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Worst yet to come for crowded hospitals

Photo courtesy of OHSU Oregon Health & Science University respiratory therapist Jenn Ellingson pauses to wipe her eyes during a shift.
Peak of omicron surge predicted for Feb. 1

With the peak of the omicron COVID-19 surge expected in less than two weeks, crowded hospitals in the Rogue Valley and across the state are battling to care for the patients they already have while preparing for more.

“The next couple weeks are going to be really tough, and it’s important for people to understand that. There is a war going on in our hospitals against this virus that isn’t visible to the public,” Becky Hultberg, president and chief executive officer of the Oregon Association of Hospitals and Health Systems, said Thursday.

Oregon hospitals were straining to care for 981 patients with COVID-19 Thursday, according to Oregon Healthy Authority data.

The latest Oregon Health & Science University forecast predicts statewide COVID-19 hospitalizations will peak at 1,550 COVID-19 patients Feb. 1 as the omicron variant of the virus continues its sweep through the population.

“The lack of available hospital beds is pushing the system everywhere to the breaking point,” Hultberg said.

Hospitals normally like to operate at 60%-70% capacity so they can provide adequate care for patients while leaving a buffer. Beds also rotate out of use temporarily as they are cleaned and sanitized between patients, health experts said.

The six-county region that includes Salem has been the hardest hit during the omicron surge. Hospitals there were 98.6% full Thursday, with only nine beds open out of 648 total, state hospitalization data shows.

At 97.5% full Thursday, a six-county region that includes Portland was faring only slightly better.

Hospitals in Jackson and Josephine counties were 92.2% full Thursday.

The Rogue Valley was the hardest hit area of the state during the delta variant surge during the summer and fall of 2021. Hospitals in Portland and the rest of the state acted like a release valve and accepted some Rogue Valley patients, but that option is less available now.

In order to make room for COVID-19 patients during the delta surge, local hospitals had to hold down their regular patient population by limiting the number of people who could come in for nonemergency surgeries.

After the delta wave subsided, patient counts stayed high as Asante hospitals worked through a backlog of delayed surgeries, said Amanda Kotler, vice president of nursing at Ashland Community Hospital and Rogue Regional Medical Center in Medford.

“We’ve never been back to normal since the delta surge,” she said.

The arrival of the omicron variant in the United States started pushing COVID-19 patient numbers up again in December.

Kotler said hospital workers are still reeling from the physical and emotional toll of caring for patients who suffered, and often died, during the delta surge.

“After the trauma they experienced with delta, it’s hard to find the resilience to do this again. That’s devastating to see,” she said.

Asante is again canceling many nonemergency surgeries. Health teams review the situation daily to see which cases are most urgent and who can move forward into surgery, Kotler said.

“It continues to be a really huge challenge,” she said.

Providence Medford Medical Center also has to evaluate what surgeries can move forward.

“Every day, we actively manage our surgery schedule and evaluate our capability to offer elective surgeries for the following day,” said Julie Denney, spokeswoman for Providence Medford Medical Center. “Several factors are considered, including the urgency of the surgery or procedure, surgical staffing and whether beds are available for patients who will require an inpatient stay following surgery. We remain available for surgeries in emergency situations.”

“Elective surgery” is a term that covers surgeries that can be scheduled in advance, including surgery for serious problems like cancer and heart conditions.

The omicron variant is causing less severe illness and a lower death rate among those who catch the virus. However, the sheer number of people infected with the highly contagious variant is pushing hospital patient counts up, Hultberg said.

Hospitals across the state are seeing less strain on their intensive care units and lower ventilator use among current COVID-19 patients. However, emergency departments and regular hospital beds are being hit hard, Hultberg said.

Providence Medford Medical Center said its intensive care units haven’t been as hard hit as other parts of the hospital. Asante said it has capacity concerns with its ICU beds and is using alternative spaces to house patients.

At Asante hospitals, much of the strain on ICU beds is coming from non-COVID-19 patients. Many patients with other conditions are arriving at Asante hospitals in worse health, Kotler said.

