Multiple regions in the U.S. are reporting that hospitals are filled to capacity with COVID patients. (Dec. 1)
Hospitals from West Texas to the upper Midwest are facing dire shortages of beds for critically ill coronavirus patients as the post-holiday surge shows no sign of relenting, new data shows.
About 1 in 8 U.S. hospitals had little or no intensive care unit space available last week. And experts say the number of hospitals struggling to accommodate the nation’s sickest patients likely will increase following another week of record COVID-19 cases.
The federal government this week released a sweeping database showing a one-week average number of COVID-19 patients in hospitals nationwide. It’s the first time the U.S. Department of Health and Human Services provided such detailed information on nearly 5,000 U.S. hospitals since the pandemic began.
The absence of hospital-level information has been a blind spot in the pandemic, as administrators must increasingly call neighboring hospitals to transfer patients when they run out of beds and available staff.
“We know what’s happening in our system, but I don’t know what’s happening in the other systems,” said Dr. Lewis Kaplan, professor of surgery at University of Pennsylvania Hospital in Philadelphia. “To have a coordinated effort you need to have that kind of data so everyone knows where everyone else happens to be.”
The HHS data release is important, said Dr. Thomas Tsai, a surgeon and assistant professor of health policy at Harvard University, as it’ll help hospitals in capacity planning by showing which neighboring hospitals are strained and by how much. Hospitals run by the U.S. Department of Veterans Affairs, Defense Health Agency and Indian Health Service are not included in the HHS data release.
Hospitals across the country are at or nearing limits on capacity. In rural towns like Ashland, Alabama, to the small city of Watertown, South Dakota, to small metro areas like Amarillo, Texas, ICUs are at or above capacity, according to the HHS data. All of those places have seen surges of COVID-19 in the last two weeks, with more than 100 deaths per 100,000 in each of their counties.
With nearly 1.5 million Americans testing positive over the past week and a new daily record of more than 3,000 deaths on Wednesday, hospitals are unlikely to see the pace slow soon.
“The picture that’s emerging is pretty stark,” Tsai said.
Rural hospitals from upper Midwest states, such as North Dakota and South Dakota, to Texas have called facilities in multiple states to find beds for critically ill patients. These smaller rural hospitals quickly run out of space, staffing or expertise when coronavirus patients need cutting-edge care.
In Amarillo, Texas, BSA Health System routinely gets calls from smaller hospitals seeking to transfer patients from the Texas Panhandle, New Mexico, Oklahoma, Colorado and Kansas. The Amarillo hospital expanded its ICU to 91 beds, up from 48 beds, but still lacks space at times, said Dr. Michael Lamanteer, BSA’s chief medical officer.
“There’s no question there have been times throughout the fall and early winter where we’ve not been able to accept patients from of our regional partners because our volumes have been so excessive,” Lamanteer said. “That bothers us greatly.”
Amarillo has been a coronavirus hotspot since this spring, when outbreaks at area meatpacking plants sent case counts higher. More recently, holiday gatherings in the summer and fall have spurred case surges in the Texas Panhandle and neighboring states.
Hospitals are getting ready for another wave of patients following the record number of weekly cases in the two weeks following Thanksgiving. The HHS data shows about 88% of ICU beds in Potter County, which includes Amarillo, were full as of a week ago.
Lamanteer and his counterpart at Northwest Texas, another Amarillo hospital, have discussed plans with city leaders to add even more ICU beds. The hospitals expect a post-Thanksgiving surge and cases after December holiday gatherings. The hospitals also will need extra bed space and staff for patients with flu and other respiratory viruses.
“The breaking point for the community would be if (ICU patients) exceed the number of beds we can handle,” Lamanteer said.
‘It’s wearing on them’
Small and mid-sized West Texas cities often serve vast, rural communities without access to advanced care, said Angela Clendenin, an epidemiologist at Texas A&M University School of Public Health.
Cities such as Lubbock, where hospital ICU units were 90% full last week, draw patients from a smaller rural towns that “aren’t equipped to handled the most severe COVID patients,” Clendenin said.
“Living in a rural community is a double-edged sword,” she said. “You might be in a less populated area where transmission is less, but if you get COVID and it becomes a severe case, you’re less apt to have close, high-level acute care.”
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Covenant Health operates hospitals in Lubbock and two nearby communities, Plainview and Levelland.
The Lubbock hospital’s ICU unit has been consistently full for nearly two months, and the hospital is committed to treating all COVID patients instead of transferring some to other hospitals, CEO Walt Cathey said.
The hospital has diverted non-COVID cases, including pneumonia and heart-failure patients, to other hospitals. Covenant opened a 25-bed unit for adults at its children’s hospital – the first time the dormant unit has been activated in 12 years.
Cathey worries his dedicated nurses, doctors and respiratory therapists are fatigued.
Before COVID-19, the vast majority of people who needed to be place on a ventilator could be weaned from the breathing devices successfully and discharged from the hospital, he said.
With COVID, too many patients never make it out of the hospital despite the medical staff’s best efforts.
“It’s wearing on them, you see it on their face,” Cathey said of his workers.
Despite therapeutic advances such as steroids, antibody treatments and the antiviral drug remdesivir, Cathey said medical providers still don’t have enough tools to fight the disease. And the lack of knowledge on why the virus is deadly to some and has little effect on others is frustrating nurses and doctors.
“It’s very alarming rounding in the hospital and talking to these caregivers and seeing a little bit of the depression that is going through the health system because we’re not winning this battle in a lot of different ways,” Cathey said.
Staffing limits ICU capacity
Hospitals say the biggest challenge over the coming weeks will be finding enough nurses, doctors, respiratory therapists and other health workers.
Nurses and doctors flocked to New York City hospitals this spring to aid overwhelmed hospitals, but those health workers are now needed closer to home.
“We can make more beds. We have more devices, but we don’t necessarily have more staff,” said Kaplan, president of the Society of Critical Care Medicine.
COVID-19 is sidelining far more health care workers, who can be exposed to the virus on the job or in their communities, than in the early weeks of the pandemic. Even if they are not sick, workers exposed to the virus often wait days for test results.
In recent weeks, positive cases and exposures have quarantined up to 150 staff members at BSA Health System, including 70 nurses at once, said Lamanteer.
Fewer nurses and other providers were quarantined this week, but Lamanteer said the toll on staff underscores the importance of vaccinating health-care workers as quickly as possible. The hospital expects to begin immunizing high-priority employees on Tuesday, once the the first vaccine is authorized by the Food and Drug Administration.
Staffing is especially critical for ICU units, which require more workers to treat patients who need round-the-clock care.
In a general hospital unit, one nurse can take care of four or five patients at once, Cathey said. That ratio lessens to one nurse for every three patients on a COVID floor. If the COVID patient needs ICU care, the ratio is one nurse for every patient, or in some cases, two patients, Cathey said.
The Lubbock hospital evaluates every non-emergency surgery to preserve staff and space for COVID patients. If such elective surgeries can be postponed, they are rescheduled.
“Staffing is the biggest challenge we face,” Cathey said. “Resources are much more stressed.”
Ken Alltucker is on Twitter as @kalltucker or can be emailed at [email protected]
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