Wednesday, November 25, 2020
Doctor Says The Funnel is Getting Clogged as Hospital Capacity Erodes
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A study out this week showed that Kansas counties that complied with the governor’s order to wear masks in public places saw cases flatline. Counties that opted out saw a surge in infection rates.
   
Thursday, October 29, 2020
 

STORY AND PHOTO BY KAREN BOSSICK

COVID GRAPHS BY PAUL RIES

Things got so bad last week that St. Luke’s began taking steps to turn its cardiac observation unit into a COVID intensive care unit with its ICU units running at 130 percent of their usual volume. The hospital was able to hold off at the eleventh hour “but we believe it’s just a matter of time,” said Dr. Jim Souza, St. Luke’s chief medical officer.

It’s gotten so bad that even some emergency surgeries may have to wait, said Dr. Steven Nemerson, chief clinical officer at Saint Alphonsus. And doctors could decide who gets intensive care and who doesn’t.

 
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Blaine County looked as if things were going better but it's experiencing another uptick.
 

“We’re not in crisis conditions yet, but we are very close,” Nemerson told reporters at a virtual press conference on Tuesday.

Hospital capacity is eroding rapidly as the state records what health officials call “gigantic increases” in COVID cases. Both St. Luke’s and Saint Alphonsus are projecting a doubling of COVID patients in the next three to four weeks.

“Which means needless suffering, needless deaths, needless utilization of our resources—all of which can be avoided,” Souza said.

Souza said rural counties are counting on hospitals in urban centers to take care of them.

 
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Idaho's new cases of coronavirus have landed it in the top five states nationwide.
 

“We’re all connected and our larger facilities are the next line of defense. But within our hospitals, capacity is eroding and the funnel is getting clogged,” he said. “We’re nowhere near herd immunity. We’re so far from that and Blaine County tells that story. It had one of the highest rates in the nation early this year but it remains vulnerable with a case rate up to 30 per 100,000 people again.”

Doctors worry that COVID has a grip on Idaho, and with good reason.

Idaho has the fifth worst case ratio right now among all the states with 350 cases per 100,000, according to data compiled this week by the New York Times.

It has the second highest positivity rate of all the states after Montana, according to the latest White House COVID Task Force Report, which was obtained through the Freedom of Information Act.

Lincoln County reported its first COVID-19 deaths on Tuesday—that of a man in his 30s and the other of a man in his 50s. The state recorded 14 new deaths on Wednesday alone for 599 deaths attributed to COVID, although doctors suspect there have been more.

The state posted 862 new cases on Wednesday for 61,785 all told. Blaine County has notched 22 new cases since Sunday.

“Extremely scary,” said Dr. David Peterman, CEO of Primary Health Medical Group. “Extremely frightening and very worrisome. That, in my mind, means we’re on fire. Fortunately, Idaho is down there at 38th for deaths per 100,000 people.”

HOSPITALS PREP FOR THE WORST

Dr. Joshua Kern, vice president of Medical Affairs for St. Luke’s Magic Valley and Wood River, said that St. Luke’s Magic Valley had 51 COVID patients on Monday, after 55 the day before. With 124 patients in the hospital for other reasons, the COVID patients make up 29 percent of the cases. The COVID unit is 97 percent full; the rest of the hospital, 92 percent full.

One man said health care workers told him that his brother, who is fighting COVID in Twin Falls, could be sent to a hospital 600 miles away in Washington.

Dr. Jim Souza said St. Luke’s Boise was also nearly full after being in the 75 percent range a week ago.

“As the community faces a surge, we can see what’s coming. And recall that COVID patients are only one part of the story. We’re seeing a 25 to 30 percent increase in strokes and heart attacks year over year, some perhaps due to COVID. And it’s not just a matter of beds. Today we have 108 employees out with COVID.”

The majority of those cases were acquired in the community, Souza added.

Souza said St. Luke’s Health System is not just standing by and waiting for the boom to lower. It hired 500 nurses since March and is looking to hire traveling nurses. But, while we can turn our hospitals progressively into COVID units, it comes at a heavy price, he added, noting how other hospital procedures must necessarily be postponed.

The hospital system will progressively reduce other care, if need be, to progressively handle more COVID patients, he added.

Nemerson said his hospital is also close to crisis and within a couple weeks of resorting to postponing procedures to make space for COVID patients. The hospital can’t divert patients out of state because hospitals in other states can’t handle their own patients.

“I don’t want people to panic, but I want them to understand we may have to make very difficult decisions,” he said.

