Most Cox COVID patients from rural areas

Wednesday, November 18, 2020

CoxHealth managing care at multiple facilities

Officials at CoxHealth are managing higher and higher numbers of COVID-19 hospitalizations, most of whom are people that live in rural areas.

Steven Edwards, president and CEO of CoxHealth, said the Cox system is setting a new record every week for patients fighting COVID. As of Monday, Cox had 130-142 patients.

“About 20 of those patients are non-isolation patients, meaning they have been there long enough they are no longer infectious, but they still need care,” Edwards said. “About 100-115 patients are at Cox South [in Springfield], another 15-20 are at Cox in Branson, and about 5 are at Cox Monett.”

Edwards said about 25 percent of patients are coming from Greene County, but the other 75 percent are patients transported in from more rural areas.

“The rate of increase right now is worrisome,” Edwards said. “The number of patients we have on ventilators and in the ICU is higher than it has ever been. We are on a trajectory to be overwhelmed. It’s important we stress that masks are effective at slowing the spread.”

Edwards also discussed how CoxHealth facilities may at times go into a “forced open” policy when beds are full, meaning they will not take transfers from rural hospitals.

“Big cities can’t always come to the rescue for rural areas,” he said. “That’s why it’s important to slow the spread, especially with the upcoming holidays.”

Since the beginning of the pandemic in March, Edwards said Cox has added 147 beds, including a 51-bed ICU built in a two-week period. That unit was available in April and sat unoccupied for about five months. As of Monday, it was full. One side of the ICU has more stable and alert patients, while the other side, about 75 percent of the patients, are on ventilators.

Overall capacity system-wide is a fluid figure, as it depends on multiple factors like available beds or staffing.

“We keep creating new levels of contingency plans,” Edwards said.

“We have to be more and more creative with our spaces, like the ER’s negative-pressure pods and the observation unit’s negative-pressure pods. We are constantly reconfiguring beds and staff.”

Edwards said Cox is hoping to get more traveling nurses, and it does have about 20 coming each week for the next few weeks, and many in training currently will become available for full-time work in January.

Just like any other workplace, the CoxHealth system is also not immune to quarantines. Edwards said at any given time, about 200-250 of the 12,000-strong workforce are in quarantine.

“One thing that is helpful is we are in full PPE, so exposures in our units are low,” he said. “About 90 percent of our exposures happen out in the community, and only 10 percent come from inside the hospitals. The quarantines go across all employee sectors, and we have not suffered any critical shortages. That said, if 300 nurses became available to us, we would take them all.”

Edwards said Cox is proud to say it has not had a single COVID case transmitted to someone else in the ICU unit, which he credits to use of PPE and employees’ extra caution.

“Their personal behavior in the community is different because they are around this virus every day and see what it’s doing to people,” he said.

Edwards said while Cox is proud of its employees, it is also considering the long-term mental effects of the pandemic.

“There will no doubt be doctors and nurses who suffer PTSD from this,” he said. “At one point, we lost eight patients in one night. I know of nurses that remember losing a couple in a week, and this was eight in a night. This is happening all over the country, so it’s not specific to us. We have counseling and support services available.

“We think the PTSD is not as prominent yet because our staff is still running on adrenaline, but the long-term effects will likely be there.”

Edwards said CoxHealth is also starting to prepare for possible vaccine distribution by expanding ultra cold storage capacity.

CoxHealth serves a 25-county region of southwest Missouri, totaling about 1 million residents.

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