We are At or Near Capacity

RMC

November 9, 2021, as published in the Valley Courier 

SAN LUIS VALLEY -- “We have seen all ages, even babies born with COVID. We had to transfer out a five-year-old child who is sick with COVID yesterday. One of our longer ICU patients was in his fifties.”

Those are the words of Donna Wehe, director of communications for San Luis Valley Health when asked about the impact of the unprecedented number of Covid related hospitalizations on the valley’s largest medical center.

The age range of people with infections – from babies to those who are middle-aged and older – is jarring, but that is just part of the story. The larger, more concerning story relates to the number of people who are requiring hospitalization.

“The last time we saw this many hospitalized COVID-positive patients was in May,” says Wehe. “But the past few weeks have exceeded those numbers. The state hospital bed capacity is at 90% and ICU beds are full. We are at or near capacity most days. There are delays in transferring patients who need a higher level of care, and it’s creating challenges with our ability to care for patients.”

This record number of hospitalizations has been going on, unabated, for three straight weeks. How that looks on a local, operational level is a sobering picture.

Dr. Hernandez, Chief Medical Officer, says, “This is unprecedented to be so full across the whole state for so long.  We had to move patients around yesterday so we could admit a COVID positive patient into an ICU room who had been waiting for longer than 40 hours in our Emergency Department.”

In general, SLV Regional Medical Center Emergency Department currently sees between forty and fifty patients on a daily basis. In the Conejos County Hospital Emergency Department, they see between ten to fifteen patients daily. Wehe says that is an increase of roughly 40 percent – almost half again as much -- over patients seen last year.

Between Labor/Delivery, ICU, and Medical/Surgical, San Luis Valley Health averages about 30-35 patients in the Regional Medical Center hospital daily. Approximately 25 percent of those have been COVID-positive patients and, among those patients, 82% have been unvaccinated – in other words, eight out of ten.

Unfortunately, a high percentage are in critical condition and require a much more intense level of medical care and treatment, including 1:1 care, more medication, more nursing assistance, treatments from respiratory therapy, and other monitoring devices.

Also, due to the highly transmissible nature of the virus, a COVID-positive patient requires that rigorous infection control precautions be taken, including, when possible, putting them in a private room.

Consequently, on an hour-by-hour, day-by-day basis, this requires staff to take extra Personal Protective Equipment precautions – which can include changing caps, gowns, gloves, and other PPE to prevent cross-contamination. That significantly limits movement from room to room.

In the past, when confronted with such intensive care requirements of critically ill patients, rural hospitals like those in the valley have had the option of transferring the sickest patients to larger regional hospitals with a greater capacity to provide the level of care critically ill patients require.

But the statewide nature of the crisis has impacted that, as well. On Wednesday, health systems and individual hospitals decided to move straight from Level 1 operation in the Combined Hospital Transfer Center to Level 3 – the highest level in the system which results in a critical patient being transferred anywhere in the state. That does not mean that patients will be refused treatment. It does mean, however, that patients can be moved to hospitals with more room, even if that move is not convenient or wanted by the patient.  

The decision to move to Level 3 has not been made at any time in the pandemic prior to now, and it may signal that the entire health system statewide is at risk of being overwhelmed.

“We have transferred to hospitals we have never sent patients to, such as in Kansas,” says Dr. Hernandez. “And we’ve accepted patients from Pagosa and Trinidad, which we’ve never done before either.”

Moving to Level 3 will involve added coordination between the system of care and individual hospitals,” says SLV Health CEO Konnie Martin in a statement to the Courier. “This may include asks of smaller facilities to patient ‘swap’ -- such as ICU for a med/surg patient -- when applicable. The most important message is that Colorado hospitals are under tremendous stress, and the burden is unlikely to lessen in the coming days.”

Martin went on to state that Level 3 will increase the frequency of communication and coordination across all hospitals, but some hospital operations are being impacted. Currently, across the state, cosmetic surgeries are on pause and elective surgeries are under consideration. “Crisis Standards of Care have also been reauthorized in Colorado – they are not activated, but that may occur soon, as well,” Martin says.

Crisis Standards of Care may involve decisions such as determining which patient gets an ICU bed, requiring nurses – already exhausted – to work longer shifts, or potentially calling in the National Guard to assist.

 “SLV Health prioritizes patient safety and quality of care,” Martin said. “Due to the current situation of limited available hospital beds across the region and at the Regional Medical Center in Alamosa, the surgery teams have chosen to postpone or reschedule some non-life-threatening surgeries where the patient may require to be hospitalized or transferred during their recovery.  Safe and quality care are the top priority at SLV Health.”

Although the situation is decidedly very serious with no signs of letting up, it is important to emphasize that there are ways individuals can lessen the intensely stressful situation Colorado hospitals are experiencing.  

One may involve the use of monoclonal antibodies. In his press conference, Governor Polis stated, “We are learning that monoclonal antibodies play an important role in preventing COVID-19 hospitalizations Colorado is working hard to increase access to monoclonal treatment across the state, with 161 providers already enrolled to provide this treatment.” 

And monoclonal treatment is currently available at SLVRMC but only on a very limited basis. “We’ve been offering the treatment in our Respiratory Clinic on a case-by-case basis,” says Wehe, “but, due to low supplies and limited facility space, we are not able to offer more.”

Nonetheless, vaccination has been – and continues to be -- the safest, most widely used, most extensively tested, most effective, and most easily accessible way to reduce the risk of COVID and, if infected, the likelihood of becoming severely ill and requiring hospitalization or worse.

 “We encourage our whole community to help decrease the transmission of the virus,” says Wehe. “What can you do to help? Our hospitals in Colorado are overwhelmed. Please stay home if you are sick. Get your flu vaccine or COVID vaccine/booster, and practice good hygiene.”