Colorado places orders for PPE from across globe, plans tiered care system for COVID-19 patients

Efforts to ramp-up hospital beds in 2 weeks to prevent overload
jared polis scott bookman covid-19 coronavirus colorado
Posted at 4:54 PM, Apr 01, 2020

CENTENNIAL, Colo. – Colorado has placed orders across the world for millions of masks, gowns, face shields, ventilators and other personal protective equipment and has created a tiered health care response system for how to treat people with varying degrees of COVID-19 as the state and providers race to massively increase the number of beds over the next few weeks before hospitals get overrun by the virus.

At an afternoon news conference Wednesday, Gov. Jared Polis said the state had ordered 2.5 million N95 masks; 1 million surgical masks; 250,000 gowns; 23,000 face shields; 1.5 million gloves and 750 ventilators from across the world supply chain – including some from China. He said Hunan Province, China was sending the state 10,000 masks.

Polis said all equipment received by the state would be tested by Colorado State University scientists to be sure they are of the quality needed for health care workers to use. He said the suppliers wouldn’t be paid until the goods are tested and approved upon their arrival and that he had even considered sending the scientists to China on a state plane should it have been necessary.

He said that the moves by Colorado were necessary as the novel coronavirus continues “spreading like wildfire” and because the state knows “we’re not getting enough from the federal government.”

And he said the move to buy more medical supplies now is necessary because he expects the global supply chain to become even more strained in coming weeks and months as the virus spreads globally.

Polis said that by hopefully getting the supplies early, Colorado can stave off having to use homemade masks and rain ponchos for PPE – as has been the case in some other places, such as New York.

“By working with people in the innovation sector … Colorado will be a leader in opening international and domestic supply chains and ramping up our own manufacturing capabilities in Colorado,” Polis said.

He went through a presentation showing that of the supplies requested by Colorado from the federal government, only a small percentage has been sent. According to the chart, Colorado has received just 11% of its requested N95 masks; 11.5% of the requested surgical masks; 40% of the face shields the state asked for; 14% of the surgical gowns it requested; 19% of the gloves requested and none of the 10,000 ventilators it has asked for.

CDPHE COVID-19 Incident Commander Scott Bookman said that Colorado expects the surge of patients that could overwhelm the state’s hospital system is expected to occur sometime between April and July of this year, hence the urgency to get more protective gear and for people to stringently follow the state stay-at-home order in order to push off the peak surge time.

He said that people who are severely ill with COVID-19 will require intensive care and be dependent on ventilators for an average of 11 to 20 days, but then will require stepdown care at a hospital and other non-critical-care facilities.

Thus, he and Polis said, the state developed a four-tiered system to classify types of patients and the facilities at which they will need to be treated. State officials expect the most-sick patients will move across the tier system as their conditions improve, and the state is planning on using various types of facilities across the different tiers to meet the needs at maximum capacity.

The top tier – Tier 1 – would put the most-ill patients within hospitals for critical care, ICU care and ventilators. The state’s goal is to increase the ICU bed capacity statewide to 5,000 beds – from 1,800 currently – by April 18. The state said it is looking at critical access hospitals and long-term care facilities to possibly expand the Tier 1 services.

Tier 2 facilities would be freestanding other sites outside critical-care hospital wards and would be used to move people out of hospitals to what Bookman called “lower acuity settings” to keep critical care beds available for the sickest patients.

Tier 3 facilities would house “subacute patients,” Bookman said – people needing once-daily monitoring by a doctor and twice-daily monitoring by a registered nurse and, in some cases, respiratory therapists. Bookman said the state was looking at turning larger facilities – including arenas, convention centers and stadiums – for these Tier 3 facilities, which are similar to the ones New York City has set up in Central Park in recent days. The state’s goal is to have 2,000 new Tier 3 beds by April 18, Bookman said.

Tier 4 facilities would be for people with mild symptoms, asymptomatic people, and communities and people who need some slight supervision, such as the state’s homeless population. The state is eyeing dormitories, hotels and other types of buildings that could be turned into medical care facilities and hopes to have 10,000 new beds of the tier by May 15, Bookman said.

Additionally, Bookman said, the state hopes to implement a patient transport unit with the department by April 10.

He said the state believes it will be able to handle all of the patients without overwhelming the hospital system if the state can accomplish those goals.

Bookman and Polis said the state had renewed licenses for 2,300 medical professionals and were working hard to get more volunteers after thousands of people already signed up to do so.

As his spokesperson said Tuesday, Polis said Wednesday that he and his team are looking at more data before it makes a final decision to extend the state stay-at-home order, which currently is set to end at the end of April 11, until April 30.

Polis said the state was hoping to get more supplies than it needs because he doesn’t want anybody to die because of a lack of supplies and in case supplies are found to be defective.

And overall, both Polis and Bookman stressed, as they have repeatedly over the past few weeks, that the only way to keep the health care system from being overrun by the virus and other medical conditions is for people to strictly follow the stay-at-home orders to spread out the peak of the curve.

“The most effective way to reduce the spread of the virus, absent effective mass testing, tracing and quarantining, is to limit person-to-person interactions,” Polis said.