Thread. A lot of misconceptions exist re: "health care capacity" (HCC), what it means on both micro and macro levels. Let's break down how we actually define this and what the implications are for stretching this capacity in a pandemic setting 1/

HCC refers to the ability to maintain adequate medical care to patients without compromising either the quality of that care or unduly depleting important resources for ongoing/future care in the process. These are interrelated 2/

The optimal scenario is operating at the lowest possible capacity so that there is an abundance of resources are available in the event of any surge in medical care needs (like in a really bad flu season or a pandemic, for example) 3/

Reality is that the HCC operates with little margin & even at the best of times, it is more than 80% in most places, and in larger ICU settings, not uncommonly >90%. This is "managed" but does not mean it is safe or desirable 4/

How do we survive if we are constantly running at high HCC? We survive because we HAVE TO but this places enormous pressure on all HCWs to manage more with less. Not an ideal formula for patient care. 5/

What REALLY happens when you stretch or exceed HCC? We can always plan for "surge capacity" meaning we can go from 100-115% of conventional beds, other resources to deal with extraordinary situations like another pandemic wave 6/

But the added "resources" are not simply a top up that solves the crisis. ICU beds can be added outside of an ICU but this means patients cannot receive the same level of monitoring, care they truly need & deserve 7/

You can't build a "satellite ICU" overnight or deploy a new cohort of staff (optimally) trained to work if they are "pinch hitting" from other areas in the hospital. You want your best lineup at all times. Not possible you exceed capacity 8/

The net effect of exceeding HCC is "makeshift medicine" = burnout for medical staff & hallway corridor care. This is a recipe for trouble. Images of patients dying in hallways, stairwells in NYC haunt me. I never want to see that 9/

Finally, what about all the NON-Covid patients? Cancer, COPD, heart disease, etc. have gone nowhere. But once critical restructuring is done during a surge, surgeries are canceled, clinics limited. Patient care suffers despite our best efforts 10/

PLEASE Don't tempt fate. HCC collapsed in Italy, NYC. It's at risk in much of Europe, US. It can happen anywhere without a lot of warning. Take #Covid19 SERIOUSLY. We want our best lineup to care for EVERYONE. Alive in a bed. Not dead in a hallway 11/ END