As Utah tops 200 patients hospitalized for COVID-19, doctors warn that hospitals are approaching capacity

(Trent Nelson | The Salt Lake Tribune) People wearing masks on Main Street in Salt Lake City on Tuesday, June 23, 2020.

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Who’s getting hospitalized for COVID-19 in Utah? It’s not who you might think.

“Our hospitals are full of COVID patients who are in their 40s, some in their 30s,” said Dr. Brandon Webb, chair of the COVID-19 Therapeutics Committee at Intermountain Healthcare. “This is not just a disease of the aged.”

The Utah Department of Health on Tuesday tallied 205 people currently hospitalized with COVID-19, the first time that figure has crossed the 200 mark. The state reported 27 new hospitalizations, bringing the total number of Utahns hospitalized since the pandemic began to 1,444.

And doctors are warning that if the July holidays bring new surges in COVID-19 hospitalizations, the state will exceed its capacity. ”We need to absolutely, 100% flatten the curve right now,” Dr. Edward Stenehjem, an infectious diseases specialist with Intermountain, said on a Tuesday online roundtable organized by the nonprofit Silicon Slopes.

“We cannot tolerate a big surge after a July 4 holiday. We just can’t,” Stenehjem said. “We don’t have the hospital capacity to do it.”

Heading into July, with both Independence Day and the state’s July 24 Pioneer Day, the Grand County Council voted 5-2 on Tuesday in favor of making face coverings mandatory inside all businesses. If Gov. Gary Herbert gives the OK, Grand County — home to the popular travel destination of Moab and Arches and Canyonlands national parks — would be the third Utah jurisdiction to have the requirement.

Last week, Salt Lake and Summit counties implemented the restriction. ”Grand County’s economy is fragile and we can’t afford to take a step backward,” said chairwoman Mary McGann. “The best thing we can do for the county is slow the spread.”

Statewide, four more Utahns have died from the coronavirus, state health officials reported on Tuesday, putting the state’s overall death toll from the virus at 172. The patients who died were a Salt Lake County woman, between 65 and 84; a San Juan County man, age 45 to 64; a Washington County man, age 18 to 44; and a Weber County woman, age 45 to 64. All four were hospitalized when they died.

The 553 new cases reported Tuesday were nearly triple the target of 200 new cases per day. Health officials have said if the number of new cases is higher than that by July 1, the state could require a total shutdown to control the virus. Newly reported cases have not been below 200 per day since late May, and have remained above more than 300 per day for more than two weeks.

During the pandemic, the average age of someone in Utah being admitted to a hospital with COVID-19 has stayed somewhat steady, Webb said — hovering in the low-to-mid 50s. That’s younger than the average in other states, a figure Webb attributes to Utah generally having a lower mean age than other states.

The age group with the most people hospitalized is the 45-to-64 range, he said, with just over 40% of all hospitalizations. The elderly, considered between the ages of 65 and 84, and the 25-to-44 group are nearly tied for second, each with just under a quarter of all hospitalizations.

While the elderly are considered one of the high-risk groups for getting sicker if they catch the coronavirus, Webb said, other high-risk groups include people with conditions younger people often have, such as high blood pressure and obesity.

New infections are being seen all over the state, and increasingly in younger patients, said Dr. Andrew Pavia, chief of the Division of Pediatric Infectious Diseases at the University of Utah.

While younger people — roughly defined as ages 25 to 44 — are considered at lower risk of complications, that’s only on average, he noted on the Silicon Slopes roundtable.

“That means on average, if you’re 30 years old and you get it, you’re less likely to end up in the hospital or in the ICU,” he said. “But if you’re the 30-year-old who dies, that lower risk doesn’t really matter. And we’re seeing a lot of disease in younger people that’s leading to more hospitalizations.”

As the state opened up, people began to congregate, then to gather in bigger groups, and were less diligent about wearing masks or staying 6 feet apart, Pavia said.

