion from D.C. and Virginia to our hospitals,” said Neall. “We’re working very closely with those two jurisdictions to ensure that doesn’t happen.”
To staff the new beds, Maryland has called on its medical reserve corps, made up of people with health care training who volunteer to serve in times of need. So far, 2,500 people have signed up, but Neall said his “very uneducated guess” was that 5,000 people would be needed to staff the 6,000 beds the state wants.
The state is working to find ways to allow medical students and nursing students to serve under licensed health care professionals. It may also require some volunteers without health care experience, Neall said.
“There may be some billets in our convalescence area that may just be volunteers – good citizens who want to help out with feeding and that sort of thing,” he said. “But I’d like to have 5,000 people with a health pedigree to staff the 6,000 surge beds that we have.”
The state’s struggles to acquire supplies, like test kits and protective equipment, have prevented Maryland from implementing some plans, like drive-up testing.
Hogan has described plans to do testing at vehicle emissions test facilities. Monday he announced a plan to perform testing in FedEx Field’s parking lot. Neall said the Glen Burnie vehicle emissions inspection site would also have testing.
But the state lacks the tests needed to actually run these sites. They are waiting on an order of 4,000 test kits from the U.S. Department of Health and Human Services but have not yet received the shipment, Neall said.
When the sites are running – Neall said it could be later this week — test sites would not be for everybody; people would need a doctor’s note in order to get the test.
The state has already done a 40-person pilot of drive-up testing in Queen Anne’s County, Neall said.
Test turnaround time is another issue. The state’s lab is capable of running 500 tests a day, with a 24-hour turnaround. It is also upgrading to be able to run the newly approved 45-minute test, Neall said.
Commercial test companies have a seven-day turnaround for test results, he said. That turnaround time could mean there is a significant gap between the number of cases currently in Maryland and the number of lab-confirmed cases the state has reported.
Personal protective equipment – which includes gloves, gowns and masks – has also been in short supply, with a scramble underway to find suppliers for the equipment.
The state has received equipment from the national stockpile, but deliveries have been sporadic and at a fraction of the amount ordered, Neall said.
“When this gets crazy, I think people are going to be wearing trash bags fastened with duct tape,” he said. “There just simply doesn’t seem to be enough equipment – unless corporate America can start the arsenal of democracy and start producing this stuff in quantity.”
In addition to traditional corporate routes for the equipment, the state and providers have also been receiving donations. Neall added that the state prisons are making plastic face guards.