Peterman said Primary Health also is dealing with shortages.

Primary Health staff have tested more than 50,000 people without catching catch COVID because of the precautions taken. But each day between 20 to 30 of Primary Health’s 600-plus employees are out, either quarantining because they had close contact with someone in the community with the virus or because they’ve been infected with the virus out in the community.

“We’ve had to close two urgent care clinics because we don’t have enough staff. If we can’t see patients—and not just COVID patients but patients with other conditions like asthma—those patients go to the emergency room. And that’s very challenging,” he said.

Souza said hospital workers have a closing, small window of opportunity to prevent getting to the point where hospitals would have to ration care.

“If we have to execute crisis standards, that’s a demonstration of the failure of the community and our leaders to step in and turn this situation around,” added Nemerson.

DOCTORS AND NURSES FATIGUED

Dealing with COVID is taking its toll on health care workers, Souza said.

“These are critically ill patients. They’re very sick, they can’t move. So, the physical burden is high. The psychological burden is high, as well, as staff need to limit visitation. We’re fatigued at watching a disease play out that’s high preventable. We’re fatigued living in a world at work where they use good practices all the time versus the public world where these things are often not on display.

“We do not need to shut down large segments of our community. But when you’re with other people who are not members of your family, put a covering on your face and watch your space.”

SECOND GUESSING THE GOV?

The doctors were reluctant to second guess Idaho Gov. Brad Little’s decision this week not to impose a statewide mask mandate, noting how easily their opinions could get politicized.

The governor’s order rolling the state back to stage three, limiting indoor gatherings to 50 and outdoor gatherings to 25 percent of capacity, was a step in the right direction, Souza said.

“I heard the governor say pretty clearly that the entities within the state that have the authority to act and issue mask mandates need to do that,” he added. “Health officials have raised the red flag of alarm to certain leaders about how our capacity for care is eroding. I’m pleased state leader listened. Now, we’re looking to local health districts to also listen.”

“As doctors we don’t know everything,” added Peterman. “But we know in this case that, if you wear a mask and if I wear a mask, we can stop the spread of this virus. And if you wear a mask and I wear a mask, we’re both protected.”

On Tuesday, the day after the governor rolled Idaho back to Stage 3 protocols, a group of Idaho lawmakers, including Lt. Gov. McGeachin, appeared in an Idaho Freedom Foundation video in which they questioned the existence of the pandemic and said they would ignore emergency orders that they said violated their rights.

It came just as Dr. Ashish Jha dean of Brown University School of Public Health, warned that the United States could soon see more than 100,000 new cases of the virus daily.

The doctors noted that they’ve been “up to their ankles” trying to convince lawmakers that COVID is not a hoax. They’ve also spent countless hours talking to school districts and writing letters suggesting health districts act in the name of safety and require masks.

Souza said he would like to see health care professionals used more to convey to state leaders, business leaders and the public the stories of families who have lost loved ones and others who have lost their health long-term because of COVID.

We should be putting our communications efforts on steroids,” he said. “We need to counter the false information that’s out there. We need to target young people in particular. If we can change the thinking there, we can change the pandemic.”

POSITIVITY RATE AMONG STUDENTS TRENDING UP

Peterman said elementary school children have historically shown a lower positivity rate. But the positivity rate among children has gone up to 16 percent from a range of 2.9 percent to 6.8 percent  since school started.

The positivity rate among students between the ages of 12 and 18 has gone up to 28 percent from a range of 4.1 to 14.0 percent.

“What the data says is that schools reflect the community. Students need to be distanced, masked. They need to wash their hands and we need contact tracing to follow up,” he said.

Idaho Gov. Brad Little has moved the State of Idaho back to a modified Stage 3 Stay Healthy Order this week. Under the new Stage 3:  

  • Indoor gatherings are limited to 50 people or less. 
  • Outdoor gatherings are limited to 25-percent capacity. 
  • Physical distancing requirements are in place for gatherings of all types. 
  • Long-term care facilities will not be allowed to operate without requiring masks on their premises.  
  • There will be seating only at bars, restaurants, and nightclubs. Nightclubs can only operate as bars. 
  • Employers should continue to protect at-risk employees by allowing telework or by making special accommodations for these individuals in the workplace. 
  • All individuals and businesses should follow recommended protocols for minimizing transmission of the virus available at Rebound.Idaho.Gov. https://rebound.idaho.gov/stages-of-reopening/

Visit https://coronavirus.idaho.gov/ for more information.

 

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