After weeks of record-breaking COVID-19 hospitalizations that greatly strained capacity at health care systems across the state, local hospitals are preparing for a surge in new cases that likely will follow the Thanksgiving holiday.
Throughout the pandemic, it’s been typical for Iowa — as well as the rest of the country — to see a spike in residents testing positive for the novel coronavirus following holidays and other occasions that prompt residents to gather outside their household groups.
“It’s the same conversations we’ve had intermittently since March,” Dr. Tony Myers, chief medical officer at Mercy Medical Center in Cedar Rapids, said Tuesday. “We’re always looking at the next holiday or the next school opening.”
Health care officials pleaded with Iowans to cancel their Thanksgiving plans this year. But in anticipation of this continued trend, hospital leaders in Cedar Rapids and Iowa City say they are “constantly” reviewing their surge plans.
“We do anticipate another possible spike in cases after Thanksgiving,” Dr. Dustin Arnold, chief medical officer of UnityPoint Health-St. Luke’s Hospital, said this past week.
“Our operational and clinical teams have worked together closely and have a plan to increase capacity incrementally as needed. This means converting more units to be designated COVID units.”
According to a COVID-19 Event Risk Assessment map by the Georgia Institute of Technology, among other researchers, attending a gathering on Thanksgiving with 10 people in Linn County, for example, carries a 45 percent chance of contracting the coronavirus. The map’s percentages are based on the assumption there are five more cases than are being reported.
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In the midst of this preparation, Myers is looking to the weeks following the holiday with a bit more optimism than earlier this month. He believes Iowa will not see the same level of surge in patients admitted for COVID-19 as hospitals did during the spike earlier in November because the risk of becoming infected with the virus a second time is low.
Myers said about 10 percent of Linn County’s population has been infected with the novel coronavirus, including estimations of residents who were not tested, which is a “significant increase compared to what it was five to six months ago.”
Myers also pointed to a recent U.S. Centers for Disease Control and Prevention study that showed Americans who practice mitigation behaviors — including wearing a mask while in public, socially distancing and avoiding gatherings — continue to do so consistently.
According to the study, published on Oct. 30, between 40 percent to 50 percent of older populations consistently practiced public health strategies between April and June, and are expected to continue these behaviors.
“Looking forward, effectively 60 percent of Linn County will have partial protection,” Myers said. “That number continues to get bigger, so the number of susceptible patients gets smaller and smaller.
”Eventually, we won’t have week after week of overwhelming hospitalizations.”
More surgeries could be delayed ‘as needed’
Eastern Iowa hospitals have continuously reviewed their surge plans, adapting as needed.
The state’s largest hospital, the University of Iowa Hospitals and Clinics, is in the first phase of its surge plan. If hospitalization rates spike once again and the system’s intensive-care unit is stressed, the second phase would be enacted, which would involve adding more ICU beds, reassigning more staff and rescheduling more nonessential surgeries, said Dr. Jorge Salinas, UIHC epidemiologist.
“We can handle surges, but they should not be viewed by the public as solutions. They are consequences,” Salinas said.
“The solution is taking the appropriate precautions to avoid infections in the first place, including avoiding large gatherings, wearing a mask and social distancing.”
All area hospitals say they have contingency plans to expand inpatient care through alternative sites, as well as plans to open more COVID-19 units within the hospital when and if necessary.
In efforts to maintain staff capacity and preserve their supply of personal protective gear, hospitals across the state in the past few weeks delayed certain elective surgical procedures that required an overnight hospital stay.
Cedar Rapids hospitals have not resumed those elective procedures. Officials are assessing that decision “hourly” based on the trends of the pandemic, UnityPoint Health-St. Luke’s Arnold said.
UIHC also plans to postpone surgical procedures “as needed.”
“It is important to understand that, while we can delay nonessential procedures or surgeries, it typically is not in the best interest of those patients,” Salinas said. “We found after the first phase that many cases worsened because of the delay.
“The best approach is to have everyone follow the safety measures so all Iowans can still get the care they need.”
Hospitals rely on collaboration
The supply of personal protective gear is in a much better place than it was earlier in the pandemic, and Myers of Mercy Medical said health care officials don’t anticipate any further disruption of supply lines.
However, he noted hospitals have not been able to truly stockpile supplies — meaning a surge in cases could put that capacity at risk.
The biggest concern for local health care leadership is their staff’s ability to keep up with the demand without becoming burned out.
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At UIHC, hundreds of staff have been cross-trained to take on other roles within the system, allowing health care workers to be shifted from outpatient to inpatient care areas in need.
Salinas said officials also have reassigned staff to help with UIHC’s influenza-like illness clinic and the call center, both of which are experiencing “increased volume in the past several weeks.”
Postponing elective procedures has helped alleviate that pressure. But hospitals also have turned to collaborations with one another.
Smaller hospitals are sending sickest patients to larger hospitals capable of providing a higher level of care, while the larger hospitals are sending healthier patients to those smaller hospitals, said Jennifer Nutt, vice president for clinical services at the Iowa Hospital Association, during a virtual news conference Tuesday.
St. Luke’s is working with its rural counterparts in the area — including Compass Memorial in Marengo and Regional Medical Center in Manchester — to help alleviate the strain the Cedar Rapids hospital is feeling by sending non-COVID-19 patients into their care.
Earlier this month, St. Luke’s officials also said they have sent COVID-19 patients from their hospital to smaller hospitals in the UnityPoint Health system, including Jones Regional Medical Center in Anamosa and Virginia Gay Hospital in Vinton.
“This is a great collaboration with the rural hospitals, and it is also helping create more capacity at St. Luke’s to care for the sickest patients in Eastern Iowa,” Arnold said.
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