(CNN) — As the US reached bleak milestones in the coronavirus outbreak health officials say the American healthcare system may not be prepared for what comes next if residents don’t heed warnings to limit their interactions.
On Tuesday, West Virginia became the 50th state to report a case and coronavirus deaths nationwide rose to more than 100.
“The bottom line is things will get much worse,” Dr. James Phillips, an assistant professor at George Washington University Hospital, told CNN Tuesday night. “We need to focus on keeping people on the front lines in the fight so we can continue to provide care to the patients. In the long run, this is about patients and keeping people from getting sick and dying.”
The past two days have seen dramatic jumps in the number of cases. At least 6,135 people have been infected with the virus in the US and 111 have died.
“We’re at a significant risk of overwhelming the number of beds we have,” Phillips said.
To keep that from happening, guidance from city, state and federal leaders echoes the same bottom line: stay home.
At least 37 states have ordered school shutdowns, while governors across multiple states, including New York, New Jersey, Ohio and Louisiana have directed restaurants and bars to transition solely to takeout services.
In Ohio, one bar was padlocked and barricaded after it was found to be violating the governor’s order Sunday and Monday, the Cincinnati Police Department said.
“Not only are you putting the general public at risk, you’re putting our officers at risk that had to go in and deal with the individuals that were in violation,” Patrol Bureau Commander Paul Neudigate said in a statement.
States including Michigan and New Mexico have limited public gatherings to fewer than 50 people, while Oregon put the cap at 25.
In guidance issued earlier this week, the federal government said Americans should avoid groups of more than 10 people.
In California’s Bay Area, nearly 8 million people have been ordered to shelter in place.
“The time for half measures is over,” San Jose Mayor Sam Liccardo said. “History will not forgive us for waiting an hour more.”
The Bay Area shelter in place mandate allows health services, grocery stores, gas stations, banks and food delivery services to remain open. Mass transit is also available but is to be used only for travel to and from essential services.
“We know these measures will significantly disrupt people’s day to day lives, but they are absolutely necessary,” San Francisco Mayor London Breed said in a statement.
With the measures, leaders hope to slow the spread of the virus and prevent the country’s healthcare system from becoming overwhelmed.
As it is, there aren’t enough hospital beds, medical staff or equipment to handle the spike in cases that could come, healthcare professionals say.
“It’s not at all clear to me that hospitals are prepared for what’s about to happen,” CNN’s Chief Medical Correspondent Dr. Sanjay Gupta said Tuesday night. “What needs to happen in this country is we need to break the cycle of transmission and it doesn’t look like that’s happening right now.”
Each community will likely experience healthcare hurdles differently, says Dr. Eric Toner, who studies hospital preparedness at the Johns Hopkins Center for Health Security. But they will all be impacted in some way and should have been preparing, he says.
“We’re two months too late in starting to do this,” he said. “I really think this is a fundamental responsibility of government to have acted on this a long time ago.”
Ventilator manufacturer Hamilton Medical Inc. said it has received hundreds of orders and requests within the past few weeks.
“It is more than we can currently provide,” Kathrin Elsner, team leader of MarCom Ventilators at Hamilton Medical, said.
Michael Dowling, the president and CEO of the Northwell Health, who was picked by New York Gov. Andrew Cuomo to lead a hospital surge team, said he wants to purchase as many as 500 ventilators, which can cost as much as $20,000 to $40,000 a machine.
“When we’re called to deal with a unique crisis we jump at the opportunity to do the best we can,” Dowling said. “This is what we do. This is our obligation and what we do.”
Meanwhile, smaller, rural hospitals across the US — which often have 25 beds or fewer and one ventilator — may be forced to transfer patients to larger facilities if they see a surge in cases.
“Who’s at risk? Elderly, low-income, people with high health needs. That is rural America,” said Alan Morgan, MPA chief executive officer of the National Rural Health Association. “You have a high proportion of low income, elderly people with high health needs so if you were to have a cluster in a rural community it would turn bad quickly.”
What may come even sooner is a shortage in staff, says Dr. David Hill, a pulmonary critical care physician and a spokesperson for the American Lung Association.
“Part of it is just exhausting our personnel,” Hill said. “Healthcare is complicated and people make mistakes when they’re overworked.”
In rural America, workforce shortages are a common thread nationwide, says Morgan.
“You’ve got a shortage of primary care, certainly a shortage of specialty care. You have a small clinical staff so you can’t afford mistakes,” Morgan said.
In communities big and small across the nation, health and public officials say the only way to curb the spread is by taking warnings seriously — but they fear that may not be happening.
On Tuesday, New York City Mayor Bill de Blasio urged New Yorkers to prepare for an order to shelter in place.
“The idea of shelter in place has to be considered now, it has to be done between, in our case, the city and state working together,” he told MSNBC Tuesday night.
Cuomo has dismissed that possibility that New York would resort to such a drastic move, but de Blasio said that although the state is handling the crisis “very, very well,” it was “decision time for more aggressive steps.”
The state has reported 1,653 cases of the virus and 15 deaths.
The first shelter in place order came from San Francisco’s mayor earlier this week. That order said that “all travel, including but not limited to walking, biking, driving, or taking public transit is prohibited” unless necessary.
“Individuals may go on a walk, get exercise, or take a pet outside to go to the bathroom, as long as at least six feet of social distancing is maintained. People riding on public transit must maintain at least six feet of social distancing from other passengers,” it said.
How well the outbreak is contained over the next few weeks — or months — will largely be determined by how closely residents follow government directives, officials have said.
“I still really get the impression people in many places aren’t taking this seriously,” Gupta said Tuesday night. “And I think that’s a problem.”
“The thing that we keep hearing over and over again, this inflection point, trying to decrease the number of cases and make sure they don’t turn into a situation like they’ve seen in Italy, is people have to social distance. They’re not doing it.”
Italy has been the hardest-hit country in Europe, with at least 2,158 deaths from the virus.
Earlier this week, US Surgeon General Dr. Jerome Adams said the US had reached a “critical inflection point,” when it hit as many cases as Italy had two weeks ago.
“We have a choice to make — do we want to really lean into social distancing and mitigation strategies and flatten the curve or do we just want to keep going on with business as usual and end up being Italy?” Adams sad.