Cox nearing COVID record

Tuesday, July 27, 2021

163 patients total in system, 5 at Cox Monett

The CoxHealth Hospital system is aiming to grow its COVID-19 care capacity, as it is reaching a record level of in-patients as the Delta variant of the virus rages through southwest Missouri.

Steve Edwards, president and CEO of CoxHealth, said as of Thursday, the system housed 163 patients with COVID, five of whom are at Cox Monett Hospital.

“We are approaching a record number,” he said. “At one point in January, I think we had about 170, but we finished that day with about 159. We have had 26 deaths [July 14-21], and 526 total patients lost at Cox, [as of July 22]. We do not think the Delta wave has peaked. We are anticipating having about 180 patients by next week and 230 by August.”

Edwards reported 15 more patients died from Friday through Sunday, and Mercy in Springfield reported 10 deaths in the same time period. In all of July, 72 people have died at Cox facilities.

“We have more than 180 traveling nurses, and we’re shooting for more than 300 traveling nurses, respiratory therapists and hospitalists to allow for more capacity in our system,” Edwards said. “The routine ratio is about 2.5-3 patients per nurse, and we are closer to 1.5 per nurse, plus the respiratory therapist, hospitalist [and other contributing specialists]. At one point recently, we had two patients coding simultaneously, and one of our physicians noted there were 15 employees working on those two patients.”

Edwards said he hopes CoxHealth does not reach the 230-patient projection, but previous projections with the Delta variant have turned out to be low compared to the eventual reality.

“Acuity is ramping up,” he said. “Early on, it was about an average of 17 days onset before going on a vent, and now, that’s about 10 days.”

Geographically, Edwards said the system has a consistent trend of about 66-75 percent of patients residing outside of Greene County.

“Right now, 57 of our 163 patients are from Greene County,” he said. “Taney and Christian counties are the next-highest, and the rest are from other counties in southwest Missouri, some are from Oklahoma and Arkansas, and we also get some people vacationing.”

When it comes to those vaccinated and those not, Edwards said there remains a clear line.

“We’re seeing a few breakthrough infections, where a person fully vaccinated tests positive, and we’ve had four patients fully vaccinated that have been hospitalized with COVID-19 pneumonia,” he said. “Some others have been asymptomatic but tested positive when coming in for unrelated procedures, like an appendectomy. Overall, 99 percent of our COVID-19 pneumonia patients are unvaccinated, and the 1 percent that are have immunocompromising issues.

“The vaccine is not 100 percent, but it is effective. We have had 526 deaths, and every one of them has been unvaccinated.”

Which vaccine is most effective is not something Cox has been able to sort, Edwards said, but the Delta variant has hit harder.

“We use Pfizer, and the Pfizer and Moderna are close to identical at 78 percent effective against the Delta variant of COVID and about 94-95 percent effective against severe symptoms due to any form of COVID.”

Edwards said going forward, Cox is working to expand care and offer more options.

“We are continuing to work with the state, which has given waivers for respiratory therapists from other states to work here without Missouri licenses,” he said. “We are also again working with Vizient to coordinate with our travelers and be reimbursed, as traveling RNs are a hot commodity and the price to get them is going up.

“We are also working on a alternate care site, which we requested but not accepted. We do not see this as a negative, as it is a complicated process. This will help with a couple things. Some patients no longer require hospitalization but still require care and are taking space away from a more acute patient. Also, as the homeless become more vulnerable, we are hoping to have a resource for their care.”

Another project Cox is working toward is with Jordan Valley Community Health Center, aimed at providing monoclonal antibody infusions for newly infected individuals, which may help head off the need for intensive care. Edwards said about 15 patients at a time can be supported.

CoxHealth and southwest Missouri have been spotlighted in national news recently for the Delta variant outbreak, and Edwards said he has been fully open about what is happening in Cox’s system.

“When the original wave went through the east and west coasts, that gave us time to prepare,” he said. “This time, the outbreak is going from the inside out, so we feel it is our duty to share what we learn and help others understand this is coming, and it comes much more rapidly. We had 14 patients in mid-May and have 163 today, so this has about five times the growth as the first wave. Our vaccination rates are similar to the south and other areas of the midwest — it’s coming your way.”

Edwards said the capacity issues have affected emergency room wait times, and triage has been more difficult.

“Many of our ER patients actually do not require emergency care and could go to urgent care, use telemedicine or see a regular doctor,” Edwards said. “Many are patients with underlying issues that they have sat on and worsened. We encourage everyone to be diligent and use urgent care and other options when available.”

Edwards received attention recently for a tweet he sent, telling those spreading falsehoods about the vaccine to “shut up.” He said he will continue to be outspoken about what is happening during the pandemic.

“I believe we have to tell the truth, even when it’s ugly,” he said. “I am focused on taking care of our employees, and when politicians and others do not stand behind us, it undermines our work. I liken it to when a soldier returns from war and someone spits in that soldier’s eye. That’s how our nurses feel. They have been running into battle and are frustrated because many of these deaths are avoidable with the vaccine.”

Edwards said some of his nurses and physicians have shared stories of regret in the ICU, as well.

“They say the level of remorse is high,” he said. “One physician told me about a man about his age who had a 16-year-old son there, and when they pulled the man off life support, everyone broke down because that 16-year-old was losing his father. It was an opportunity missed with the vaccine.”

Edwards said going forward, he hopes people steer away from the politicization of the virus and focus on the advice of healthcare professionals and research.

“There is a state representative, whose main work is owning a car wash, who has differing opinions on masking and the vaccine. If I was to get cancer, I would not take my medical advice from a politician who owns a car wash. I would go to an oncologist.”

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