Post #535: Answer: Milk, white bread, and kitty litter

Posted on February 28, 2020


Question:  What three items does every grocery story in NoVA run out of when snow is predicted?

That’s sure how it was throughout my childhood.  Like clockwork, at the first prediction of snow, everybody would decide to stock up on those staples.  And so stripped the stores down to the bare shelves.

As of last night, I’d say that panic buying remains the key emergency preparedness strategy here in Northern Virginia.  And possibly throughout America.

I say that because there was not a dusk mask to be had for love nor money at the Merrifield Home Depot last night.  And I mean, not one.  Everything from the cheapest nuisance dust mask (useless) to full-face respirators (overkill) was gone.  Bare shelves.

I didn’t go so far as to check the others in the area, but it’s a pretty good bet that they’re in the same state.

Is there anything more annoying than going to panic-buy something, only to find that your neighbors beat you to it?  The selfish bastards.*

* Seriously, though, I get enough negative blowback from this website that I had better say outright that this is just artistic license. Home Depot was stripped to the bare shelves last night, but I already have what I fervently hope is a more-than-lifetime supply of masks.  That’s owing to living in a home with suspected lead paint.  The particulate-arresting rating for masks I use for sanding paint (P100) more than meets the standard for casual coronavirus protection (N95).

In case you care, “N95 mask” refers to an industry standard rating system.  No clue what the technical details are, but the higher the number, the better the filtration.  N refers to masks that cannot handle oily particles, P refers to masks that can.  Presumably  any of N95, N100, P95, or P100 masks would be adequate for situations that call for an N95 mask as the standard, such as avoiding aerosol-borne virus.  There’s a separate rating (CR-AP) for any mask that doesn’t seal tightly around your face.  (That’s another attempted joke — if it doesn’t seal, a mask isn’t worth crap.)

More to the point, I thought I’d see if I could find any formal emergency preparedness plans, for Vienna or Fairfax County or Virginia, regarding lethal contagious diseases.  I also thought I might as well count empty hospital beds in Fairfax County, just to put the problem of epidemics in the correct light.

Just to be crystal clear, as of this writing that are no known cases of coronavirus in the Commonwealth of Virginia.  None.  Zero.  Just want to be clear about that before proceeding.

Easy question first:  Counting empty hospital beds.

If you know where to look, this is a simple look-up.  As with much of US health care, what we know, we know because of the Public Health Service and the Medicare program.  The US Public Health Service’s Area Resource File lists four acute-care hospitals located in Fairfax County (although two of them are actually within Fairfax City, I think).  The Medicare program’s annual data files give both the number of licensed hospital beds and the “average daily census”, which is more or less the count of beds that are occupied, on average.

The difference is the average number of empty acute-care hospital beds.  On any given day, Fairfax County has just over 400 empty hospital beds.

Source:  Medicare 2020 hospital inpatient proposed rule, impact file.

Fairfax County has about 1.15M inhabitants.  From that, we can deduce that if more than 0.03% of the population suddenly needs to be hospitalized, we will exceed the capacity of our local hospitals.  So if an additional one person in  3000 requires hospitalization, that takes up all the empty (staffed hospital acute-care) beds available in Fairfax County. 

This is of course a simplification.  Hospitals can boost capacity to some degree by delaying scheduled (elective) surgery, by staffing beds temporarily set up in corridors or wards, and so on.  (Conversely, trained personnel places a separate limit on capacity, and you only have so many nursing hours available).  And there are non-hospital settings with domiciliary-type beds (a.k.a., “nursing homes”) that, in a pinch, could be used to expand the supply of beds (but not trained personnel).

But the main point is correct.  I think it’s fairly well recognized that the US acute-care system is not set up to handle mass epidemics.  Nor should it be, as epidemics for diseases requiring hospitalization are (mostly) a thing of the past.

The moral of the story for the next epidemic is either plan to get sick early, or plan to take care of yourself.  Any contagious disease requiring hospitalization for a significant fraction of those infected will rapidly overwhelm the existing health care system.

