HCA Healthcare: The Latest Covid-19 Wave Worries Hospitals With New Treatments

By Melanie Evans and Elizabeth Findell

Advances in Covid-19 treatment have reduced hospital stays and reduced the burden of capacity. However, doctors and medical disaster specialists say that the benefits are not sufficient to accommodate the sustained increase in hospitalization, especially in remote areas of countries where hospitals are small and medical professionals are scarce.

Nationally, the spring surge in hospitalizations due to Covid-19 peaked in mid-April, followed by a second wave in late July. The latest rise began in late September, with data from the Covid Tracking Project showing that numbers have jumped 60% from their monthly lows. The number of people admitted to Covid-19 in the United States and its territory reached 46,095 on Thursday.

Treatment of the illness remains limited, and too many long-term patients can overwhelm the available doctors and nurses, overwhelming the emergency department and intensive care units, they say.

These risks are greater than they are now, as malaise due to restrictions on public life complicates efforts to stop transmission. The virus has also reached sparsely populated areas of the United States, where many hospitals are small and far away. Consistent with the recent surge, the country has entered the flu season. And it usually fills the hospital bed every year.

“This is just a game of numbers,” said Utah intensivist Dixie Harris, who calculated for himself how long beds would be available in a hospital in Salt Lake City.

Dr. Harris saw the overwhelming impact of the hospital first hand when he volunteered in New York in April. “You don’t want to be in the ICU without adequate nursing,” she said. “Without good care, it will be difficult to survive.”

Increasing hospitalizations are annoying, but they do not fully reflect the risks to hospitals and patients from the latest waves, medical personnel and disaster response experts said.

“Some things aren’t clear just by looking at country numbers,” said Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security. He said the latest waves are spreading over a wider geographic area.

According to Dr. Toner, areas infected with Covid-19 in the spring were concentrated in several places, mainly in New York. Patients are now flowing into hospitals in many states, so fewer unaffected areas, such as temporary nurses and doctors, can send help.

Hospitals in New York and New Jersey account for nearly half (45%) of hospitalizations in the United States and the region, according to data from the Covid Tracking Project. The second wave is concentrated in California, Florida, and Texas, with 49% of hospitalizations occurring during peak hours in late July. Today, about the same percentage is spread across nine states: Texas, California, Illinois, Florida, Georgia, Indiana, Ohio, Wisconsin, and Tennessee.

“If everyone is in pain at the same time, it’s much more difficult,” said Jonathan Green, a preparation and response official within the US Department of Health and Human Services. “We have a limited number of resources.”

Mr Green oversees some health care workers who are stationed to provide federal relief in the event of a disaster. During the pandemic, he said, many such personnel had already been dispatched multiple times to assist in the Covid-19 emergency.

Incidents are also skyrocketing across rural areas of the country. According to Green, the total number of Covid-19 inpatients is small, but the number of remote hospitals is also small. If there is no other hospital nearby, more external assistance is needed.

Beatus Billings Clinic CEO Kelly Evans said in Red Lodge, Montana, local 10-bed hospitals often exceed capacity and are commonly used by patients who require temporary observation. He said he had an overflowing patient in his bed.

The Red Lodge Facility is one of 14 small hospitals owned or contracted by the Billings Clinic. Small hospitals, 470 miles away, typically transfer sick patients to the Billings Clinic Hospital, the flagship of Billings, Montana.

However, as coronavirus cases surged in the state, a 290-bed flagship hospital sent Covid-19 patients to Beartooth, which continues to take care of local patients. As the overall area occupancy increases, Beartooth and other hospitals are exchanging staff to make up for the urgent shortage of health care workers entering quarantine after being exposed to the virus.

According to Evans, Beartooth had one radiologist who covered the emergency room 24 hours a day after two other technicians had to quarantine. She said doctors would rush to consider options for treating trauma patients without diagnostic imaging before temporary help arrives from another hospital.

Beartooth easily sent nurses to Billings, but couldn’t afford to go long without them. “Tight,” Evans said. “It’s completely tight. We all have to take a deep breath and say,’I can do this today.'”

So far, Beartooth has never seen a patient with the flu, but the seasonal virus usually fills several beds each year. “It keeps me at night,” Evans said. “I don’t know how long this will last.”

Last year, influenza sent about 400,000 people to US hospitals during what the US Centers for Disease Control and Prevention called a moderate period. Authorities fear that the flu virus overlaps with Covid-19, which could lead to little relief for hospitals in the coming months.

“This is a sign of the future,” said Jim Murphy, director of the infectious disease and testing services division of the Montana Department of Public Health and Welfare.

HCA Healthcare Inc., one of the largest hospital systems in the United States, said ICU capacity increased as the Nashville-based company used data analysis to monitor the care of critically ill patients and the use of ventilators. Sam Hazen, chief executive officer, told analysts earlier this month. “It shortens the patient’s length of stay and ultimately results in much better results,” he said.

Although new treatments are limited, they have also helped improve care for Covid-19 patients and shorten hospital stays. According to epidemiologists, these increases and the increase in the number of infections among young people who are least likely to die if infected are difficult to measure mortality, but probably to reduce mortality. It was useful.

Steroids and remdesivir are “excellent weapons in Covid 19’s arsenal,” shortening hospital stays, said Ryan Mierke, spokesman for the University Medical Center in El Paso.

But if people relax health precautions, the benefits of improved care and shorter hospitalizations can be overwhelmed, he said.

A month ago, the University Medical Center had 30 Covid-19 patients. He said 206 people were accommodated on Thursday, many of them in tents that acted as temporary ICUs in cities where coronavirus cases have been on the rise for several weeks.

“It’s fatigue,” Mielke said. “Mitigation measures such as leaving the group are beginning to be set aside, people want to meet friends, go to restaurants. People don’t wear masks.”

Authorities said the majority of new cases involved people under the age of 30, but they have spread the infection to more vulnerable populations.

New cases of Covid-19 have been steadily increasing for a month in El Paso, Texas’ sixth largest city, and hospital managers warn that the facility is approaching capacity. El Paso County has experienced an average of 942 new cases per day in the last two weeks. This is the highest number in Texas, up from an average of 137 per day in September. Deaths that are weeks behind new cases are usually in the single digits. The area sought help from the state as Covid patients filled more than one-third of hospital beds.

Other hospitals in El Paso treating patients with coronavirus have added tents. However, some patients are taken to hospitals in cities hundreds of miles away, such as Dallas and San Antonio. The Texas Emergency Management Agency has dispatched medical equipment and personnel to transform the El Paso Venture and Performing Arts Center into a temporary hospital with up to 100 beds. The state has also assisted hospitals with extra beds and more than 900 healthcare professionals.

“Alternative medicine facilities and auxiliary medicine units will reduce the burden on El Paso’s hospitals as they contain the Covid-19 epidemic in the region,” Governor Greg Abbott said in a news release.

Write to Melanie Evans at [email protected] and Elizabeth Findell at [email protected].

(End) Dow Jones News Wire

10-30-20 1630ET