Data Analysis: COVID-19 Is Filling Up Hospitals In Small Cities
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Judy and Larry Pichon on their wedding day in 1986. Judy had a rare autoimmune disease and was unable to get an ICU bed in July because they were full, and she died. If it weren’t for the pandemic, Larry believes his wife would be alive.
Larry Pichon
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Larry Pichon
An NPR analysis of new COVID-19 cases and hospital capacity shows that in addition to well-known hot spots like Arizona, Texas and Florida, there’s cause for concern in other parts of the country, too. Places like southwest Louisiana, eastern Washington state and Boise, Idaho, have had to shuffle patients between hospitals in order to ensure everyone can get a bed.
The NPR analysis looked at new cases in hospital referral regions, which are areas of the country where patients are likely to be referred when they’re trying to get care. Because coronavirus case counts are generally available at only the county level — and since hospital capacity can fluctuate — NPR’s figures are estimates for how many cases a hospital referral region has.
Southwest Louisiana: Staff Shortages
Lake Charles is among two regions in Louisiana where the renewed wave of the pandemic may overwhelm hospital capacity. It sits at the edge of the Gulf of Mexico and the border with Texas. For weeks, Lake Charles and another hospital referral region, Lafayette, have had the state’s highest rates of new coronavirus cases and its greatest growth in hospitalizations. According to state data, there are just 20 intensive care unit beds left in the Lake Charles region as of Sunday. Lafayette, a few hours west of New Orleans in the heart of Acadiana, has just 26. In both, the major hospitals are either near capacity or already full.
The governor has requested extra ICU nurses, doctors and respiratory therapists through the Federal Emergency Management Agency, but the request is pending. Hospitals have been tapping contract nurses, but «that is drying up pretty quick, said Dr. Manley Jordan, the chief medical officer of Lake Charles Memorial Hospital.
«Everybody has their limits. Everybody has a breaking point, Jordan said. «What keeps me up at night is not having any light at the end of the tunnel.
Some hospitals are so full that they’re on what’s called «diversion — meaning that they restrict which patients they take from surrounding areas or other facilities, sending some patients farther away to get care. In those hospitals, the only way in is through the emergency room.
Lafayette General Health, a Level II trauma center, has been on complete diversion for over a week, even for patients from smaller local facilities within its own network. Chief Medical Officer Amanda Logue said she doesn’t think the community understands that a hospital swamped with coronavirus patients has an impact on other health care, too.
«It’s all the other things that them and their family need. And we’ve had to turn them all away, she said. «So if you’re in a car accident, I’m sorry, but we can’t take you at this time.
Boise: Walking A Fine Line
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Two intensive care units at St. Luke’s Health System hospitals filled up last week in Idaho. They began sending patients to the main facility in Boise.
Sáša Woodruff/Boise State Public Radio
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Leola Reeves has set up more than 8,000 red flags, each one with a black silhouette, to represent COVID-19 cases in Yakima County, Wash.
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Leola Reeves has set up more than 8,000 red flags, each one with a black silhouette, to represent COVID-19 cases in Yakima County, Wash.
Will Stone for NPR
On the side of a busy roadway, Reeves has helped set up more than 8,000 red flags, each with a black silhouette, to represent the number of confirmed coronavirus cases in her hometown.
Yakima’s health care system was particularly vulnerable to that surge of patients. In January a major hospital closed, leaving only one other hospital in the city with just 11 critical care beds.
At one point, Dr. Tanny Davenport with Virginia Mason Memorial hospital in Yakima said 17 patients were transferred out of the county in a single day. «We’ve never had anything close to that number ever in our history, Davenport said.
Leola Reeves began to worry her stepfather might be transferred hours away to Seattle. «Luckily, that did not happen. And they were able to care for him here.
One reason he didn’t have to be transferred is because of the way the hospital adapted during the crisis.
Virginia Mason Memorial doubled its critical care beds and retrofitted floors to care for patients. Davenport said the biggest challenge wasn’t just physical space. «We had beds, but what we didn’t have was team members to safely take care of those patients, he said.
The health care system was still on the brink. Then a combination of good fortune and community action led to a remarkable turnaround. While Yakima was inundated, other parts of Washington got the virus under control, so there was always somewhere to transfer patients.
«That was really our saving grace, Davenport said.
Meanwhile, local health officials, working with the hospital, businesses and community groups, launched a massive face mask awareness campaign. A survey from Memorial Day weekend showed only 35% of people in Yakima were wearing face masks.
«Having that data point actually was really helpful, said Lilian Bravo with the Yakima Health District. Bravo said they blanketed the community with free masks and shifted their messaging to focus on the goal of improving that number so Yakima could reopen.
«That was a key turning point, Bravo said. «Having that tangible goal ended up being very, very effective.
A month later, the same survey showed 95% of people were wearing face masks, and the results became even more clear as hospitalizations and cases continue to fall.
«Masking is what has changed, Davenport said. «For us to go from 200 cases a day to 100 cases a day in six weeks is incredible.
Nationwide: What’s Next?
Whether hospitals and communities can continue to keep ahead of rising caseloads is the challenge and the question.
Dr. Ashish Jha, the director of Harvard Global Health Institute, originally compiled hospital capacity data used in NPR’s analysis in March to estimate when hospitals might fill up. At that time, health leaders were worried about a single crushing incident of coronavirus infections that would overwhelm U.S. hospitals. Now, he says, he’s concerned about something else, too.
«It may come differently as opposed to a single massive surge that overwhelms hospitals. What we might get is just this constant flow of critically ill patients that are just barely what a hospital can manage, Jha says.
«Once you get out of those major academic centers and start getting into community hospitals and regional hospitals, they don’t have those deep benches. They don’t have the wealth of resources that they can tap into. So I am very worried that in the days and weeks ahead, if these hospitals continue to function at or above capacity, they’re going to have a very hard time keeping going.
Additional reporting by Jingnan Huo.
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