SALT LAKE CITY — The day after Utah reached its record number of current COVID-19 hospitalizations, health care officials warned that the state’s hospital systems are under increasing stress as cases continue to surge.
“We are in a very precarious situation,” Dr. Russell Vinik, University of Utah Health chief medical operations officer, told the Deseret News on Monday.
“I think that we can say that we are pretty close to 100% of capacity and it’s varying from day to day.”
Although teens and young adults contributed to the spike soon after school resumed for the fall, all other age groups are now seeing their cases surge. The average hospitalized COVID-19 patient continues to be in the 45 to 64 age group. About 2⁄3 of patients require treatment in a nonintensive care setting, while the other third require more intensive care, Vinik said.
That’s why it’s important for teens and young adults to recognize that although the disease severity might not be significant for most of them, they are largely driving high rates of transmission in older age groups leading to increased hospitalizations, said Dr. Brandon Webb, Intermountain Healthcare infectious diseases physician.
“And in terms of prevention, it’s really now needing to shift to a major push among our community members to mask up and to social distance, among those groups that we tend to be more familiar with that we tend to let our guard down, because that’s actually where we’re seeing a lot of this transmission,” Webb said.
On Sunday, Utah reported 254 current hospitalizations — the highest number since the Utah Department of Health began releasing current hospitalizations in addition to cumulative hospitalizations in May. The state hit its summer high number of hospitalizations on July 24, with 225. On Wednesday, hospitalizations in Utah began climbing back above 225 again.
Like U. Health, Intermountain Healthcare is “seeing exactly what the state’s seeing. We’re seeing an unprecedented volume of hospitalizations and our COVID units are filling up, and we’re monitoring that really carefully because we’re getting close to filling up,” Webb said.
To respond to demand, Webb said clinical care teams at Intermountain are developing “creative ways” to take care of patients and discharge them as quickly as it is safe, while also continuing to take care of those with other medical conditions.
“And the combination of that plus this dramatic increase in our community transmission is filling our hospitals to capacity,” Webb said.
University of Utah Health has continued “being careful” about scheduling elective procedures and delaying those that can wait. “And unfortunately we’re also having to assess transfers that we get from out of state and trying to see if some of those can potentially go to other states,” Vinik said.
Earlier in the pandemic, hospital systems used what’s known as “load balancing” to respond to demand by transferring patients between hospitals. That worked then because high infection rates were focused in specific hot spot areas, Webb said.
“What we’re seeing now is that across the board and across the state our hospitals are full taking care of the breadth of health conditions that people need hospital care for,” he said.
Contingency plans
Early in the pandemic, the Utah Division of Emergency Management set up a makeshift hospital in the Mountain America Expo Center in Sandy through a contract with Salt Lake County. That contract expired in June, and the hospital was dismantled.
But the state is permitted to keep semitrailers filled with supplies on site should the need for the facility arise, said Joe Dougherty, spokesman with the Division of Emergency Management.
Although the expo center was originally touted as a place to potentially treat non-COVID-19 patients during a surge, officials ultimately decided it could be used as a COVID-19 facility if needed.
Dougherty said the makeshift hospital could be set up again in less than a day — but only as a last resort.
Before that happens, however, hospitals will need to do load-leveling within their own systems. If they can’t, the state’s separate hospital systems will work together to transfer patients between them.
“Those are really important conversations that are happening,” Dougherty said.
Utah also has contracts with three long-term care skilled nursing facilities, which could be used as a “pressure relief valve” for treating coronavirus patients. Those facilities are in Weber, Salt Lake and Washington counties, according to Dougherty.
In deciding when to use the nursing facilities or makeshift hospital, Dougherty said officials are looking at overall use of intensive care units instead of simply the number of COVID-19 patients in hospitals.
“We know that if more people with COVID are requiring ICU care, then that takes away from total ICU beds available for people who have other illnesses or accidents,” Dougherty said.
On Monday, the state’s some 600 intensive care beds were 64.2% full — a manageable number, Dougherty said. But if they get over 75% full, “that is very concerning statewide,” he said.
“So far hospital systems are managing by themselves, but with the numbers that we’re seeing, this is not sustainable, and it’s not going to take much to push that over the edge to where we are using what (state epidemiologist Dr. Angela Dunn) called crisis standards of care,” Dougherty said. “We just cannot get to that point because then people are dying unnecessarily.”
‘An emotional and physical toll’
While hospital bed capacity is easier to evaluate, those who can treat patients with the most serious illnesses represent a more important measure, Webb said.
“Not all hospitals are able to take care of patients who have advanced care needs who require the advanced care that needs to take place in the ICU,” Webb said.
“From a personnel standpoint, our nurses and our front-line physicians and other staff have been doing this for months now, and they’re getting exhausted.”
Burnout due to the pandemic is one of the biggest challenges they face, he said.
“These caregivers are passionate about delivering top-quality care, but this is bleeding into all facets of their life. We have nursing staff and physicians who go home and they’re dealing with online school, and they’re dealing with family members who test positive, and they’re dealing with being on quarantines themselves due to exposures,” Webb noted.
And while providers are developing better ways to treat COVID-19 patients once they’re in the hospital, there’s still a lack of treatment options for those with coronavirus before they get there, he said.
“And that’s a major point where we need to come together as a community and start doing better and physical distancing and wearing masks,” even among family members and friends, he said.
Hospital officials are concerned that if the system becomes more overwhelmed, doctors, nurses and other specialists will face additional strain.
“We want to care for everybody and ultimately, we’re a long way from the point where we would just not be able to take care of people. But what we will do — and probably very soon, if this continues — is have to stretch our staff. Doctors and nurses and respiratory therapists are taking care of more people than what they normally would,” Vinik said.
For example, anesthesiologists might need to take care of more critically ill patients. “And that’s doable, but it also means that we won’t be providing the same level of care that we normally do,” Vinik said.
To date, Utah’s death rate due to the disease has remained among the lowest in the nation, at 0.6%, as patients have been able to receive the care they need.
“But if this continues we will be stressed and I don’t know if outcomes will stay as good as they have been,” Vinik said.
Because of the death rate, some may not be taking the disease seriously, he noted. But the low death rate “shouldn’t be a reason for us to be less cautious, because a lot of COVID transmission is preventable if we did the things that we know we should do. And that’s frustrating to us as providers. If we’re having to give care beyond our capability when so much of this could be prevented.”
New cases
Utah confirmed 988 new COVID-19 cases out of 4,360 tests, with a 22.7% positive rate, according to the Utah Department of Health. The rolling seven-day average for new cases is now 1,145 per day, and the average positive test rate is 13.9%.
Currently, 249 patients are hospitalized with COVID-19 in Utah, five fewer than were hospitalized on Sunday.
Five deaths were also reported Monday: two Washington County men and a Davis County man between 65 and 84, and a Salt Lake County woman older than 85. Those four were all long-term care residents. A Garfield County woman between the ages of 45 and 64 also died while hospitalized.
They bring the state’s number of people who have died with the coronavirus to 522.
Now 86,832 cases have been confirmed of 922,931 people tested since the beginning of the pandemic in Utah, a 9.4% positive rate. Hospitalizations in the state since the outbreak began now total 4,331.
Just under 64,000 of Utah’s cases are considered recovered after surviving the three-week point since their diagnoses, meaning about 22,300 cases remain active.