Hospitals face COVID surge

Wednesday, December 9, 2020

Deaths climbing as colder weather sets in

As COVID-19 cases across the country are on the rise, area hospitals are hoping to get ahead of the curve to deal with the surge in local cases, especially in rural areas.

CoxHealth and Mercy, the leading healthcare providers in southwest Missouri, are each taking steps to manage an increase in cases and hospitalizations.

In the coming weeks, the CoxHealth system will add 33 beds to its fifth floor COVID-19 ICU unit at Cox South. Including this expansion, the health system will have added more than 180 beds to its hospitals since the COVID-19 pandemic began.

“We have said from the beginning that we would rather build spaces and not need them than need them and not have them,” said Steve Edwards, president and CEO of CoxHealth. “Our great hope is that we never need this expansion to care for COVID-19 patients, but it will have been worth it to us to have it ready if we do.

“From a patient’s perspective, these are not as comfortable because it is an open unit with less privacy, but it does give us the ability to give more direct and timely care.”

Work on the approximately $1 million project, which will transform remaining shell space on the fifth floor into a medical unit, is expected to be completed by the end of December. It will start after construction is complete on another new unit in the hospital, which will potentially also be used initially for COVID-19 patients.

CoxHealth has applied for additional staffing resources through the state, is bringing in traveling health professionals, and is aggressively hiring to help staff the new areas.

The Center for Disease Control (CDC) recommends as cold weather moves in, people spend more time indoors. As the holidays approach, take steps to slow the spread of COVID-19. Wear a mask, stay at least six feet apart, avoid crowds, and wash your hands often. The more steps people take, the more protected they are against COVID-19.

Edwards said the uptick in cases and hospitalizations is having a large effect on all facilities in the state and surrounding states. The COVID unit built in March, with 51 beds, sat empty for months but is now continually full, and Edwards said about 70 percent of admissions are from rural areas outside of Greene County.

Edwards said although the overall fatality rate of patients ventilators has dropped from about 80 percent in March to about 35 percent now, the sheer number of new patients is drastically driving up the number of deaths.

“In the first nine months of the pandemic, we had about 180 deaths,” he said. “In the past two months, we have had about 60. We expect total deaths in the U.S. and locally to double in December and January compared to March through November.

“We’ve treated over 2,000 patients, and about 70 percent of them are rural. While the majority of our additions are here in Springfield, we are doing it for you guys [in rural counties] too.”

Edwards said the COVID unit additions help centralize resources and knowledge, as staff who have been working in that unit can use the experience with COVID to their advantage in providing the best care possible.

A growing strain on capacity is also leading to related issues in the healthcare system.

“A crisis in the midwest is that there is nowhere for critical patients [with other health issues] to go for care,” he said. “All the hospitals we refer to are seeing a surge in bed needs at the same time, especially in Kansas City and St. Louis.

“[On Monday], we had 140 COVID patients, and that’s down from 169 last week. Beds alone don’t determine capacity, as we have to have the staff for them. At any given time, we have about 150 staff out due to quarantines, mostly from community exposures.”

Edwards said demand is also filtering into emergency rooms, and there have been multiple times Cox has not had a bed available upon arrival.

“There have been many times we could not immediately take a patient, and they have to sit until there is capacity,” he said. “A patient at those times may be sitting in the ER up to a day waiting on a bed, and we, along with Mercy, are on diversion about half the time now and cannot take new patients.”

Edwards said almost every respiratory illness ramps up when colder weather sets in, and the Cox system is also still bracing for the after-effect of Thanksgiving get-togethers.

“About 17 days [after an exposure] is when patients usually begin to show up, sometimes sooner,” he said.

Edwards said going forward, people should take great caution when going to events, especially indoors and with large crowds.

Beyond the addition of beds, Cox is also implementing a couple other new strategies. Beginning today, urgent care facilities in Monett, Springfield, Lebanon, Branson and Ozark will offer rapid testing with a turnaround time of 20-30 minutes. The antigen tests are about 95 percent accurate compared to the 99 percent accuracy of a PCR test, which identifies the virus-specific genetic material.

“The rapid tests are not recommended for use unless there is a high volume of symptomatic patients,” Edwards said. “But, it is quicker than the 24- to 36-hour turnaround for the PCR test.”

On Friday, Cox also began a home-patient program, which aims to allow non-infectious patients to return home earlier and receive care, like oxygen and twice-per-day virtual checkups.

“This helps to get some people home sooner to recover, as well as build more capacity within the hospitals,” Edwards said. “But, we are being more careful about sending rural patients home early and how that may affect the community hospitals.”

Edwards said another area outside the hospital system that is struggling are county health departments, many of which are overwhelmed, especially with keeping track of close contacts.

“Health departments are struggling because different areas have unequal resources and staffing, so it’s easy for them to become overwhelmed,” he said. “We could write a book about how this pandemic has shown the structure of public healthcare has failed. We are set up for acute care, but not for public health. The fractured approach we have works very well, except for during a pandemic.

“The people working at health departments are heroes, and they are not getting the recognition they deserve. Our job would be much, much harder without them.”

Mercy is also aiming to manage the uptick in cases, as it is tapping into its Mercy Virtual expertise to care for select COVID-19 patients at home.

Mercy COVID Care @ Home will offer remote, in-home care for patients with mild symptoms who may need low-flow rates of oxygen, offering virtual home monitoring in real time. This 24-hour care will include measurement of oxygen saturation by pulse oximetry, adjusting oxygen flow as necessary, along with additional evaluations and appropriate interventions.

“We have learned that not all patients who were admitted at the onset of COVID-19 need to be hospitalized,” said Dr. Carter Fenton, medical director of Mercy Virtual vAcute. “By caring for select patients at home, with ongoing monitoring and management, we can reserve the hospital beds for those with more serious disease symptoms.”

If the status of any patient changes during monitoring or symptoms worsen, patients will be evaluated by the Mercy Virtual team and directed to the most appropriate level of care. An emergency medicine physician will help determine the type of care the patient needs – from an in-home visit, evaluation in one of the outpatient clinic offerings or the hospital setting. 

“Providing the opportunity for care in different settings is extremely important - for both the patients as well as our medical teams,” Fenton said. “The challenging part for patients is determining their needs and our Mercy Virtual providers will help them through that process.”

Much more is understood about COVID-19 since the beginning of the pandemic, from new therapies to best practices, and health systems across the country are learning from each other. Mercy worked with Northwell Health, New York’s largest health care provider, to gain insight from its experience of setting up a similar program during the first surge in the spring. Northwell Health was able to provide care with equal or better outcomes in an at-home setting. 

Mercy Virtual’s care team has been caring for chronically ill patients since 2015 with the goal of keeping patients comfortable at home and out of the hospital.

“We’re able to take our five years of experience in providing virtual, in-home care and translate it into caring for COVID-19 patients,” said Dr. Gavin Helton, Mercy Virtual president. “We hope by caring for certain COVID-19 patients in their homes, it will make them more comfortable and still connected to care, while lightening the load on hospital caregivers and in-patient resources.”

As of Dec. 2, Barry County had seen 1,956 total cases of COVID-19, with 128 active cases. Eight of those were hospitalized at that time.

There have been 31 deaths in the county, all of whom were age 41 or older. Of the deaths, 16 have been residents of congregate care facilities, and 15 lived independently in their homes. A total of 27 suffered from underlying health conditions. Gender-wise, 19 males and 12 females have died.

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