A leaked presentation reveals the document US hospitals are using to prepare for a major coronavirus outbreak. It estimates 96 million US coronavirus cases and 480,000 deaths.

5 hours ago

Hospitals are confronting the rising threat of the novel coronavirus in the US.
In a February webinar presentation hosted by the American Hospital Association, national healthcare experts from organizations across the US laid out what hospitals need to know as they face the virus that causes COVID-19.
Here's a look at the presentation, which includes estimated projections of as many as 96 million cases in the US, 4.8 million hospitalizations, and 480,000 deaths associated with the novel coronavirus.
It also includes the proper ways to identify coronavirus patients, isolate them, and keep caregivers at the hospitals informed.
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The spread of the coronavirus outbreak in the US could push the healthcare system to its limits.

Hospitals are bracing for what could be millions of admissions nationwide as the virus spreads.

The American Hospital Association, which represents thousands of hospitals and health systems, hosted a webinar in February with its member hospitals and health systems. Business Insider obtained a copy of the slides.

The presentation, titled "What healthcare leaders need to know: Preparing for the COVID-19," happened on February 26 with representatives from the National Ebola Training and Education Center.

The presentation contained an overview of the virus, projections and estimates of how much the virus might spread in the US, and proper ways to identify coronavirus patients, isolate them, and keep caregivers at the hospitals informed.

In particular, one slide presented by an expert included "best guess" estimates that there could be as many as:

4.8 million hospitalizations associated with the novel coronavirus.
96 million cases overall in the US.
480,000 deaths.
Overall, the slide says hospitals should prepare for an impact to the system that's 10 times greater than a severe flu season.

Those estimates come from Dr. James Lawler, a professor at the University of Nebraska Medical Center. They "represent his interpretation of the data available. It's possible that forecast will change as more information becomes available," a spokesman for Nebraska Medicine told Business Insider in an email.

The American Hospital Association said the webinar reflected the views of the experts who spoke during it, not its own.

"The AHA regularly hosts webinars and conference calls that include a variety of voices and opinions that seek to provide relevant information to professionals at hospitals and health systems that are on the front lines of preparing for and protecting their patients and communities," a spokeswoman for the AHA told Business Insider in an emailed statement. "The slides you shared reflect the various perspectives of field experts and should not be attributed to the AHA."

Here's a look at slides presented in the webinar:

The presentation featured "national experts from several health care organizations," the AHA said on its website. Its focus: getting healthcare leaders up to speed on how to prepare for the novel coronavirus, which causes the disease known as COVID-19

Source: AHA

As part of the presentation, the experts laid out facts about the virus, how hospitals can prepare, and details on what prevention tactics might be key to combating its spread.

In attendance were experts from Massachusetts General Hospital, the University of Nebraska Medical Center ...

... Emory University Hospital and HCA Healthcare.

Some are affiliated with the National Ebola Training and Education Center, an organization created in the wake of the Ebola outbreak in 2015 to help hospitals and public-health organizations safely manage patients with suspected and confirmed cases of Ebola and other pathogens.

The presentation started with an overview of the novel coronavirus as of the end of February.

At that point, there were 81,191 total confirmed cases around the globe. Now more than 100,000 people have been infected. The vast majority of the cases are in China.

Source: Business Insider

The presentation laid out the distinction between quarantine and isolation, which are both being used to quell the spread of infection.

It also pointed to recent literature published on the outbreak showing the number of cases in China per day.

Source: JAMA

Cumulatively, hospitalization rates were going up, especially in Wuhan in the days since the outbreak began.

The presentation also highlighted the different factors that contribute to mortality with the novel coronavirus. The death rate among those 80 and up is significantly higher than in other age brackets.

Read more: What to know about the coronavirus outbreak in 9 charts and maps

In a part of the presentation conducted by Dr. James Lawler, a professor at the University of Nebraska Medical Center Department of Internal Medicine, he estimated that the US could have 96 million cases, of which 4.8 million could result in hospital admissions. The slide does not give a particular time frame.

"Those estimates were from Dr. Lawler's presentation and represent his interpretation of the data available. It's possible that forecast will change as more information becomes available," a spokesman for Nebraska Medicine told Business Insider in an email.

In particular, the slide says hospitals should prepare for an impact to the system that's 10 times greater than a severe flu season.

Lawler isn't alone in anticipating widespread infections. Marc Lipsitch, an epidemiology professor at Harvard University, told The Atlantic he predicted anywhere from 40 to 70% of people globally would be infected with the novel coronavirus within the next year.

Other experts also presented.

The presentation explored how hospitals could be ready as HCA's chief of preparedness and emergency operations, Mike Wargo, presented.

That includes having the team in place to handle an emergency, from clinical teams to teams monitoring the situation to those making sure there aren't issues getting supplies.

The bulk of the presentation focused on laying out best ways to "identify, isolate," and "inform."

Here's a look at the clinical criteria used to evaluate potential coronavirus patients.

Source: CDC

As more patients around the US start presenting symptoms, having a safe way to identify them will be key.

The presenters highlighted the different ways patients might come to the hospital, through the emergency department and by ambulance, in a number of different conditions.

The presenters suggested putting up signage that could help patients identify themselves as those who could have the novel coronavirus and might need a face mask.

Here's an example of a screening protocol from Nebraska Medicine based on guidelines around travel as an indicator for the disease.

Isolating patients who have a confirmed infection will be key for health systems as well.

The presenters recommended putting patients in masks who present with respiratory-illness symptoms and following good hand hygiene for both healthcare providers and the patients.

The presenters pointed to guidelines from the Centers for Disease Control and Prevention for infection control.

Finally, the experts presented on what hospitals should do to keep their communities informed: both within and outside hospitals.

That includes making sure teams are entirely linked up if cases arise.

That includes contacting people outside the organization, including local and state public-health organizations.

The presentation also laid out what protective equipment is needed for COVID-19.

That includes a face shield, N95 respirator mask, isolation gown, and a pair of gloves.

This part of the presentation deals with the importance of communicating about the outbreak within hospitals.

Hospitals need to prepare to communicate with their workers and the media.

This slide has some best practices developed in Nebraska.

The presentation also included a discussion of supply-chain issues for hospitals.

It ends with resources for health systems.

The webinar also provided links through which AHA's members could continue reading for more information.

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