Robert Gehrke: We should consider a better way to provide hospital care during the pandemic

Robert Gehrke

Last week, I was sad to learn that one of my favorite people growing up — one of those unfailingly upbeat and positive people who lifts up everyone around them — died. He wasn’t a victim of COVID-19, at least not directly.

He suffered a fall and injured his back one evening. He was taken to the hospital where a doctor ordered an X-ray, gave him pain medication and sent him home, not wanting to admit him, his son told me, because of the pandemic.

Within a couple of days, the pain had worsened and he died.

I’m not naming him — his family asked that I don’t — or the hospital, because perhaps, under the circumstances, it did what it could.

But his death did drive home the secondary impacts of this pandemic on our health care system that are sometimes ignored.

Doctors across the country, including here in Utah, say they are seeing fewer people in emergency rooms for things like strokes or heart attacks. Obviously strokes and heart attacks didn’t stop, but people aren’t going to the hospital because they’re afraid of the virus.

Let me be crystal clear about this: If you have symptoms of a stroke or heart attack, GO … NOW!

Hospitals are taking extraordinary precautions, their emergency rooms are safe and, in a situation like that, time is of the essence.

We also need to face a couple of realities: First, that the coronavirus will be with us for months, with some models showing a resurgence likely in the fall. Second, the number of coronavirus patients currently in the hospital is, fortunately, nowhere near what we feared it might be.

Statewide, it has hovered around 100 for more than a week.

In Salt Lake County, it was about half that many. Treating that number of patients, however, has disrupted operations at the county’s 19 hospitals.

Nonessential surgeries, postponed for weeks to avoid depleting the stockpile of protective equipment, are resuming. That’s a good thing, because hospitals around the state are losing absurd amounts of money, hundreds of millions of dollars, Utah Hospital Association President Greg Bell told me last week. And some number of people — we’ll never know exactly how many — are not getting the care they need.

Maybe it’s time we rethink how we provide medical care. What if, instead of burdening every hospital in Salt Lake County, we designated two — one in the north end of the county, one in the south — to exclusively treat COVID-19 patients?

That would free up the remaining hospitals to return to some semblance of normalcy, to get patients the treatments and surgeries that have been put off for too long, and ease fears that are keeping people away from even the most serious emergency care.

It’s not a novel concept. Places from China to Massachusetts have designated hospitals to treat COVID patients. It’s especially common where cases have surged.

I acknowledge I am way outside my area of expertise here — like a high school graduate who dons a lab coat and prescribes colloidal silver as a miracle cure. (Not quite that bad, and seriously, don’t take silver.)

There are obvious barriers that would need to be overcome.

Hospitals compete tooth and nail and none of them would want to be chosen to treat the coronavirus. There would have to be a way to share the financial burden, but getting a portion of some revenue is probably better then getting all of nothing (or close to it) like they are now.

Dr. Tom Miller, chief medical officer at the University of Utah Health System, said patients are coming back, beds are filling up, hospitals can manage the demand — that there’s no need to make drastic changes that might have made more sense when hospitals were preparing for an unknowable coronavirus hit.

There are practical concerns, too, according to Dr. Arlen Jarrett, the chief medical officer of Steward Health Systems for Utah.

Moving patients from one hospital to another carries risk, especially those on ventilators, he said. Second, you want to think about what’s best for the patients, which typically is to keep them local, closer to their family and their doctor.

Valid points, to be sure. But coronavirus patients right now can’t really see visitors, and I’d envision the non-COVID hospitals to phase out coronavirus patients as they recover, not relocate them.

Both Jarrett and Miller say hospitals have figured out how to manage COVID patients, with separate wards for those who are positive, those whose status is unknown and those who are in the hospital for reasons other than COVID-19.

I do have confidence the hospitals can control the virus within their walls. But they’re still not operating anywhere near their normal levels, and this virus is going to hang around for months.

“We’re down dramatically in terms of our outpatient volumes — outpatient surgeries and the emergency department,” Jarrett said. “Even testing — mammograms, colonoscopies, things like that — we’re 10% of what we had been.”

Those mammograms and colonoscopies are important, just like the stroke and heart screenings and emergency visits.

Concentrating coronavirus patients in one or two hospitals would let the other hospitals operate somewhat normally and could even return them to profitability.

More importantly, it would help patients, giving people the confidence to go to the hospital when they need to, even for routine procedures, and return a level of care to our suffering system that can’t realistically continue to manage this COVID outbreak as we have for the long months to come.