Coronavirus in Colorado: Hospital expansion plan seeks arenas, college dorms

As many as 2,000 Coloradans fighting less-severe cases of the respiratory illness caused by the coronavirus will lie in hospital beds inside arenas, convention centers or even repurposed warehouses, attended to by a mix of medical professionals and volunteers.

That is the expected reality in just over two weeks under emerging plans for makeshift field hospitals outlined Wednesday by state officials — and it’s just the beginning. By mid-May, they plan to set up 10,000 more beds in hotel rooms, college dormitories, skilled nursing facilities and other places for people in need only of basic medical supervision or a place to quarantine.

Colorado is among states looking at ways to quickly scale-up its hospital system with both large and small facilities. It’s all part of a shift of resources aimed at freeing up space within hospitals to take in the potentially thousands more intensive care patients expected in coming weeks as cases of COVID-19, the disease caused by the coronavirus, continue to explode.

The plans echo rapid efforts in New York City, where a 68-bed tent hospital opened this week in Central Park, joining a 1,200-bed field hospital set up inside a large Manhattan convention center.

“It is incredibly important to understand that the physical space and capacity within our healthcare system will be challenged,” said Scott Bookman, the Colorado Department of Public Health and Environment’s incident commander for the coronavirus pandemic, during a state briefing Wednesday. “Our job is to create more space within that system.”

Several large buildings constructed for completely different purposes are part of the discussion with local governments and private operators.

In Loveland, the Budweiser Events Center could host as many as two field hospitals as part of a partnership between the state and Larimer County. In Broomfield, city officials said last week that they were talking with the 1stBank Center about hosting patients. And in downtown Denver, the Colorado Convention Center is part of the conversation.

“We’re definitely at the table and working on what makes sense,” said Erika Martinez, a spokesperson for the city’s Joint Information Center. “At this point, locations aren’t set in stone.”

With help from the U.S. Army Corps of Engineers, which assisted New York and is advising other states, Colorado officials have begun evaluating potential locations in Grand Junction, Durango, Pueblo and along the Front Range, said Mike Willis, director of the state’s Office of Emergency Management.

“Really the idea is to build capacity regionally around the state so that, depending on how COVID-19 manifests itself, we can decompress hospitals regionally,” Willis said in an interview.

With a disaster declaration approved already for Colorado by President Donald Trump, state officials anticipate receiving significant financial assistance from the Federal Emergency Management Agency for the field hospitals. Willis said he signed Colorado’s application for a “mission assignment” to FEMA on Wednesday.

Colorado’s health care system hasn’t been overwhelmed by patients yet. But the number of people hospitalized so far — 620 as of Wednesday’s CDPHE data release — has been increasing rapidly. The number of confirmed cases of COVID-19 cases reached 3,342, and 80 people have died.

The vast majority of cases do not require hospitalization, but experts say people older than 60 and those with other conditions are more likely to develop severe illnesses. Thousands will fall into this category soon, public health models predict, even as Colorado’s stay-at-home order and other restrictive measures are expected to tamp down the still-exponential spread of the virus.

How the makeshift expansion will work

Earlier this week, CDPHE officials outlined plans to expand the health care system’s capacity by summer. But on Wednesday, spooked by hospitalization projections, they sped up the timeline.

Colorado’s “wildly important goals” for coming weeks, as Bookman put it during a news conference, start with increasing the number of intensive care unit (ICU) beds inside hospitals across the state from 1,849 to 5,000 — all by April 18.

That number would accommodate the worst-case ICU capacity needed to treat patients with the most severe conditions around that time, which is when hospitalizations are expected to peak, he said. Many of those patients will need ventilators, dialysis or other equipment to survive, and Gov. Jared Polis’ administration has been trying to address potential shortages of those items, too.

During Wednesday’s briefing, Bookman outlined a four-tier classification system for patients and the facilities that will treat them, with some patients being moved as their conditions worsen or improve:

• Tier 1 patients will go to intensive care units in hospitals, including beds in areas not usually used for that purpose.
• Tier 2 patients with less-severe cases but who still need closely monitored care will be treated in outpatient surgical centers, freestanding emergency departments and other critical-access hospitals, Bookman said. Hospital operators are coordinating to free up those beds now.
• The new field hospitals come into play for Tier 3 patients with “sub-acute” conditions. They will receive treatment and periodic monitoring in arenas, warehouses, stadiums or convention centers, among other possible sites set up by April 18
• Tier 4 facilities, potentially including hotels, dorms and other places that would open by May 15, would provide basic supervision for people with mild symptoms as well as providing places to quarantine.

Will the extensive ICU capacity and the 12,000 beds in Tier 3 and 4 facilities really all be needed? It’s hard to say, state officials acknowledge, and they don’t want to be caught in a situation in which doctors are rationing resources to patients on their deathbeds.

Some projection models estimate the peak shortage of ICU beds here will be much lower than the upwards of 3,000 the state is trying to add, for instance. The Institute for Health Metrics and Evaluation at the University of Washington estimates Colorado would have a shortage of fewer than 800 ICU beds — or as many as 1,500 in an upper-range estimate — by mid-April, when it agrees that hospitalizations are likely to peak.

“There are a lot of models out there,” Willis said, “and they range from really draconian to not a big deal,” relatively speaking. “It’s very challenging to reconcile all those different models. … We really put a lot of thought and energy into (asking), what is the right course of action that is prudent under this really ambiguous environment. That’s how we came up with these numbers.”

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