‘We cannot close.’ Washington hospitals edge closer to the brink as COVID cases surge
The stress of the latest COVID-19 surge is taking its toll not just at overflowing testing sites in places like Pierce County but also in Washington state hospitals.
Once again, non-emergency care is being postponed, with patients awaiting cancer surgery, heart valve replacements and other serious conditions, unable to be admitted for lack of beds.
“Unlike airlines who can cancel planes when staff call out sick or other industries that can scale back their operations, we cannot close,” said Cassie Sauer, CEO of the Washington State Hospital Association, during a Thursday briefing with reporters.
Officials acknowledged hospitals statewide were “closer than we’ve ever been” in hitting crisis standards of care, which can only be declared by the governor and Department of Health. The standard is the highest level of emergency, involving rationing care.
Hospitals can independently move to other staffing standards in terms of quarantine/isolation of ill workers.
DOH updated its guidance Jan. 1 with interim recommendations to mitigate staffing shortages, which is based on CDC’s guidance issued last week calling for shorter quarantine/isolation times for those asymptomatic after five days.
The DOH memo cites the three levels of mitigation operation: conventional, contingency capacity and crisis capacity. The protocols allow the hospital to deploy staff to other units as needed and to move patients to other parts of the hospital where beds are available during the current surge in cases.
In the DOH summary of CDC guidance, if a hospital hits crisis capacity standards (separate from crisis standards of care), the least amount of work restrictions are applied when it comes to quarantine/isolation of workers.
Rising case numbers
Pierce County remains at or near the top in case rates and hospitalizations in the state, according to state Department of Health data.
Washington state reported a record 11,325 new cases on Wednesday, while Pierce County has seen new cases soar beyond 6,000 since Dec. 26.
State Secretary of Health Dr. Umair Shah said Thursday at his department’s briefing that ”new cases are now somewhere in that 15,000 range.”
“It will get worse,” he added, “and things will be looking kind of bleak for a bit. But we do recognize that things are going to get better. We just have to continue to work together.”
Hospital officials told reporters on Thursday during WSHA’s briefing that the surge so far was worse in Western Washington compared with Eastern Washington, but predicted Eastern Washington was set to see similar levels of disease in a matter of weeks.
Sauer said as of Wednesday there were 1,387 patients hospitalized with COVID across the state, with 126 of those on ventilators.
“A month ago, the seven-day average for patients hospitalized with COVID was 664 and the most recent seven-day average was 1,248,” she said.
Staffing levels
June Altaras, registered nurse and chief quality, safety and nursing officer at MultiCare Health System, told reporters Thursday that the system hit crisis capacity staffing in its Puget Sound area hospitals on Monday.
The standard refers to how soon workers can return after illness, “so that we can appropriately bring back employees a bit sooner so we can continue to deliver the standard of care we expect for all of our patients,” she said Thursday.
“We’re running out of the operational internal levers we typically do to meet our community’s demand,” Altaras said.
She noted that more than 90 percent of the health system’s hospitalized COVID patients are unvaccinated.
“We had 25 percent of the COVID positive patients in the state within our Puget Sound regional hospitals and we are not 25 percent of the state footprint,” Altaras said.
St. Joseph Medical Center in Tacoma confirmed with The News Tribune it is operating under contingency internal emergency status, also activated this week, because of the overload of COVID cases and staff shortages with health care workers out sick.
“This is a direct result of the recent increase in COVID cases – the system is at or above the highest number of COVID patients hospitalized at any point in the pandemic, which significantly impacts our hospital capacity,” the system said in a statement issued Thursday.
“Most hospitals around the state have operated at contingency staffing at some point in the pandemic. We are hearing that many are currently in this position again,” said Beth Zborowski, media representative for the Washington State Hospital Association, in response to questions Wednesday.
Dr. Stephen Cook of Community Health Care, during Wednesday’s Tacoma-Pierce County Board of Health meeting, noted omicron’s doubling rate is eight days, “from 100 to greater than 200 patients,” compared with 28 days during the Delta surge.
