Lessons learned: COVID-19 numbers are up, but hospital is better equipped
STEAMBOAT SPRINGS — Across the UCHealth system, the mortality rate, length of hospital stay and need for ventilators for COVID-19 patients has decreased by about 50% from the spring, said Soniya Fidler, president of UCHealth Yampa Valley Medical Center in Steamboat Springs.
“We know how to better take care of COVID patients,” Fidler said.
As hospitalization rates skyrocket, health care professionals are putting into action many of the lessons learned over a relatively quiet summer.
From last spring to today, a lot has changed, according to Dr. Richard Zane, UCHealth chief innovation officer and professor and chair of emergency medicine at the University of Colorado School of Medicine.
“Both in our understanding and treatment of the disease,” he continued. “We are seeing far more patients with signs and symptoms of COVID-19 than in the spring — many, many more.”
From a proportionality perspective, Zane said there are fewer COVID-19 patients being admitted to the hospital, and of those, a smaller proportion are requiring ICU care and ventilators.
Those lower proportional rates can be attributed to a number of things, he said, and there remain unknowns as to the reasons.
Primarily, doctors are better at recognizing those who present the highest risk for severe disease, which continues to be older people and those with comorbidities.
Zane, who has been treating COVID patients throughout the pandemic, said the identifying predictors of patients who are going to do well and those who are not have become much clearer. That means looking closely at the patient’s history, age and comorbidities, as well as taking an assessment of things such as blood pressure and oxygen levels.
Based on those, doctors come up with a decision on whether it is safe for the patient to go home, Zane said.
And while the vast majority end up doing fine, Zane said COVID-19 is a serious disease, and there are people who get exceptionally ill. Not all those are people who are older or have comorbidities, Zane added.
“It can be a little capricious,” he explained. “This is not something you want. You ubiquitously want to avoid it.”
Zane described critically ill patients dying of COVID-19 is like drowning in Elmer’s glue.
“The lungs fill up with goop. You can’t get oxygen, and the body shuts down,” Zane said. “Organs fail. The kidneys and lungs fail. Every molecule shuts down. It’s a horrible way to die.”
While health care professionals now have nine months of data and experience under their belts, the current numbers are nonetheless disturbing.
The goal remains to avoid overwhelming health care resources.
“The situation has really escalated over the last couple days,” said Fidler. “We are at an all-time high across the system. Admissions far exceed discharges.”
Preparing for a pandemic is something hospitals always do. They have playbooks and drills, and in the spring, the Steamboat hospital took various steps as it prepared for the possibility capacity would be breached.
“We continue to refine the surge plans developed in the spring,” Fidler said.
The medical center in Steamboat has 39 beds. Of those, four are ICU beds, 20 are medical/surgical beds and 15 are in the birth center, including the special care nursery.
But Fidler emphasized the significance of the hospital being part of the larger UCHealth system.
“We can’t stress enough that being part of a large system with 11 other hospitals and almost 2,000 inpatient beds brings tremendous benefits to YVMC and our community,” said UCHealth Communications Specialist Lindsey Reznicek. “When needed, we can more easily transfer patients to other UCHealth hospitals, use experts from other locations to help care for our patients here and get resources moved here when needed.”
There are more than 10 ventilators at YVMC, “with the ability to support multiple patients on applicable ventilators,” according to Reznicek.
Additional ventilators were brought in over the summer, she said, but an exact number is not always provided because UCHealth can bring more as needed.
Asked exactly how many people are hospitalized at YVMC at this moment, Fidler pointed to the county’s data dashboard, which lists three people in the most recent week of data. That doesn’t mean those patients are still in the hospital, and a week’s average was a better way of reporting to maintain confidentiality in a small community, Fidler said.
That also does not mean there aren’t people with COVID-19 from Routt County who are hospitalized elsewhere.
Patients may be — and have been — taken elsewhere based on what type of care is needed, Fidler noted.
