Cancelling elective surgeries, increasing respiratory beds, and ignoring patients' insurance status will do little to manage a moderate influenza outbreak, and much less to abate a severe one that may strike Los Angeles County.
A recently released report predicts that a moderate outbreak of influenza will increase emergency room visits by 201,800, or by 15%, in a 25-week scenario. In a more severe model of an influenza epidemic, ED visits will rise by nearly 500,000, or about 37%.
But what's far more worrisome is the projection that a moderate flu season will increase the total number of inpatient days for intensive care unit and med/surg beds by 138,900, and in a severe flu scenario, 332,000 inpatient days.
The onslaught of such scenarios will require care that Los Angeles County's 72 hospitals will not be able to provide.
Jim Lott, who represents the Hospital Association of Southern California, says he's not that concerned about the impact on emergency rooms. "We can expand our emergency department capacity on the fly by setting up tents," Lott says. "But the need to hospitalize these patients in acute care settings is where the danger lies."
Also of concern, Lott says, is the need for inpatient pediatric beds. "The demand on pediatric critical care beds will be the most severe problem," he says. "This is the population that both the CDC [Centers for Disease Control and Prevention] and state public health officials say could be the most severely impacted."
He adds that a major hospital for children in Los Angeles, Cedars Sinai Medical Center, is one of only 12 acute pediatric specialty centers in the county. "And they're concerned about being overwhelmed."
The scary scenarios were described in Los Angeles County Pandemic Flu Hospital Surge Planning Model, prepared by the National Health Foundation, a nonprofit health advocacy group in Los Angeles. The report sought to address what it called "a paucity of information" regarding supply and demand of hospital care during a flu epidemic and the consequences for LA County residents.
"Absent any intervention, hundreds of thousands of Los Angeles County residents will require hospital care during a flu pandemic when no hospital supply is available," the report warns.
While policy interventions might decrease unmet need by between 11% and 19% depending on the pandemic's severity, "the interventions modeled are not adequate to address the surge in demand."
The report continued, "The hospital system alone cannot meet the increase in demand expected during a flu pandemic . . . Policymakers need to pursue early, aggressive, targeted, and layered community interventions."
Eugene Grigsby, president and CEO of the NHF, says he doesn't think the challenges in meeting demand stop at the Los Angeles County line.
"We think it will be a problem throughout the whole state," he says.
"Without a really good disaster plan, the rollout period could be very confusing and messy, and so the inability to really be effective in dealing with the demand could be exacerbated," he adds.
Additionally, Grigsby says, most hospitals in the Los Angeles area "have no good count on how many respirators they really have." Even the state stockpile, which was purchased several years ago, may be in question. "If there is a stockpile and these respirators haven't been used, no one knows whether they will work or not," he says.
"The real story coming out of our report," Grigsby says, "is who's in charge. Is there a plan? Who knows about it? And is it well articulated. How all this is coordinated is a really critical aspect."