Not to be defending “preppers”, but in this light, maybe those folks buying up the masks at Home Depot don’t look quite so irrational.  Selfish, sure.  And hopefully a waste of money.  The US individual “prepper” model for disasters, where it’s every person for him/her self, is an inherently wasteful approach that relies on selfishness as the principal driving force.  So, selfish and probably wasteful, sure.  But hardly irrational.

The harder question:  What’s the plan.

Really, what I’m after here is any on-line mention of a specific set of plans to deal with an epidemic of any serious disease.  Either local, regional, or state-level.

Town of Vienna emergency plans. 

First, weirdly, did you know that the Mayor of the Town of Vienna can, in effect, declare martial law?  It’s written into the Town Code, Section 2.59, Mayor’s emergency powers.  Declare a curfew, close roads, close businesses, including but not limited to bars, liquor stores, gas stations, and gun shops. And do pretty much anything else required to maintain public order.

So if Vienna has drunken riots with Molotov cocktails and firearms, we’ve got that situation well covered.  The Mayor can shut that sort of thing right down.

But that’s all focused on riot and disorderly behavior, not on pandemics.   It’s not clear that any department within Town government would even have responsibility for such an issue.  Searching the Town’s website for “epidemic”, I can find:

  • Mandatory cat vaccinations due to a rabies epidemic.
  • Some contracts where the contract is no longer valid in case of disasters (of which, epidemics were listed as a type of disaster).

And so, the Town has no role here.  The Town really has no public health functions, period.  Of which, no plan for epidemics is part.

Fairfax County and the Commonwealth of Virginia.

Fairfax County:  Off the crack of the bat, we find that Fairfax has an active posting on coronavirus.  There are no known cases in Fairfax County at this time.  They have a web page up dealing with the topic.  We can see that one person in NoVA was tested but was negative for coronavirus.

FCPS:  Obviously a key player in this will be the school system.  The Fairfax County Public Schools has its own coronavirus update page, which includes a link to a handout for cornonavirus (.pdf), but which provides nothing more than standard guidance for avoiding the flu (stay home, avoid contact with sick people, wash your hands.)

Virginia Department of Health.  And Fairfax leads you directly to the Virginia Department of Health, where they have a summary page for activities related to corona virus.  And the Commonwealth has a more detailed page with (e.g.) instructions for health care providers.

OK, that pretty much seems to exhaust the plain-vanilla advice for member of the public.  But surely the Commonwealth has detailed plans in case (e.g.) the hospitals are filled.

Virginia Office of Emergency Preparedness.  Their web page is here. Unfortunately, what I see here is mostly oriented toward individual prep for standard disasters.  The readily-available literature does not even address pandemics.  At best, for coronavirus, they refer you to the CDC’s public-facing webpage on coronavirus.

That CDC web page and subsequent links are arguably the best sites so far for any detailed information on dealing with a pandemic.  For example, they address the potential shortage of face masks in light of a pandemic.

No, I mean a plan for what happens if all the hospital beds are filled.

So far, what I’ve been able to find consists mostly of plans for helping prevent the spread of coronavirus, along with a little general information in personal emergency preparedness.  All of that is quite reasonable, but that’s not where I was heading.

Is there any back-up plan if this overwhelms the existing supply of hospital beds?  Near as I can tell, no.  (Or, if there is one, I can’t find it on-line).  No list of facilities that would serve as second-tier resources in the event that hospitals are filled.  And certainly nothing like centralized rosters of the medical personnel needed to staff those second-tier beds.

I hope I’m wrong about that.  I hope that, somewhere, there is some well-worked-out and orderly plan for that eventuality.  I would love to be proven wrong, and i if you know about such plans, please email me (address is on the splash page for this website).

But at this point, I don’t see evidence of that.  The planned excess capacity of the Fairfax County health care system, for dealing with individuals requiring an inpatient level of care, appears to consists of the roughly 400 empty acute-care beds that we have here in Fairfax on any given day.

Beyond that, I think we’re on our own.  You’d hate to think that a bunch of people buying respirators at the Home Depot is about as sophisticated as we get in terms of true emergency planning.  But at this point, I can’t rule that out.

Again, zero cases of coronavirus in Virginia, as of today.