Capacity Crowds: Hospitals report limited bed space as COVID numbers climb

Arizona hospitals are seeing more COVID patients as the state faces its third wave of coronavirus cases.

Last week, the number of ICU patients in Banner Health Care’s Arizona hospitals, for both COVID and non-COVID patients, reached the peak numbers of those seen in the summer 2020 surge, said Banner Chief Clinical Officer Dr. Marjorie Bessel at a media conference on Aug. 18.

She reported only 30% of those patients are COVID positive, compared to the last surge when 50 to 60% were COVID positive. Bessel believes the high number of non-COVID patients in the ICU is partly due to patients delaying care in 2020 because of the pandemic and are now seeking care for illnesses and medical issues that have become more severe.

“The high number of non-COVID patients that we were caring for, coupled with the week over week increase in COVID hospitalizations is troubling,” said Bessel.

During the past week, Banner continued to see an increase in COVID-19 hospitalizations, ICU admissions and ventilator usage. Banner has also seen exponential growth in pediatric COVID hospitalizations. In the first two weeks of August, Banner had as many pediatric COVID admissions as they did the entire month of June, according to Bessel. She said they are on track to surpass the number of pediatric COVID patients seen during the winter surge.

Due to the rise in cases and decreased hospital capacity, the Pima County Health Department updated its Public Health Advisory on Aug. 17.

Similar to Banner, Pima County hospitals are seeing more people coming to the ER for reasons other than COVID-19—such as heart attacks, RSV and sepsis—who require hospital admission. According to the Public Health Advisory, local hospitals are also experiencing abnormally long wait times for EMS to be able to transfer care of their patient to the hospital staff, which limits their ability to respond to other emergencies.

“It is NOT the norm for area hospitals to be experiencing such high hospital admission rates, reduced hospital surge capacity and long EMS offload times at this time of year,” according to the health advisory.

Alongside decreased hospital capacity, area hospitals face severe nursing workforce shortages due to high rates of turnover and burnout from the pandemic.

Banner Health has several core positions available and is securing external contracted labor for both nurses and therapists. Bessel said they have individuals who are starting each week and expect that to continue throughout the winter. Banner is requiring all employees to receive the COVID-19 vaccine by Nov. 1 and would include vaccination in the onboarding process for new employees. Bessel does not believe this requirement will have a large impact as many other health care systems in the communities where they operate have similar

“We do expect that staffing will continue to be our greatest challenge as we continue to face this surge,” said Bessel.

The Pima County Health Department is actively assisting area hospitals to request federal assistance to address the healthcare workforce shortages and alleviate decreased surge capacity.

Banner is currently available for both COVID and non-COVID patients, but Bessel warned of a possible reduction in services based on the experience of previous surges.

“If our COVID patients overwhelm our healthcare systems, there may come a point where we have to reduce or cut back on other services such as ambulatory services or patients that have planned elective surgeries,” said Bessel. “It is our absolute hope and desire to not get to that point and so we ask all of you who are out there listening to please do your part, so that we can be here for you to take care of both COVID and non-COVID illnesses.”

According to Bessel, 94% of COVID patients hospitalized at a Banner facility last week were unvaccinated and those patients are younger than those treated in prior surges, with most between the ages of 20 and 60.

Bessel asked the public to do their part and get vaccinated not only to protect themselves but also to support the health care systems in their communities.

“They sacrificed so much for you and rose to the occasion during the prior two surges when there was no solution as effective as we have now today, which is vaccine to prevent hospitalizations. We now have that solution available to us, and we need everyone to take it,” said Bessel.           

Booster shots on the way

Immunocompromised individuals can receive a booster shot and the general public may soon be eligible as well.

With the prevalence of the highly contagious Delta variant and recent evidence showing the decrease of the vaccine protection over time, last week the FDA modified the emergency use authorization for Pfizer and Moderna mRNA vaccines to allow an additional dose in some cases. 

“Based on our latest assessment, the current protection against severe disease, hospitalization, and death could diminish in the months ahead, especially among those who are at higher risk or were vaccinated during the earlier phases of the vaccination rollout. For that reason, we conclude that a booster shot will be needed to maximize vaccine-induced protection and prolong its durability,” said CDC Director Dr. Rochelle Walensky in a joint statement with the U.S. Department of Health and Human Services (HHS) and other medical experts released Wednesday.

On Aug. 13, the Advisory Committee on Immunization Practices (ACIP) recommended the third shot for moderately to severely immunocompromised individuals and said the booster would benefit compromised people by building a stronger resistance to COVID-19.

Following CDC guidance, the Pima County Health Department announced last week they would begin to offer a COVID booster shot to immunocompromised individuals. 

People who are not deemed immunocompromised are yet not eligible for the booster. Immunocompromised individuals, such as those taking immune-suppressing medications could receive a third dose.

It is recommended people receive the same brand of vaccine and booster shots. If your brand is unavailable, the other mRNA vaccine, either Pfizer or Moderna, can be used. The additional dose should be at least 28 days after completion of the initial two-dose series.

The third dose has only been approved to follow the Pfizer/Moderna vaccines. The Johnson & Johnson vaccine has yet to be approved for a booster shot. Pfizer vaccines have been approved for people 12 and older while Moderna is approved for people 18 and older.

On Friday, Aug. 20, HHS also announced a plan to begin offering booster shots to the general public the week of Sept. 20 and eight months after an individual’s second dose. However, this is contingent on a recommendation from ACIP. 

Anticipating the need to immunize a significant number of people, Cullen said Pima County is developing a plan. They hope to work with hospitals and pharmacies to provide boosters for healthcare works, assisted living and long-term care, who were some of the first to get vaccinated during the initial rollout in January. The health department is also looking at the need for mobile clinics. 

Cullen estimates they would give approximately 20,000 vaccines a week over the course of several months once boosters become available to the general public starting Sept. 20.