The value of understanding hospital resources amid COVID-19

How mapping hospital resources across Arizona can create a roadmap for discovering strengths and areas of need

April 13, 2020

As cases of COVID-19 rise in Arizona, it’s essential to take a closer look at the current hospital resources that are available in our state. A quick Google search can help you find the nearest hospital. Still, critical metrics like the number of hospital beds, availability of specialized ICU beds and average ventilator use per week are not so easy to find.

Arizona has a total of 15 counties, some like Maricopa and Pima, which boast dense populations with at least 1 million residents. On the other hand, Greenlee is the smallest Arizona county and has a population of less than 10,000. How do resources look across these counties?  Screenshot of the interactive map featuring a wide-view of Arizona Screenshot of the interactive map featuring a wide view of Arizona.

Chuyuan “Carter” Wang, an assistant research professor for Arizona State University's Knowledge Exchange for Resilience and the School of Geographical Sciences and Urban Planning, weighs in with a mapping tool featuring four distinct layers including hospitals and hospital beds; confirmed COVID-19 cases by county; CDC social vulnerability index; and population by age group.

This interactive map is a powerful tool that increases knowledge of hospital resources available and paints a picture of where Arizona may need to allocate resources.

The first layer, titled Hospitals and Hospital Beds, shows the total number of licensed hospital beds in Arizona (17,889), 5.4% (1,882) of which are specialized ICU beds. A total of 46 hospitals have the potential to increase their bed capacity, with 25 hospitals located in Maricopa County and 11 in Pima County.

The second layer shows Confirmed COVID-19 Cases by County, and this data in comparison to the hospital resources can be alarming in some counties.

“As the COVID-19 cases increase, the demands of ICU beds and ventilators are also likely to increase in the next few weeks as well," Wang said. "Greenlee County has no hospital or hospital beds. Navajo County has 287 cases, but only 200 beds and 24 ICU beds potentially available as of April 10, 2020. These two counties need more attention from the ADHS and the state government."

The third layer, which shows the CDC Social Vulnerability Index helps people to more easily understand which populations have a heightened vulnerability risk based on census tracts.

“The SVI index ranges from zero to one, with higher values indicating greater vulnerability. The zero value means no vulnerability, and the one value means the greatest vulnerability,” Wang said.

The last layer includes Population by Age Group by Census Tract, which shows an overview of the population by age groups in Arizona. Based on the 2018 census data, there are more than 1 million residents age 65 and older in Arizona.

"It is still uncertain about which age group is the most vulnerable to COVID-19. But worldwide data shows that seniors aged 65 and older may be at higher risk. And they may experience severe symptoms due to underlying and preexisting health conditions," he added.

Above: An animation of the interactive map's zoom feature including a wide view of Arizona, then the city of Tempe and finally St. Joseph's Hospital and Medical Center hospital resource data. Explore the full map here.

In the most practical use, Arizona residents can use this map to find their nearby hospital and have more in-depth knowledge about the resources available to them. But, the value of these four combined layers can be used across sectors as combined knowledge of hospital resources and vulnerable populations creates a roadmap for areas of focus.

Dawn Augusta, a clinical associate professor for the Edson College of Nursing and Health Innovation and Knowledge Exchange for Resilience fellow works in developing innovative approaches to bridge education and health care systems design. She is also a registered nurse and has a nursing career that spans over 15 years.

When asked about the value of the interactive map, she said it can help people visualize the scarcity of resources and encourage a shift in attitudes about when to use hospital services.

“People are used to going to hospitals and often use emergency departments as primary care instead of true emergencies,” Augusta said.

Reserving the emergency department for people that need it the most, creates an opportunity for the industry to breathe and allocate resources more strategically.

With experience working on the front lines, Augusta said it’s an exhausting time for health care workers.

“It’s just a never-ending cycle. Each day the night shift hands the baton to the day shift and one back to the other. And you hope that every time you come back to give a report, it’s going to be a better story,” she added.

“The people in the hospital feel like they can’t do anything about the bottleneck, but the people in the community can loosen the grip,” she said.

Community members can make a difference if they properly isolate and participate in meticulous infection protocols like handwashing and not touching their face. The Centers for Disease Control and Prevention guidelines can offer more recommendations.

Another takeaway Augusta noted is the highly vulnerable population of 3,800 people experiencing homelessness in downtown Phoenix.

“Everyday people can look at this map and say wow, there is a scarce resource. There’s a huge risk of homeless people huddled in Phoenix getting sick very quickly, and all at the same time,” Augusta said.

