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Utah hospital staff are ‘afraid,’ monoclonal antibodies are running out and COVID-19 test sites are flooded

Thursday’s record-breaking case count is part of a “dire” environment, hospital administrators said.

(Trent Nelson | The Salt Lake Tribune) Intermountain Medical Center in Murray on Thursday, Jan. 6, 2022. In a joint news conference Thursday, several hospital leaders from across Utah warned of staff shortages due to COVID-19 and treatment shortages due to demand during an unprecedented surge in new cases.

Utah’s supply of monoclonal antibodies and antiviral medications for COVID-19 is running out as the number of new cases broke a state record again Thursday.

And Utah’s hospital leaders are warning that more bed shortages are imminent amid record coronavirus infections.

“Our staff are afraid to come to work,” said Tracey Nixon, chief nursing officer for University of Utah Health. “They know we do not have the staff to care for the patients the way we need.”

In a single hospital department on Tuesday, Nixon said, “I had three nurses leave because they can’t do this again. They feel like we’re going backward.”

More than 8,900 cases were reported Thursday, breaking Wednesday’s record high 7,200 new cases. Thirteen new deaths were recorded Thursday, including a child, said Dr. Michelle Hofmann, deputy director of the Utah Department of Health.

Hospitalizations for the coronavirus have been rising since Christmas — 530 coronavirus patients were hospitalized as of Thursday, UDOH reported, and intensive care units at Utah’s large “referral” hospitals were at 96% of capacity. ICUs are considered “full” at 85%, and Utah’s major hospitals have exceeded that since mid-August.

But Utah’s hospitals have not yet seen the worst of the recent spike in cases, as patients typically aren’t admitted for at least a few days after testing positive.

“We are likely looking at having to close more beds,” Nixon said. “This is just starting.”

Although the omicron variant of the virus generally produces milder illness than previous dominant variants did, health experts have warned that the sheer number of new infections means hospital admissions are almost certain to continue rising.

“How many patients are we admitting to hospitals two or three weeks from now? And what does that do — not only those COVID patients, but to people who come in in the middle of a heart attack, people who are involved in motor vehicle trauma because of the weather?” asked Dr. Marion Bishop, emergency medicine physician at Brigham City and Cache Valley hospitals.

“I want to be able to take care of those patients, too,” Bishop said. “And long after that peak [in cases] falls, I’m seeing the sickest of the sick in the emergency room. And so we need everyone’s help on the front end to protect us on the back so we can be there for folks.”

(Trent Nelson | The Salt Lake Tribune) An ambulance parked at Intermountain Medical Center in Murray on Thursday, Jan. 6, 2022.

Meanwhile, Utah hospitals already are short-staffed because so many employees are calling in sick or isolating because family members have fallen ill. University of Utah Hospital on Tuesday reported more than 500 of its employees were out sick, and some scheduled surgeries were being delayed.

“We were on ambulance divert for six hours last night because our [emergency department] was overwhelmed with patients seeking care,” Nixon said. “We are turning transfers away.”

And one resource Utah had promoted to avoid hospitalizations — monoclonal antibodies provided to high-risk patients shortly after diagnosis — is nearly gone.

“Just a couple of weeks ago, we were treating more than 1,000 people per week with monoclonal antibodies. Last month at this time we were ordering about 1,300 treatments per week,” Hofmann said in an online news conference with hospital administrators. “This week we were only able to order 264.”

With only about 220 courses of oral antiviral treatments available statewide, those two treatments are now available to less than 1 in 8 qualifying high-risk patients who are infected, Hoffmann said.

The shortage comes partly because of nationwide shortages as more and more high-risk patients are infected. The other reason is that, of the three versions of monoclonal antibodies that had been available, only one is effective against the omicron variant, Hoffman said.

“If your strategy was to hedge on getting vaccinated and seek treatment with monoclonal antibodies in the event that you test positive, it is time to rethink your strategy,” Hoffman said.

Caseloads are likely to become more “explosive” in coming weeks, with at least 12,000 new daily cases expected by the end of the month, Hofmann said — if infected people can get tested in the first place.

“Our testing locations are bursting at the seams,” Hofmann said. “People are spending hours in their vehicles waiting to be tested.”

Before this week, the highest daily case count was less than 5,000.

Hospital administrators and health officials — as well as Gov. Spencer Cox — begged Utahns to get vaccinated and get their booster shots. The Centers for Disease Control and Prevention late Wednesday recommended COVID-19 booster shots for kids ages 15 to 17.

“The one resource that is not scarce is vaccines,” Hofmann said.

(Trent Nelson | The Salt Lake Tribune) Intermountain Medical Center in Murray on Thursday, Jan. 6, 2022.

Cox, who did not join Thursday’s briefing, sent a written statement reiterating that vaccines and boosters are the best way to avoid serious illness from the coronavirus.

“If, for whatever reason, you have been putting off getting vaccinated or boosted, now is the time,” Cox wrote.

The highly transmissible omicron variant has produced breakthrough infections in people who are vaccinated, but the vaccine and booster have proven extremely effective in reducing symptoms and keeping patients out of the hospital.

During the past four weeks, unvaccinated Utahns have been 17.1 times likelier to die than those who are vaccinated, and 8.9 times more likely to require hospital care, UDOH reported Thursday. They have been 2.6 times more likely to test positive.

“I’ve taken care of more COVID patients over the course of the last two years than I can count, and I’ve now seen enough patients with breakthrough infections — people who are immunized, who’ve had both doses and sometimes a booster — to tell you that those are two very different diseases,” Bishop said.

“Unimmunized patients I have to give a pretty grim prognosis to when they land in the emergency room,” Bishop continued, “where I [am] incredibly relieved to hear that a COVID-positive patient has been immunized, because we can tell them to plan for what is likely to be a much easier course.”

Vaccinations and boosters will allow hospitals to avoid denying care as admissions likely rise in coming days, Bishop said.

“I would be going against my moral compass to say, ‘Don’t come to the hospital,’” Bishop said. “We want to be there. We’ve trained to do this. We want to stay in the fight for people, but we also need to have the capacity to take care of people.”

Webb disputed the idea that the omicron variant is mild enough that its widespread transmission could safely achieve a degree of herd immunity.

“Although we may see some peak and decline in transmission that may end up being partly because of reaching some degree of ‘herd immunity,’ it will be at a terrible cost,” Webb said. “And the cost will be to those who are unvaccinated and unfortunately, to populations who are more vulnerable, immunocompromised or in the highest of the high risk group.”

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