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Plan of action and more ventilators to cope

Emergency measures: a temporary tent installed outside the King Edward VII Memorial Hospital

Twenty ventilators are available at the island’s general hospital and eight more are on their way, the Bermuda Hospitals Board said last night.A BHB spokeswoman added there was also a plan to look after critical patients outside King Edward VII Memorial Hospital’s intensive care unit if the Covid-19 pandemic caused widespread serious illness.She said: “This is an exceptional situation. There is not a hospital or healthcare system that is built, supplied and staffed to be ready for a pandemic like this.”The spokeswoman added the board had still to get an estimated time of arrival for the extra ventilators.However, she said the equipment — machines that help patients with respiratory problems to breathe — was only part of the equation.She explained: “You need bed spaces where there is oxygen available, and critical care staff who are specially trained to look after ventilated patients.“Although Covid-19 most significantly affects the lungs, all critically ill patients are at risk of multiple organ failure, so this specialised critical care training is vital. “So our ability to care for critically ill Covid-19 patients relies equally on equipment, such as ventilators, staff and space.“For this reason, we are looking at increasing our capacity outside of the intensive care unit at KEMH and utilising all bed space with available oxygen.”The spokeswoman said increasing acute and critical care bed capacity was an immediate priority, as well as “cross-training and upskilling” existing staff.The King Edward suspended elective surgeries last week to start the training.The hospitals board will also collaborate with “healthcare colleagues in the community” for extra back-up.KEMH has 120 acute care beds, with 90 in the acute care wing and 30 in the general wing. There are nine beds in the ICU.The acute care beds were 80 per cent occupied and the ICU beds were 77 per cent occupied last Friday evening.The bed occupancy varies and is monitored daily.The BHB spokeswoman said: “Our current plan is to use other areas of the hospital for ventilated patients. Today, we could care for up to 20 people on ventilators. When our additional ventilators arrive, we will be able to use them all.”She added: “We are working with Government to discharge at least 30 long-term care patients, use operating room spaces and other ward areas. “Some good news is that we were in the middle of a bed replacement programme.” The spokeswoman said 48 new beds would arrive today and would be used immediately if needed.BHB had 420 nurses — 383 full time and 34 casuals — 118 doctors, 203 nurse aides (165 full-time, 37 casuals, one temporary) on staff in February.There were also 31 emergency medical technicians — 22 full time, eight casuals and one part-time.The spokeswoman said: “There are additional nurses in administrative and leadership functions and nurses and doctors in the community who can also add to these numbers in a time of crisis, especially if staff themselves are ill or in quarantine.”About 40 of BHB’s nurses have critical care training, along with 12 anaesthetists, plus two doctors outside the hospital with training who could support, and 13 emergency department doctors. The spokeswoman added: “There are also certain speciality doctors and nurses in the hospital and community who can help work to support Emergency Department and inpatient care. This will need to be a team effort to get through.”A study by the Harvard Global Health Institute released last week warned that US hospitals could be overwhelmed by the illness.The review suggested that in a worst-case scenario, 60 per cent of the US population would get Covid-19, with a moderate scenario of 40 per cent and a best-case scenario of 20 per cent. Those numbers were specific to the US.The study predicted 20 per cent of adults who caught the coronavirus would need hospitalisation and 20 per cent of those hospitalised would need a ventilator.David Burt said last night that although there were six confirmed cases in Bermuda, there had not yet been one that required hospitalisation.He said in a Facebook Q&A on Saturday that the Government had imposed strict measures to limit community spread of the virus here.The Premier added: “I do not have a concern that our hospital will be overrun and I have no intention of letting us get to that particular point at all.”Bermuda’s population was 63,779, with 17 per cent aged over 65, in 2016, according to the census.The BHB spokeswoman said: “It is sobering looking at numbers and our hope is that people pay attention as they are the front line of protection and can help us towards the best case scenario, which would be most manageable. “As healthcare workers on the frontline, we will do everything we can. “The healthcare community is pulling together, and we are planning, testing and looking into every option we have to cope.”She added: “This is why we cannot stress strongly enough that the community actions now — social, physical distancing; washing hands; not touching our eyes, nose and mouth; adhering to quarantine and isolation guidelines; and staying at home — are the most important actions that will enable the healthcare system to cope, along with on-island testing, and border control. “This gives us the chance to slow and maybe even eradicate the virus in Bermuda.”• To view a Q&A with the Bermuda Hospitals Board on hospital preparedness, click on the PDF link under “Related Media”

<p>Covid-19 statistics</p>

Positive results: 6 (5 imported, 1 close contact)

Hospitalisations: 0

Tests sent: 46

Results pending: 14

Negative results: 26

Ventilators: King Edward VII Memorial Hospital has 20, with 8 more ordered (ETA not yet known)

Acute care beds: 120

Intensive care beds: 9

New beds: 48 arriving today (Monday), which will be used as additional bed stock

Clinical care tents: Bermuda Hospitals Board has three and has ordered negative pressure equipment to attach to them to stop the air flowing out. No more ordered but hospitals board says it is “constantly reviewing what will be needed”.

Nurses: 420 (383 full-time, 34 casuals)

Doctors: 118

Nurse aides: 203 (165 full time, 37 casuals, 1 temporary)

Emergency medical technicians: 22 full time, 8 casuals, 1 part-time

Specialised staff for dealing with extreme cases of Covid-19

Critical care nurses: About 40

Anaesthetists: 12, plus 2 physicians in the community with training who could support

Emergency department doctors: 13

Test kits on island: 150

Test kits on order: 800, according to David Burt, which are due to arrive within the next two weeks. The Premier said on Saturday: “I have already asked for more to be ordered so that we have enough to test, test, test, test.”

Population of Bermuda: 63,779 in the 2016 census