Department of Health media representative Cory Portner, in response to questions, told The News Tribune DOH did not have numbers for how many hospitals were using either staffing option.
Other strategies to help hospitals include “DOH working to deploy contracted health care staff statewide to help augment staffing needs at hospitals,” he added.
“It’s important to note that this situation is largely preventable. The increase in COVID-19 hospital admissions is occurring almost exclusively among people who are not vaccinated,” Portner noted.
St. Joseph as of Wednesday had five patients who tested positive for COVID-19 after admittance under routine surveillance. No staff has tested positive related to that specific outbreak, according to the VMFH representative, of which St. Joseph is part of its network.
Anonymous tips sent to The News Tribune this week contend workers who are ill have been on shift at both MultiCare and VMFH hospitals as the systems struggle to maintain basic care levels amid the surge. Relatives of health care workers have taken to social media describing nine-plus hour waits in ERs and patients being treated outside or in halls for lack of beds.
Among workers testing positive for COVID, “Employees are able to return to work after five days, but only if they are asymptomatic. Those with symptoms would not be permitted to return to work,” VMFH told The News Tribune on Wednesday through a representative.
“Employees who have tested positive can only return to work after 5 days if they were asymptomatic throughout their infection and at least 5 days have passed since the date of their first positive viral test with a negative result, if mild to moderate symptoms have improved, it has been 5 days since symptoms first appeared, and at least 24 hours have passed since last fever without the use of fever-reducing medications,” the health system said in a follow-up statement Thursday.
“When a health care worker is permitted to return to work, they must wear an N95 continuously through day 10 after symptom onset or positive test date and practice physical distancing.”
“MultiCare’s return to work policy for staff who test positive for COVID-19 is based on CDC and DOH recommendations,” said Holly Harvey, media representative for MultiCare, in an email Wednesday evening. “Work restrictions and return-to-work time vary based upon factors such as symptoms, severity of illness and testing.”
Emergency rooms overrun and need to improve masks
Emergency rooms are faced with overflow from testing sites as people are showing up seeking tests, something officials have said shouldn’t be happening.
“There’s been a huge jump of people 25 to 49 years old coming into the emergency room looking for minor COVID care,” Sauer told reporters. “And as I mentioned before, there’s a federal law that requires us to screen and stabilize every patient who comes and is causing a huge backlog in our ERs. It’s jeopardizing care for people ... and it is totally burning out our staff.”
“We need people to avoid going to emergency departments unless they have a life threatening emergency,” Zborowski told The News Tribune on Wednesday. “We know COVID testing is very difficult to find, but the emergency departments need to be reserved for those with life threatening conditions.”
Cook, speaking at Wednesday’s Tacoma-Pierce County Board of Health meeting, suggested the health department add hospital capacity data to its weekly reports.
“My office is six blocks from each hospital and right here, everything looks very peaceful. But I think if every person who’s not taking things too seriously had to look at what the emergency room looks like, we might see some change in behavior.“
If the surge continues, Sauer didn’t mince words about what’s next:
“If this continues to worsen the worst option that we are facing is that we will have to deny care to people who need care. And that is terrible. That could lead to their disability or their death.”
The other officials said staff would continue to keep that from happening, but it depended on community transmission as to whether that would be possible.
“As a reminder, we’ll do everything we can not to ever have to enact (Crisis Standards of Care) in the state of Washington,” Shah said Thursday.
Officials recommended complete vaccination series including the booster and wearing as high-quality of mask as possible, and limiting gatherings and travel for now.
“I invite you to take your cute floral or Hello Kitty or favorite sports team cloth mask and put it right in the garbage or maybe hang on your wall as decoration,” Sauer said. “Or at the most what you could do with it is put it over a surgical mask as a second layer of protection. We really want people to be wearing surgical masks, KF94 or KN95 or N95 mask.”
This story was originally published January 6, 2022 at 11:32 AM.
