SALT LAKE CITY — Utah health officials on Tuesday reported a state record in current COVID-19 hospitalizations, as well as 1,669 new cases and six deaths.

Under pressure as infection rates have continued to far surpass what the Beehive State saw during its summer surge, hospital leaders and state officials continue working to address shortages — not of beds, but of those who can care for the most critically ill patients.

“We’ve dealt with the space and the supplies, but now we’re getting to an understanding that really, one of the critical shortages and limiting factors is going to be available staffing,” said Kevin McCulley, preparedness manager with the Utah Department of Health Bureau of Emergency Medical Services.

Currently, 366 patients are hospitalized with the disease in Utah, which is 18 more than were hospitalized on Monday, according to the Utah Department of Health. Intensive care units were 73.7% full, and nonICUs were 48.1% full.

The new record comes after a month of climbing case counts. Just one month ago, 175 COVID-19 cases were in Utah’s hospitals.

ICUs in most of the state’s largest referral hospitals — University of Utah Hospital in Salt Lake City, nearby Intermountain Medical Center in Murray, and McKay-Dee Hospital in Ogden — were nearly full on Tuesday, said Greg Bell, Utah Hospital Association president. U. Health and Intermountain Medical Center have added contingency space, and providers have worked extra shifts.

But within the last two days, six patients have already been turned away from those hospitals and diverted to Steward Health or MountainStar Healthcare, Bell said.

About a third of Utah residents have SelectHealth insurance, which is part of Intermountain Healthcare. That means they get referred to Intermountain hospitals for treatment first.

“But when hospitals are overflowing, that’s not a consideration and they’re just transferred where they can get the best care,” Bell said.

While going to an out-of-network hospital for treatment would typically cost patients more, providers that have received federal pandemic relief funding have agreed not to charge patients amounts greater than what they would have been required to pay by an in-network provider, according to the Department of Health and Human Services.

Meanwhile, Dixie Regional Medical Center in St. George and Utah Valley Hospital in Provo still have some capacity, Bell said.

The state’s hospital systems combined have around 500 ICU beds, according to Bell. But 50 of them are in rural settings where providers don’t have the training or resources to care for the most serious COVID-19 patients, meaning the true intensive care capacity for those patients is 453 beds.

For now, Bell explained, “Rural (hospitals) have been told, ‘You need to hold your own as long as you can, but if there’s someone serious, call us and we will find space as long as we have beds.’”

Hospitals in neighboring states including Wyoming, Idaho, Nevada and Montana also often fly critical patients who require specialized care to the University of Utah Hospital and Intermountain Medical Center.

“When they hear that the University of Utah or (Intermountain Medical Center) are full — that’s their normal referral pattern — that makes them very nervous,” Bell said.

Addressing staff shortage

McCulley said his team is searching for nurses and other medical providers who could help if current hospital staffing becomes overstretched throughout the state.

“We recognize that there are no good solutions to this staffing shortage. There’s just not. We’re turning every stone over to see what we might be able to do,” McCulley said.

Officials are trying to identify potential workers in-state, including retirees, through the Division of Occupational and Professional Licensing, nursing schools, medical reserve corps and volunteer groups. The state is also looking for workers outside of Utah who could potentially help respond to the surge.

Officials are also considering requesting staffing through federal agencies, including the Department of Health and Human Services, the Department of Defense and the National Disaster Medical System.

“And the reason we’re doing so many different activities is there’s really no magic bullet for finding staff. It’s extremely difficult,” McCulley said.

The pandemic has created a unique challenge as emergencies like earthquakes tend to affect a relatively small geographic area, and health care workers can deploy there to help. But as other states are also battling their own disease surges, Utah faces competition trying to bring in additional resources.

“So it’s either we try and scrounge people up from within the state, of which there are few, or we look out of state. But then we’re competing on a national platform,” McCulley said.

Utah also has a young population, meaning there aren’t a large number of retirees who can step in, McCulley noted. But due to the COVID-19 disaster, the state has flexibility to bring in student nurses in a way that normally wouldn’t be allowed.

Early in the pandemic, state officials developed contingency plans for the potential that existing hospital resources get maxed out. One of those plans included contracts with three skilled nursing facilities in Ogden, Salt Lake City and St. George.

Those facilities are roughly 60% to 70% full with COVID-19 patients who remain ill but no longer need care in hospitals

“That’s really been a great safety valve,” Bell said.

But it won’t address the overflow issue for those who need more critical care.

The Mountain America Expo Center, available through a contract between the state and Salt Lake County, is also an overflow option. But who would staff it isn’t yet clear.

“Beds don’t treat people, people treat people. So we’re having a hard time staffing our full ICU bed complement because we’ve been doing this since the middle of March,” Bell said.

“We’re coming on eight months of these people around the clock, extra shifts, wearing big amounts of PPE and living in these ventilated suits for the medical workers. I mean it’s a burdensome, difficult thing, and it’s also emotionally draining to lose people and not have people attended by their families. They’re not only the caregivers but the emotional support.”

When asked if the expo center might actually be put to use, Bell said: “It depends on how broad our surge is and to what extent our hospitals get overwhelmed. Then the state is trying to recruit retired people, traveling nurses and doctors, supplemental personnel. And could you stand something up like that if you use every resource? I just don’t know.”

At the same time, Bell praised state officials “for how far-sighted they’ve been and how they really tried to prepare for every contingency.”

New cases

Tuesday’s 1,669 new cases were confirmed out of 7,834 tests, with a 21.3% positive rate. The rolling seven-day average for new cases is 1,726 per day, and the average positive test rate is 19.1%.

Now 119,375 coronavirus cases have been confirmed in Utah out of 1,105,427 people tested since the start of the pandemic — which means about 35% of the population has received at least one test, with nearly 4% of the population positive for the disease.

“The truth is, the more tests we administer, the faster we can loosen restrictions. By forgoing testing when you’re exposed or feeling symptoms, you may be unknowingly contributing to the spread of COVID in Utah. If you meet the requirements for testing, don’t delay,” Gov. Gary Herbert said Tuesday on Twitter.

About 90,000 are considered recovered after surviving the three-week point since their diagnoses.

Hospitalizations since the outbreak hit Utah total 5,665.

They latest deaths included two Salt Lake County men between ages 65 and 84, one of whom was hospitalized when he died; a Utah County woman between 45 and 64, who was a long-term care resident; a Sanpete County woman between 45 and 64, who was hospitalized; a Tooele County woman between 65 and 84, who was not hospitalized; and a Utah County man between 65 and 84 whose hospitalization status was unknown.

They bring the state’s toll due to the novel coronavirus to 620.