Those patients are staying longer in the hospital. COVID-19 patients with the omicron variant are having shorter stays than those who had delta, Kotler said.

Providence Medford Medical Center and Asante’s three Rogue Valley hospitals haven’t had to use crisis standards of care in which they choose who will get critical resources such as ventilators in case of a shortage. Ventilator supplies remain adequate, Denney and Kotler said.

The state has offered guidelines for hospitals to follow in case the omicron surge overwhelms their abilities. Patients who are most likely to survive until discharge and who have the least damage to their brains, hearts and other organs get priority.

Hospitals in the Rogue Valley and across the state remain frustrated that they can’t find beds in nursing homes and rehabilitation centers for patients who are awaiting discharge.

On Thursday, 582 patients were stuck in Oregon hospitals because they had nowhere to go, Hultberg said.

Asante’s three Rogue Valley hospitals were caring for 76 patients Thursday who no longer need hospital-level care but couldn’t be discharged, Kotler said.

Denney said Providence was caring for 100 patients awaiting discharge in its hospitals around the state.

The state of Oregon has funded care facility beds to try and ease the problem, but finding places for patients awaiting discharge has remained a problem throughout the pandemic, hospitals say.

“The ability to discharge patients who no longer require hospitalization remains a challenge. Our case managers work diligently to find safe and appropriate placements for our patients, but the options are limited,” Denney said. “Many of the local care facilities, including those sponsored by the state, are experiencing staffing shortages, which limits the number of patients they are able to accept. Some patients are homeless or are awaiting Medicaid approval for care.”

While 582 patients were awaiting discharge with nowhere to go, 229 patients who need hospital-level care were stuck in hospital emergency departments across the state Thursday — hoping for a hospital bed to open up, Hultberg said.

“Hospitals have been sounding alarm bells for the entire pandemic about the challenges of discharging patients, and we need help in moving patients out of the hospital to free up beds for people in the community who need them,” she said.

National associations for nursing homes say their staffing levels have been decimated during the pandemic. They also say they face low reimbursement rates for patient care that makes it hard to cover costs.

Gov. Kate Brown has deployed more than 1,200 National Guard members to help hospitals in nonmedical roles. But state officials said the soldiers aren’t being sent to nursing homes because that wouldn’t increase their capacity.

Oregon is putting more funding into “decompression unit” nursing facilities that can take discharged hospital patients. It’s also paying for more clinical workers to increase staffing, state officials said.

National Guard members arrived this week to help Rogue Valley hospitals. They’re helping with nonmedical duties such as cleaning, clerical work and transportation, Denney said.

“We are incredibly grateful for their assistance. The deployment is for 30 days but can be extended at the governor’s discretion,” she said.

Soldiers were also deployed during the previous delta surge. Oregon isn’t deploying soldiers in medical specialties because they are busy in their civilian health care jobs.

The National Guard members are especially important because hospitals have depleted workforces.

“Hospitals are in a much worse position with staffing than at any prior point in the pandemic. After two years on this COVID-19 roller coaster, many health care professionals just want off,” Hultberg said. “Staff are physically and emotionally exhausted and dealing with challenging patients and conditions. Nationally, nearly one in five health care workers has quit during the pandemic, so this is not unique to Oregon.”

Long term, Hultberg said, Oregon and the nation have to figure out how to attract more people into health care jobs, and how to provide more education and training opportunities.

For now, hospitals are asking the public to help by getting vaccinated against COVID-19 and getting booster shots, wearing masks, limiting indoor gatherings and avoiding emergency departments for nonemergency care.

People can also lend a hand by donating blood to ease the worst blood supply crisis in the U.S. in more than a decade. Visit redcross.org to make a blood donation appointment.

"This isn’t over. I know how tired we all are,“ Kotler said. ”People can help by continuing to use precautions to protect themselves and others.“

Reach Mail Tribune reporter Vickie Aldous at 541-776-4486 or valdous@rosebudmedia.com. Follow her on Twitter @VickieAldous.