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Utah’s hospitals set another unwanted record Monday — an indicator, say doctors, that a drastic shift in health care standards during the COVID-19 pandemic is getting closer.
According to the Utah Department of Health’s daily COVID-19 report, 348 patients are currently hospitalized due to the coronavirus — topping the record of 342 patients set Sunday.
“These are unprecedented hospital volumes,” said Dr. Brandon Webb, an infectious disease physician at Intermountain Healthcare. “They are far in excess of what we saw during the last peak in July.”
A week ago, officials with the Utah Hospital Association warned Gov. Gary Herbert that if the number of COVID-19 patients didn’t fall, hospitals in the state would have to start implementing “crisis standards of care” — which mean some patients who are not getting better may be transferred out of intensive care units to make room for others.
On Monday, the state recorded 1,196 new cases of COVID-19, UDOH reported, bringing the seven-day average of new daily cases down — to 1,647 cases per day — for the first time in more than two weeks.
That’s a tiny decrease, and Utah’s hospitals are taking the first steps toward “contingency care,” trying to stave off more drastic practices.
University of Utah Hospital, which has two ICU teams under normal conditions, has had a “surge unit” that’s half ICU and half acute care open for the last three weeks, said Dr. Russell Vinik, chief medical operations officer at University of Utah Health. That “surge unit” will likely transition to all ICU beds this week — and the hospital is looking to enact a fourth team of critical care providers.
Intermountain, Webb said, is already feeling the strain, with longer-than-usual wait times in the hospital system’s emergency rooms. It is figuring out how to safely send some non-COVID patients home sooner using home-health services.
The hospital system, Utah’s largest, has been transferring patients from full hospitals to facilities with more room — a practice called “load leveling” — but, Webb said, “you can’t ‘load level’ when everybody is full.”
Intermountain is working to find other creative solutions, Webb said, such as opening up pediatric beds at some regional hospitals for adult patients — and concentrating pediatric patients at its Primary Children’s Hospital near the University of Utah.
Another step both Intermountain and University Hospital will implement soon: bringing in doctors who don’t usually work in hospitals.
Under their contingency plans, when doctors in a hospital hit their capacity, hospitals will enlist doctors “who work in the outpatient world to come in and provide in-patient care,” Webb said, adding, “it’s not ideal.”
Vinik agreed. “We’re asking people to do things that they trained for, maybe when they were a resident, but they haven’t done in three years,” he said. “There’s quite a bit of runway with redeployed workforce and contingency staffing, but once you get into those areas, the quality of care is not at the level where we want it to be.”
Utah’s death toll from the coronavirus stood at 614 on Monday, with no new fatalities reported since Sunday.
There were 8,744 new test results reported Monday, just over the average of about 8,620 new tests per day for the past week. For the past week, 19% of all tests have come back positive — up from Sunday’s previous record high of 18.7%, and a rate that indicates a large number of infected people are not being tested, state officials have said.
There have been 888 Utahns reported hospitalized for COVID-19 in the past two weeks. In total, 5,576 patients have been hospitalized statewide for COVID-19, up 50 from the day before.
Utah’s intensive care units were 71.6% occupied as of Monday, down a bit from the 75.7% mark reached on Friday. The figure reflects statewide ICU capacity and does not account for different needs from city to city, or for certain medical specialties.
The rates of hospital admissions and ICU capacity, Webb said, “are very predictable,” because they lag behind the case counts that have averaged at least 1,000 new cases a day for nearly a month.
“It’s an inevitability, unless we do something at the community level to interrupt the cycle of transmission,” Webb said, adding that the public and policymakers need to help bring down case counts.
Utah’s health care workers will continue working to save lives, Vinik said. “We will do what we have to do,” he said. “But the more you stretch that elastic band, the weaker it is.”