As of Wednesday, there were 360 people hospitalized with COVID-19 across the UCHealth system, Fidler said.
On Monday morning, there were 298.
“It’s a big uptick just in a few days,” she said, and a rate of increase they haven’t seen before during this pandemic.
According to the Colorado Department of Public Health and Environment, as of Monday, 9% of hospital facilities across the state were anticipating a shortage of ICU beds within the next week. Hospitals reported 84% of ICU beds in use over a seven-day average, with 44% of critical care ventilators in use.
In terms of staffing, numbers at YVMC are being more impacted now by employees who either have the virus or are quarantining because they had contact with an infected person, said Eli Nykamp, director of operations at YVMC and the hospital’s COVID-19 incident commander.
At this point, they are still able to fill all their shifts “with other staffing support mechanisms,” he said.
Personal protective equipment supply levels remain strong, Nykamp said. And if needed, the local hospital is able to access UCHealth system’s inventory.
On Saturday, Colorado Gov. Jared Polis ordered the State Emergency Operations Center to Level 1 — the highest level, which brings together federal and state agencies, as well as relevant volunteer organizations.
Polis signed an executive order requiring every hospital to produce a plan to increase bed capacity by at least 50%, along with the necessary staffing and equipment. The order also plans for an interhospital transfer system across the entire state.
The order also calls for hospitals to scale back on elective procedures if they are unable to sufficiently increase their capacity.
Hospitals are required to report their ICU and other staffed beds to the state twice per day.
YVMC has not yet hit the capacity needed to reschedule elective procedures, as took place in the spring. Fidler noted that most elective surgeries are actually surgeries that are needed, with many being pain related.
And she asks people in the community not to postpone their care. That happened in the spring, she said, and “the severity of illnesses that occurred because of that decision were very impactful.”
“We are open and ready” for all medical needs, Nykamp stressed, and the hospital continues to take a number of additional measures to keep it safe for patient care.
The Routt County Incident Management Team was approved for activation this week by the Routt County Board of Commissioners.
The team, according to Routt County Emergency Operations Director David “Mo” DeMorat, is comprised of county and municipal government representatives from numerous departments and special district representatives and is focused on the following priorities: COVID-19 testing; contact tracing; isolation and quarantine direction; medical surge and patient movement; public health order protocol; first responder and healthcare sustainability; vulnerable populations; and immunizations.
Regular team meetings resumed Monday.
DeMorat said the Routt County Office of Emergency Management also expects to activate the Emergency Operations Center.
In the spring, the Routt County Office of Emergency Management explored several options for housing an overflow of either COVID-19 or non-COVID patients.
Nykamp said the state has now taken more initiative on that front, with several state-run overflow centers and a statewide system for identifying available beds within hospitals.
One of the biggest lessons learned from the beginning, Zane emphasized again and again, is that physical distancing, masking and hand washing works.
The spread of the virus is simply a mathematical equation.
“The only way to combat this is with masking, social distancing and washing hands,” Zane said. “It’s not that it will help a little. It will be defining in how we tackle this pandemic.”
Science has never moved faster, Zane said, with a vaccine likely available to frontline workers within weeks. More therapeutics, including the antibody therapy, are showing promise and becoming more available, he said.
UCHealth is now providing free meals to all hospital staff and health care providers, Fidler said. They continue to focus on taking care of staff, including related to mental health care. She stresses self-care for everyone.
In the larger community, “We are seeing the impacts of the pandemic on mental health and its pretty significant.”
In terms of how the community can best support health care workers at this time, “What the staff really asks for is people follow the five commitments,” Fidler said. “That way they can stay safe and continue to provide care. And we can hopefully reduce the spread and lower the added stress on our system because of it.”
To reach Kari Dequine Harden, call 970-871-4205, email kharden@SteamboatPilot.com or follow her on Twitter @kariharden.
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Editor’s note: This story discusses the sensitive topics of domestic violence and abuse.