“We really have conflated the need to get back to work with the sense that it was all over,” he said. “We really needed to keep our guard up, which we have not done as well as we needed to.”

Of the 205 Utahns currently in hospitals for COVID-19, 83 are in intensive care units. The state also reports another 45 people in hospitals as “under investigation” for COVID-19.

UDOH reports that 62.4% of ICU beds in the state are occupied, and 65.3% of non-ICU beds are occupied.

When measuring hospital capacity, “the state is good at counting real beds, not beds that aren’t usable,” said Dr. Russell Vinik, chief medical operations officer at University of Utah Health.

“We’re not counting mental health beds, we’re not counting rehabilitation beds, we’re not counting neonatal beds,” Vinik said. “You’re not going to put a COVID patient next door to a woman in the [maternity ward.]”

Counting available ICU beds can be tricky, Webb said. “Although the number of ICU-capable beds is publicly reported,” Webb said, “the number of ICU beds that are actually staffed with ICU-level experienced nursing and ICU-trained physicians is much, much lower.”

At some large hospitals, Webb said, “they have designated ICUs — that normally are full of other intensive-care patients — that are now completely and entirely full of COVID patients, and we’ve had to open up new entire ICU wings simply for COVID.”

By rule of thumb, Webb said, when a spike of community-spread cases hits, just under 10% of those who test positive will become sick enough to need hospitalization. A local hospital, he said, then has about a week or 10 days after an outbreak is detected to prepare for those patients to be admitted — either because they’ve been tagged by contact tracing, or because they have developed symptoms.

Hospital systems, such as Intermountain or University Health, sometimes practice what’s called “load leveling,” in which patients can be shifted to hospitals that have space. That flexibility is important, Vinik said.

“A hospital that’s running at 90% of capacity is essentially running at 100% of capacity,” Vinik said. “When we hit 90% capacity, that’s when patients end up boarding in the emergency room, or in the recovery room. Those beds aren’t available when you need them.”

Testing has been relatively high for the past week or so, with 6,848 test results reported since Monday. But, contrary to President Donald Trump’s claim that increased testing has inflated the prevalence of the virus,Utah’s testing rate doesn’t explain the prolonged stretch of hundreds of new positive results every day, Stenehjem said.

“The number of tests that we’ve done has remained stable … but what we’re seeing is an increase in the test positivity,” Stenehjem said. “So this is not an artificial reflection of just more testing. This is legitimate increases in cases.”

The rate of positive results for the past seven days has been about 10.2% — slightly below last week’s high of 12.6% but still far above the 3-5% positive test rate in the state during April and May, when fewer people were being tested.

It would be a mistake to alter testing plans, health officials said.

“Utah’s position has always been, and remains, that testing is a critical element of the response and that we should be doing as much testing as possible to determine where COVID-19 is spreading and to what extent,” UDOH spokesman Tom Hudachko wrote in a prepared statement.

And Utah’s testing capacity should remain stable for a while, even as case numbers shoot up in most states.

“I think we’re in a good position,” said Dr. Jon Genzen, chief operating officer at ARUP Laboratories in Salt Lake City. “I would recognize it’s a changing landscape. How we feel today could be different from how we feel one month or two months from now. ... But ... we have been in the mode of building extra capacity over the past month and will continue to do so over the next month or two.”

Labs statewide have the capacity to run about 7,000 coronavirus tests per day, Hudachko said. The Utah Public Health Lab alone, which can do about 1,100 tests per day, has stockpiled 250,000 test kits, with another 250,000 swabs beyond those in the kits, Hudachko said.

“We feel confident in the current supply chain of testing materials,” Hudachko said.

There have been 22,217 Utahns diagnosed with the coronavirus since the beginning of the pandemic.

Kathy Stephenson contributed to this report.

Editor’s note: Clint Betts, executive director of Silicon Slopes, serves on the The Salt Lake Tribune’s nonprofit board of directors.