With a surge in COVID-19 cases among people experiencing homelessness in Phoenix, it can affect neighboring cities since they could use Valleywide resources. She said Arizona needs to voice this concern.

“Let your concern be known to city leaders and ask them to make a strong commitment to finding places for people to go and get temporary emergency shelter. It doesn’t have to be forever. It’s not the new normal; it’s the new now,” Augusta said.

The ASU Knowledge Exchange for Resilience is supported by Virginia G. Piper Charitable Trust.The conclusions, views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Virginia G. Piper Charitable Trust.

Crystal Alvarez

Communications manager , Knowledge Exchange for Resilience


ASU researcher explores harmful species on a global scale

New model finds countries should work together to control pests, parasites and diseases

April 13, 2020

If you’ve spent time in national parks or state recreational areas, you’ve likely seen warnings about the spread of invasive species. From inspection checkpoints for cars and boats to restrictions on bringing firewood and fruit across state lines, officials are working to prevent outbreaks of pests, parasites and diseases, which can wreak havoc on entire ecosystems.

Most examples are relatively small — impacting one localized region. But policymakers face difficult choices when vast numbers of invasive species and other kinds of harmful species affect multiple countries. Think of species like locusts and starlings or even diseases like smallpox and COVID-19. Should countries work together in multiple hot spots or divide the land between them for treatment?  pest, insects, leaf Photo courtesy of Pixabay. Download Full Image

Adam Lampert, an assistant professor with the School of Human Evolution and Social Change at Arizona State University, turned to mathematical modeling for answers. His findings, published this week in the Proceedings of the National Academy of Sciences, indicate that sometimes a “divide and conquer” approach is better, while in other situations it is more effective to cooperate in several locations.

“If you want to eradicate the harmful species, or reduce its abundance rapidly, then you may want to split the duties of the agents,” Lampert said. “If you want to control it, and keep it at a low level for prolonged periods, then working together becomes important.”

To reach this conclusion, Lampert developed a mathematical model based on game theory, which attempts to predict the behavior of players in a scenario. His model compares several scenarios on the assumption that each party will work in their own best interest.

Harmful Species Research, Adam Lampert, Figure 1

Two countries would like to treat a harmful species population in two hot spots. They may decide to divide things up, such that each country works only in its designated hot spot (A), or they may work together in both hotspots (B). To determine the best option, Lampert developed a mathematical model (C) that compares them.

Within the context of invasive species, this means the model considers the most likely action each country will take. Even when working cooperatively, each country will presumably act in ways that promote the most socially desirable outcome for its own citizens.

But that’s only part of the equation. Given the findings, if the goal of either controlling or eradicating determines the best approach, then a key question is when to focus on eradicating or merely controlling a harmful species outbreak.

Lampert identified three factors to determine if the species should be controlled or eradicated: the annual cost of maintaining the population, the natural growth rate of the harmful species, and its response to the treatment. In general, eradication is more likely when the cost of treatment does not depend on the density of the species.

For example, when treating an invasive insect outbreak, managers cannot target individual bugs. They spray pesticide over a large area as a general treatment method. If some insects survive the first round of spraying, the managers can spray the area again, but it would not be as cost-effective as the first time. In this situation, controlling the invasive species population at a low density is more likely than eradication.

A more targeted approach can be applied if the species can easily be seen. For example, complete eradication of a harmful plant species is plausible, because managers can physically remove each plant.

Given the ongoing spread of novel coronavirus, Lampert shared that we’re seeing a mix of blanketed and targeted control efforts.

“With diseases, you can put a lockdown on the entire country, or a region, and say, ‘OK, nobody goes out,’ and this way you reduce the infection level over time,” he said. “Or you can do some more targeted actions by identifying the people who are sick — and keeping them at home.”

Lampert’s research indicates that most effective control methods to reduce the spread of novel coronavirus require international cooperation. He said it is unlikely that we will be able to completely eradicate the virus, but controlling the spread is necessary for our social welfare and can be accomplished most effectively if countries work together.

Lampert is already working on additional research applying these findings to COVID-19, specifically. In the future, we can expect to see more intensive findings about the spread and control of invasive species, as the issue is not likely to disappear anytime soon.

“The impact of invasive species is a major problem in ecological systems,” Lampert said. “And it’s only becoming more and more prevalent because of globalization.”

Taylor Woods

Communications program coordinator, School of Human Evolution and Social Change