Emergency rooms across the state and nation are bracing for an influx of coronavirus cases, but with limited capacity and supplies, concerns are being raised that they will not be to handle a surge of sick people.

The virus could result in 10 million to 34 million hospital visits nationwide, according to the Harvard Global Health Institute, based on statistics from other infected countries. Roughly one-fifth of those patients will require intensive care units with ventilators and other equipment needed to treat respiratory infections, the group said.

With an estimated 2.8 hospital beds per 1,000 people in U.S., the country has fewer than the 3.2 beds per 1,000 in Italy, where an explosion of cases has overwhelmed hospitals.

Massachusetts hospitals only have about 4,000 available beds at any given time.

Experts have suggested that hospitals will be forced to extreme measures to accommodate a surge of patients, such as renting space in nearby facilities or setting up makeshift hospital rooms.

Steve Walsh, president of the Massachusetts Health and Hospitals Association, which represents the state's hospitals, said the best way to prevent the hospital system from being overloaded is to curb the spread of the virus by social distancing and other preventative measures, and protecting health care workers who will be treating the sick.

"The only way to manage capacity is to flatten the rate of infection," Walsh said Friday during a teleconference with health experts. "That will be the only shot we have."

Gov. Charlie Baker echoed those sentiments Friday, when he announced a new round of measures under his state emergency declaration to prevent spread of the virus, including banning public gatherings of more than 250 people.

Baker said the best way to deal with the capacity issue in the state's hospitals is to "flatten the curve."

"Right now, the data indicates the number of people infected and requiring medical attention is very much within the health care system's capacity to serve and handle," Baker told reporters. "If everyone does their part in slowing the spread down, the number of people who become infected and require medical attention doesn't spike at once."

Lacking protection

In Massachusetts the number of people with the virus, which causes a disease called COVID-19, stood at 108 statewide Friday. That included two cases in Essex County. There were a half-dozen in New Hampshire, and more than 1,200 nationally.

On Wednesday, the World Health Organization designated the new coronavirus outbreak, which began in Wuhan, China, a pandemic.

Another issue facing hospitals and front-line health care workers in the state is a lack of protective equipment.

The federal government maintains stockpiles of masks, full-body suits and other emergency supplies that hospitals can tap into when patient volume substantially increases.

But Donna Kelly-Williams, president of the Massachusetts Nurses Association, said the "personal protective equipment" is in short supply in the state's hospitals.

She said the state's hospitals need to set up triage centers to screen patients as the arrive, and set up designated areas within their facility to specifically treat the infected.

She said hospitals also need tests to show definitively who is infected.

"We desperately need point-of-care testing that hasn't been available," she said. "We need to be able to identify patients quickly when they come and to protect the people who are going to be taking care of those who get infected."

Walsh said hospitals are going to run out of protective equipment "in the very near future" if supplies aren't made available by the federal government.

"It is vital," he said. "We do not want to stop seeing patients because we can't protect our workforce."

Marylou Sudders, the state's Health and Human Services Secretary, said the state on Thursday received its first "partial" shipment of protective equipment from the Strategic National Stockpile, including masks, gowns, eye protection and gloves.

She said the equipment is being deployed quickly to hospitals around the state.

More needed

Sen. Ed Markey, who huddled with health care officials in Boston on Friday to discuss the state's response to the virus, said the federal government needs to be doing more.

"Our hospitals need more resources in order to protect our nurses and doctors so they can do their job," he told reporters in a briefing.

The federal stockpile also includes ventilators, which could become crucial in fighting the severe respiratory infections that can be caused by the new coronavirus.

Dr. Paul Biddinger, the emergency preparedness chief at Massachusetts General Hospital, said shortages of beds and supplies is a major concern.

"Every hospital in the commonwealth has been trying to source material from anywhere they can," he said. "Almost never are we able to get the quantity we would like."

Walsh said hospitals have been forced to get creative to stretch out dwindling supplies. They're relying on technology to minimize the need for doctors and nurses to be in close proximity to infected patients, such as giving them tablets to communicate with medical staff.

"Everybody needs to get as innovative as possible about ways that we can provide optimal patient care but preserve this equipment," he said.

Taking precautions

In addition to preparing for a possible surge of patients, health care centers have activated emergency operations and taken numerous preventative steps to try to prevent transmission of the illness, from quarantining doctors and nurses who have had contact with infected patients to limiting the number of visitors to facilities.

Lawrence General, for example, is screening visitors and restricting access to its main campus in response to the COVID-19 outbreak.

"Hospital entrances are staffed by security and clinical staff to screen each person entering the hospital," the hospital said in a statement Thursday. "No one will be permitted to visit a patient if they have signs or symptoms including fever, cough, sore throat, runny nose, shortness of breath, fatigue, chills, vomiting or diarrhea."

Walsh said there are likely to be additional disruptions at hospitals. He noted that Baker's emergency declaration eases state regulations to allow doctors to treat patients outside of a hospital setting in order to prevent spread to others seeking medical attention, use telemedicine to screen and check on patients and hire more caregivers.

Massachusetts hospitals have been prepping for a viral pandemic a since the Ebola outbreak of 2014, but rapid spread of COVID-19 has caught many off guard.

"We are facing one of the most cataclysmic public health crises in our history," Dr. George Daley, dean of the Harvard Medical School, said in a briefing Friday. "This crisis we have to meet on the frontlines of health care, but there has to be a longer term response. We have to learn the lessons from this crisis so we can be prepared the next time."

Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group’s newspapers and websites. Email him at cwade@cnhi.com

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