By Lynne Terry, Oregon Capital Chronicle
The leader of Oregon’s hospital association warned on Thursday that a steady increase in Covid patients needing hospital care is pushing the state’s hospitals to a “breaking point.”
Becky Hultberg, president and CEO of the Oregon Association of Hospitals and Health Systems, said during an online news conference that hospitals are treating dozens of new coronavirus patients a day. On Thursday, they soared past 1,050, according to state data.
Hospitalizations are expected to peak in the next 10 days.
“The next few weeks will be really tough, and it’s important for people to understand that,” Hultberg said.
She said that many hospitals are limiting non-urgent procedures to ensure they have enough available beds.
“Hospitals are managing elective surgeries on a day-to-day basis,” Hultberg said.
The latest forecast by Peter Graven, an assistant professor at Oregon Health & Science University, predicted that about 1,550 people with Covid will need a hospital bed by Feb. 1 – about 100 fewer than he had anticipated.
That’s about 350 more than in early September when hospitalizations during the delta surge peaked and some hospitals ran out of beds.
The situation this time is different, Hultberg acknowledged. The omicron variant appears to cause less severe symptoms, so the need for critical care services is not as great, she said.
The Oregon Health Authority has contracted with temporary staffing agencies to provide hundreds of extra personnel to hospitals, skilled nursing homes and long-term care facilities. Gov. Kate Brown also ordered 1,200 National Guard members deployed to hospitals to provide transport, cleaning, dietary and other services to free up clinical staff to treat patients.
Hultberg thanked the state for the moves, which she said were “very helpful.”
More than 750 temporary workers have been deployed to health care facilities, according to Erica Heartquist, an Oregon Health Authority spokeswoman. But those are divided among a range of facilities, from behavioral health care and long-term care to rehabilitation facilities and hospitals.
Hospitals alone have requested nearly 1,370 clinicians, Heartquist wrote in an email. One staffing agency created a relief pool of 200 workers for daily emergencies, and they’re now mostly in the field.
“New requests are drawing on that pool almost as fast as clinicians can be assigned,” the state agency said in a statement. “So for a standby pool of clinicians ready to be deployed in just 24 hours, the number in the pool is 0 to 50 at any given time.”
Care could be affected
Hultberg declined to say whether she thought hospitals might have to activate crisis standards of care, guidelines that health care professionals use to ration care when they run out of space or supplies.
“Things could get really tough,” Hultberg said. “Whether that means that hospitals have to evoke crisis standards of care remains to be seen.”
What could happen, Hultberg indicated, is that hospitals may have to scale down care in the face of shortages. She didn’t elaborate.
“We are obviously in an environment where care may look different than it did before the pandemic because of staffing shortages or other things,” Hultberg said. “That doesn’t necessarily trigger crisis standards of care.”
Those standards are for critical care services only. The current surge of omicron cases is more likely to affect the supply of regular beds, Hultberg said.
Hultberg said hospitals in every region are under pressure, compared with the delta surge which affected southern and central Oregon facilities the most. Oregon Health Authority data show that beds are available at hospitals in every region of the state. According to its release on Thursday, 7% of the state’s adult intensive care beds are available and 6% of regular adult beds are free.
Graven’s forecast showed that as of Tuesday 25% of patients in Oregon intensive care units had Covid.
Though the numbers fluctuate, Hultberg said Oregon hospitals have more patients than usual. Before the pandemic 60% to 70% of their beds were typically free.
Patients remain stuck in beds
One of the biggest problems, she said, was that hundreds of patients continue to be stuck in a hospital bed despite being ready for discharge. The number of people “boarding” in an emergency room while awaiting hospital admission or discharge to a mental health facility, for example, have varied throughout the pandemic. State data show there are now more than 250 in this situation, more than double during the peak in delta cases this summer.
Nearly 590 patients are awaiting discharge to a skilled nursing facility, long-term care center or elsewhere. That number has been as high as 610 this month.
The contracted temporary workers are supposed to help long-term care facilities, which, like hospitals, have faced staffing shortages along with outbreaks that require staff or residents to quarantine.
Health care facilities also face shortages of supplies, including blood and treatments. There is only one monoclonal antibody that works against omicron and it’s in short supply.
The health authority said clinics that serve low-income patients, tribal facilities and hospitals in areas hard hit by Covid that can administer an intravenous medication have top priority to get the antibody. Those who face the highest risk of severe disease, including unvaccinated people, are first in line, the health authority said.
“People who are at high risk for severe Covid-19, and, for whatever reason, have not been immunized are typically at much higher risk of severe illness or death,” Rudy Owens, a spokesman for the health authority, said in a statement. “They need protection based on their risk, just like you or me.”
The health authority is also allocating supplies of Paxlovid, an antiviral drug against Covid-19 that needs to be taken soon after infection.
“As supplies increase, we are planning ahead to make sure these medicines are more broadly available to the elderly and others at increased risk of severe Covid-19,” Owens’ statement said.
Hultberg encouraged the public to wear masks, maintain social distance and get vaccinated to protect themselves and others from needing to be treated or hospitalized.
She offered no short-term fixes to stem the pressures now on hospitals but she said Oregon needs to examine its systems.
“Over the long term, we’re going to have to look at the care continuum,” Hultberg said.
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