CORONAVIRUS

Iowa hospitals fear overwhelming patient surge if coronavirus cases continue to climb

Local officials say biggest concern is overworked health care workers

Medical assistant Alex Abodeely holds a swab taken from a patient for a coronavirus test as she places it in a container
Medical assistant Alex Abodeely holds a swab taken from a patient for a coronavirus test as she places it in a container toe be transported for analysis at the University of Iowa Hospitals and Clinics Family Medicine Clinic in Iowa City on Monday, April 20, 2020. (Andy Abeyta/The Gazette)
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Iowa has broken the record for the highest number of hospitalized COVID-19 patients more than once this past week.

The spike in new novel coronavirus cases in recent weeks has driven a record number of sick patients into hospitals across the state. Over the past week, Iowa continuously has reached new highs in the number people hospitalized with the virus, topping off at 545 total patients as of Saturday morning.

Does that indicate the state’s hospitals are at risk for being overwhelmed?

“That’s the difficult part,” said Suresh Gunasekaran, chief executive officer at the University of Iowa Hospitals and Clinics. “None of us have a crystal ball as to how it’s going to spread and what each hospital is going to be able to do.

“But I would certainly say that it very much is possible to overwhelm hospitals.”

Corridor hospitals have not seen a sharp increase in patient counts currently in evidence in other parts of the state, including the Quad Cities and parts of western Iowa.

The majority of infected patients don’t require hospitalization, but increasing case counts — including in Linn and Johnson counties — boost the likelihood of severe outcomes among patients.

“We have seen for weeks now a continued increase (in cases) across the state, and I’m extremely worried about what this means not just for hospitals, but for the health of Iowans,” Gunasekaran said.

Iowa will run out of intensive-care unit beds for its COVID-19 patients in early December, and remain short until early January, according to projections from the Institute for Health Metrics and Evaluation at the University of Washington.

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The institute, whose projections have been cited by the White House, says while the state has plenty of hospital beds — more than 4,000 — there are only 247 ICU beds across the state.

Those totals differ from the Iowa Department of Health’s coronavirus website, which states that the state has more than 500 ICU beds and, as of Thursday, that 134 were being used.

The need for invasive ventilators mirrors the ICU bed demand, but the institute does not have data showing how many ventilators Iowa’s hospitals have. The Iowa Department of Public Health website said the state has more than 800 ventilators and 49 were in use as of Thursday.

In her news conference on Oct. 7, Gov. Kim Reynolds said the state’s health care system is “strong” and can handle the surge.

“This is disappointing news, and sadly it’s what can happen when we are experiencing community spread,” Reynolds said of the hospitalizations. “Even though the number of Iowans hospitalized is the highest it’s been, we’ve not approached the peak of our hospital capacity.”

At the time of the conference, the state’s hospitals were treating 444 COVID-19 patients. Reynolds has not held a news conference since then.

“I don’t really worry about UIHC specifically,” Gunasekaran said. “I really do worry about these really alarming infection rates, I really do worry about the health of Iowans, and I worry about other communities being overwhelmed if just half a dozen nurses get sick.”

Most hospitals have room for patients, but the concern is staffing

Unlike early on in the pandemic, officials at Eastern Iowa hospitals say they have enough personal protective gear and bed capacity to take on any patient need — whether they’ve been infected with COVID-19 or need other inpatient care.

The limiting factor as Iowa enters another peak is hospital staff’s ability to meet a new demand, said Dr. Tony Myers, chief medical officer at Mercy Medical Center in Cedar Rapids.

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“We’ve got enough space,” Myers said. “I don’t know if (hospitals) will be able to staff that space.”

Officials at those hospitals say they are turning their attention to the needs of their doctors, nurses and other health care providers who have been working long hours and extra shifts throughout the pandemic.

In short, they are tired, said Dr. Dustin Arnold, chief medical officer at UnityPoint Health-St. Luke’s Hospital.

“This has been seven months of a lot of long days, and that’s tough on people,” Arnold said. “... That’s the first element of the contingency plan we would have to address.”

Officials said could shift staff from outpatient services and other parts of the hospitals to fill a critical care need, or hire traveling nurses or recruit professionals from other parts of the country to help fill gaps in certain services on a temporary basis.

Iowa isn’t the only part of the Midwest experiencing a surge in new cases, but one of several states that recently has reported record-breaking patient counts in hospitals. Therefore, recruiting help from elsewhere may not be a sustainable option during the pandemic, Myers said.

“We can always shift resources to some extent, but it’s hard to do that for the long term,” Myers said.

Hospitalizations in Iowa previously had spiked on May 6 with 414 patients, including 151 in ICUs and 105 on ventilators. Those numbers dropped in June, but saw another resurgence the following month — around the same time COVID-19 restrictions were eased and businesses began to reopen.

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Among the 536 patients being treated for the virus in Iowa, 134 were in the ICU, according to state coronavirus data. Patients on ventilators dropped to 49, compared to the 53 patients on ventilators 24-hours before, according to analysis by The Gazette.

Many new cases linked to family gatherings, weddings

Local hospital officials report the vast majority of cases were a result of community spread — but not as a result of super spreader events or in public spaces such as restaurants or schools. That is, their patients were exposed during large family gatherings, such as weddings.

“Even my patients that have done a fantastic job of protecting themselves, they’re still going out and doing some things,” Myers said. “It’s not going to a bar — they’re going to see their family.

“That’s really tough when you can’t see your family.”

Iowans likely are becoming lax in following social-distancing recommendations and taking more risks.

“You can clearly tell that citizens are tiring of the pandemic and are tiring of the safety hazards,” Gunasekaran said.

Myers would be supportive of “any public policy that would protect hospitals’ ability to care for people,” but added that no state mandate could stop individuals from gathering with their families for Thanksgiving or other upcoming holidays.

Policies such as visitor restrictions and screening for symptoms will remain in place for the foreseeable future, but Corridor hospital officials have not announced any new mitigation strategies in light of the recent increase.

• READ MORE: Nursing home deaths account for half of Iowa’s COVID-19 fatalities

Eastern Iowa hospital officials noted they don’t have a specific threshold they are watching for when it comes to implementing contingency plans, such as devoting more bed capacity for COVID-19 patients.

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In the meantime, Arnold emphasized that if Iowans need a hospital bed, “You will get one.”

Officials said the key to preventing overwhelming hospitals is a message that has been touted since the beginning — flatten the curve by following all recommended public health guidelines. That includes social distancing, avoiding congregate settings and wearing a mask.

“We need to do better from that standpoint,” Myers said.

Comments: (319) 398-8469; michaela.ramm@thegazette.com

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