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Hospitals fear they may run short of beds

With COVID-19 cases and hospitalizations spiking this month, local hospitals are worried a post-Thanksgiving surge could push bed capacity and health care workers to their limits.

“Holiday gatherings could add fuel to the fire,” said Dr. Jason Kuhl, chief medical officer for Providence Medford Medical Center.

Correction: Oregon Health Authority data on COVID-19 hospitalizations, intensive care bed use and ventilator use has been corrected in this story.

Jackson and Josephine counties, which make up Region 5 for health care in Oregon, had 13 hospitalized confirmed and suspected COVID-19 patients on Nov. 1.

That number had climbed to 69 hospitalized patients as of Tuesday, according to Oregon Health Authority hospitalization data.

The number of COVID-19 patients in intensive care units rose from four to 15 this month.

The region has 57 staffed adult ICU beds and 42 of those were filled Tuesday.

Kuhl said modeling predicts that COVID-19 cases will continue to rise until mid-December.

“We’re not at the turning point yet. If everyone does their part, we hope to start flattening the curve. But we’re in for it for the next few weeks,” he said.

Health care workers who already are exhausted are bracing for the impact of even higher cases, Kuhl said.

For now, Rogue Valley hospitals are still able to handle COVID-19 patients plus others who come in for vital care, including victims of heart attacks and car wrecks, he said.

“We haven’t hit that threshold yet, but it’s a real concern that it could become a reality in the next few weeks if the numbers continue to rise and people don’t take precautions,” Kuhl said.

The Asante medical system — which has hospitals in Medford, Ashland and Grants Pass — is also grappling with the case surge.

“I think we all have significant concerns that if we don’t flatten the curve, we won’t have adequate supplies of hospital beds,” said Amanda Kotler, vice president of nursing for Asante Rogue Regional Medical Center in Medford and Asante Ashland Community Hospital.

Jackson and Josephine County have 447 staffed adult non-ICU beds. As of Tuesday, 384 of those were occupied, the OHA said.

The number of COVID-19 patients on ventilators in the valley doubled from two on Nov. 1 to four on Tuesday, the OHA said.

The local health care system still has a plentiful supply of available ventilators.

Kotler and Kuhl said the public can help by wearing masks, practicing social distancing, washing their hands, staying home if they are sick and limiting group gatherings.

“Following these precautions will help the community and keep people out of the hospital,” Kotler said.

Staffing strain

Both the Providence and Asante hospital systems have enough staffing for now to handle the current volume of patients, Kuhl and Kotler said.

But with health care workers falling ill during the cold and flu season and being exposed to COVID-19, more are being sidelined. The staffing situation is tenuous.

“That remains a bit of a house of cards,” Kuhl said.

The number of available hospital beds isn’t a fixed number. Capacity depends on whether there are enough nurses and other health care workers left to handle patient volumes.

“Staffing is our No. 1 concern. Without staffing, we can’t use the available beds we have. Asante is monitoring staffing at all three hospitals to ensure optimal care,” Kotler said.

Kuhl said the complexity of COVID-19 means those patients need more attention. A nurse taking care of four regular patients, for example, can only be assigned three COVID-19 patients.

Traveling nurses are in demand across the nation, he said.

“We have a limited ability to bring on new nurses,” Kuhl said.

In normal times, hospitals discharge patients who still need some care into skilled nursing facilities.

But many of Jackson County’s nursing homes and retirement communities have been hard-hit by the virus.

They had suffered 334 COVID-19 cases and 15 fatalities as of Tuesday, according to Jackson County Public Health.

“Not only is there an influx of COVID patients coming in, but patients are unable to leave the hospital. They have nowhere else to go,” Kotler said.

Patients who need follow-up care as they recover are being kept longer in hospitals.

Kuhl said Providence, Asante, Jackson County Public Health and state legislators are working to designate more “swing beds” in hospitals. Recovering patients in those beds can be treated more like skilled nursing home patients.

The nurse-to-patient staffing ratio is more flexible, and doctors don’t have to see the patients every day, Kuhl said.

The Portland area is designating some rehabilitation facilities as COVID-19 and non-COVID-19 facilities. That might be an option for the future in the Rogue Valley, he said.

Kuhl said the Providence emergency department can still handle the patient volume.

“The emergency department is not overwhelmed. At this point, if patients are ill, they don’t need to be fearful of coming into the emergency department. We want to see them earlier so we can intervene and have better clinical outcomes,” Kuhl said.

Providence Medford Medical Center is cutting back on some non-urgent, non-emergency surgeries. It normally runs six operating rooms per week, but is using five this week, he said.

To preserve vital inpatient beds, Asante is reviewing its non-urgent, non-emergency surgery schedule and considering whether to cancel or postpone cases that require inpatient post-operative recovery, Kotler said.

If they start running short of beds, both hospital systems have back-up plans to convert other hospital rooms into spaces for patient beds.

Operating rooms, conference rooms and spaces for outpatient care are among the Providence spots that could be converted, Kuhl said.

Outdoor tents or field hospitals would be a last option, Kotler and Kuhl said.

On the front lines

When it comes to the impact of COVID-19 on patients, they are experiencing varying levels of severity from the illness. Even those who do relatively well are suffering emotionally from being separated from their families during treatment, Kotler said.

Since the beginning of the pandemic, the medical community has learned more about how to treat COVID-19. Medications like the antiviral drug Remdesivir are helping, and patients are less likely to need supplemental oxygen or be put on ventilators, Kuhl said.

Still, with total cases spiking this month, the number of people in intensive care and on ventilators is going up, as are deaths.

Providence and Asante could both starting receiving COVID-19 vaccines in December to start vaccinating front-line health care workers, paramedics and nursing home staff, Kuhl said.

Vaccinating health care workers protects the community’s first line of defense against virus. Other populations will follow as the vaccine becomes more widely available, he said.

Until then, health care workers are continuing to wage the war against COVID-19, while also taking care of kids who can’t go to school and dealing with other hardships from the pandemic.

“There’s a significant level of fatigue. I’m in awe of the compassion and care our caregivers are providing. They continue to come in on a daily basis,” Kuhl said.

Kotler said health care workers are putting in 12-hour shifts, often working all day or night under layers of personal protective equipment to protect themselves, their families and their patients.

“There’s a fear of what they could bring home to their loved ones,” Kotler said.

For many, their morale is low and they are physically and emotionally exhausted from a job that can be hard and devastating, she said.

“They are giving their heart and soul to care for the community,” Kotler said. “It doesn’t come without sacrifice. We’re so fortunate to have such dedicated caregivers in the Rogue Valley.”

Reach Mail Tribune reporter Vickie Aldous at valdous@rosebudmedia.com. Follow her on Twitter @VickieAldous.

Photo courtesy of AsanteRegistered nurses Libby Johnson, left, and Mischa Fiske wear layers of personal protective equipment in the Three Rivers Medical Center emergency department.