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Experts plan for 'worst-case scenario' with COVID-19, flu cases expected to surge in fall

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Hospitals around the region are preparing for a spike of coronavirus and influenza cases this fall.

While many said they’re generally ready for this surge, experts are still planning for the “worst-case scenario” – of becoming overwhelmed by patients in the months ahead.

"Every hospital in this state should basically be at the same level of care and the state has worked very hard on making sure that’s true," said Dr. John Lynch, UW Associate Professor and Harborview Medical Director for Infection Prevention and Control and Employee Health.

Lynch said medical experts across the state are working on what’s called “crisis standards of care” -- where experts are collaborating on how they would collectively manage if a sharp rise in critically-ill patients led to an extreme lack of resources like ventilators, supporting one another with the right equipment so that not one single hospital is burdened.

"What we have here in Washington State and this has even gotten better over the last six months is that we have a fantastic process. It is open. It is robust to share information and to move patients and equipment across the state so that no hospital is ever an outlier," Lynch said. "Every hospital in this state should basically be at the same level of care and the state has worked very hard on making sure that’s true. We’re really lucky here in Washington State. We have a level of cooperation among all those different groups, it’s actually not common in the United States and I think we benefit from it enormously."

The goal is to prevent this “worst-case scenario” from happening by pushing everyone to get the flu vaccine to lower the number of people needing care in regional hospitals.

"The goal of the crisis standards of care in those discussions is that we never ever get to that point where we have to triage who gets care and who doesn’t, but I think it would be, you know, it would be turning a blind eye if we didn’t talk about it and come to an agreement about it as a community," Lynch said.

Doctors said it’s possible that patients could become co-infected this fall by both influenza and coronavirus. While there’s a lot of uncertainty about what this co-infection would look like, Lynch said it would likely be worse than just having one of the viruses.

"Do we treat one differently than the other?" Lynch said. "Some of the treatments aren’t good for both."

Lynch and other doctors say they need testing with rapid results to determine whether someone has the flu, COVID-19 or both. That's because some treatments for COVID-19 (for example, a particular steroid used for severe COVID-19 infections in the hospital called dexamethasone) might actually make the flu worse.

"It's working through a lot of those details, you know for patient care but also for the healthcare side, how do we keep healthcare workers safe as these patients come into our clinics and our hospitals and our emergency departments," Lynch said.

The Washington State Department of Health is one of the leading agencies to develop these “crisis standards of care.”

Along with other organizations, the Department of Health is ready to help hospitals coordinate for a surge in patients this fall. Among many other efforts, the agency is working with several other partners to develop a robust supply of PPE for workers on the front lines.

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Dr. Ali Mokdad with UW's Institute for Health Metrics and Evaluation said hospitals in Western Washington won’t likely have too much trouble handling this expected spike in cases this fall. However, he said hospitals in sparsely populated areas in Eastern Washington will probably face more challenges.

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