Colorado hospitals are better prepared for COVID-19 than in March, but flu creates uncertainty
Colorado’s hospitals have some advantages now they didn’t have this spring, even if the third wave of COVID-19 cases continues to grow. But what will happen if the flu hits at the same time is anyone’s guess.
As of Friday, 352 people were hospitalized with the new coronavirus, which is the highest total since May 27, but less than half the number receiving hospital care on the peak day of the pandemic’s early wave in April.
Dr. Heather Young, medical director of infection prevention and control at Denver Health, said they were treating about 20 COVID-19 patients as of Thursday morning. At the highest point, the hospital had about 70 coronavirus patients, and at the lowest point, it had fewer than 10. A committee meets at least weekly to assess how cases are trending in Denver and statewide, which gives some warning about how the number of patients might change over the next week or two, she said.
“As we see increases in the community, we’re going to see increases in hospitalizations,” she said.
Dr. Reginald Washington, chief medical officer at Presbyterian/St. Luke’s Hospital and Rocky Mountain Children’s Hospital, said they have seen a similar pattern. The HealthOne hospitals across the Denver area had 53 coronavirus patients on Thursday, which is an increase, but still less than half the number they had on a typical day in April, he said.
An average of 78% of intensive-care hospital beds and 79% of acute-care beds across Colorado were in use over the seven days ending Thursday. That doesn’t put hospitals at the breaking point, but they are monitoring that to decide about opening additional beds or canceling procedures that aren’t urgent, said Dr. Darlene Tad-y, vice president for clinical affairs at the Colorado Hospital Association.
“It’s a signal for us to pay attention,” she said.
Flu impact still unknown
Representatives for multiple hospitals and health systems emphasized that everyone six months or older should get a flu shot and continue to take precautions to prevent the spread of respiratory viruses. Last year, about 3,500 people were hospitalized for flu complications in Colorado between October and May, with most activity falling between December and February.
There are only a few reports of cases when a patient had both viruses at the same time, but those patients had more severe symptoms and took longer to get well than those who only had one of the viruses, Washington said. Also, if a patient could have either virus, or both, it’s going to take longer to determine the right treatment, he said.
Typically, hospitals can get an idea of what the flu season will be like by looking to Australia, whose winter flu season is during the Northern Hemisphere’s summer, said Dr. Michelle Barron, medical director of infection prevention at UCHealth.
The Australians had a mild flu season this year, but that’s not guaranteed to happen in the United States, because Australia closed many businesses and banned gatherings to contain the new coronavirus, she said.
“You plan and strategize for the worst possible thing you can think of, and modify that based on what happens,” she said.
Unlike in the spring, hospitals have had time to stockpile supplies and plan for possible scenarios that could play out this winter, Barron said. That includes stockpiling equipment, considering what units could take COVID-19 patients if space runs short and deciding how they’ll cope if staff have to stay home with sick children, she said.
In the spring, supply chains nearly broke down as hospitals, nursing homes and other facilities needed more protective equipment than usual, while the virus temporarily closed factories in China and elsewhere. Supply chains still aren’t operating as smoothly as before the pandemic, but a relatively calm summer in Colorado allowed hospitals to rebuild their stockpiles, said Dr. Andrew French, chief medical officer at St. Anthony North Health Campus
St. Anthony’s parent company, Centura, started manufacturing its own gowns for employees to wear over their scrubs in COVID-19 patients’ rooms, French said. Denver Health switched to reusable gowns and respirators, to reduce the need for large amounts of disposable equipment, and other hospitals reported stockpiling at least one month’s worth of masks and other supplies.
Running out of ventilators isn’t a large concern now, since fewer patients need them than originally thought, Tad-y said. The bigger issue is making sure staff and supplies make it to hot spots, she said.
Preparing for a possible surge
Kevin Stansbury, chief executive officer of Lincoln Community Hospital in Hugo, said that in addition to building their stockpiles, they also are revisiting their plans, including how to transfer patients to and from Front Range hospitals.
In the spring, Lincoln Community Hospital participated in a program where hospitals with too many patients could send those who no longer need intensive care to Hugo. A handful of patients came from Greeley and Denver to free up space in those hospitals and continue recovering until they could go home, Stansbury said. They’re making sure they’re ready to take those patients again, if the need arises, he said.
So far, hospitals don’t have enough patients to need the overflow space they prepared in the spring. Since they worked out the procedure in March and April, it won’t be difficult to convert spaces again if needed, French said. For example, with a few equipment changes, a unit where they watch for trouble as people come out of anesthesia could treat patients with COVID-19, he said.
“We try to be prepared really at any point in time,” he said.
Earlier this month, the Colorado State Emergency Operations Center announced it would take down two field hospital sites, in Grand Junction and Loveland. The sites were set up in April to take less seriously ill patients if hospitals were overwhelmed, but were never used. Three field hospital locations are still standing, at the Colorado Convention Center in Denver, St. Mary Corwin Hospital in Pueblo and the St. Anthony North campus in Westminster.
Doctors understand much more about how to treat COVID-19 than they did in March and April, including which medications might be helpful and that not every patient with low oxygen levels needs to be on a ventilator, Tad-y said. That’s a benefit for patients, and also may reduce the risk of overcrowding, because when a patient recovers a few days sooner, that means the bed is available for someone else, she said.
Fewer patients are needing intensive care now than were in the spring, at least partly because there are fewer patients from the highest-risk age groups recently, Washington said. Hospitals have learned quite a bit about how to care for patients, but that doesn’t mean people can stop wearing masks, keeping their distance from others and washing their hands frequently, he said.
“We can deal with it better than we could before, but it’s still a nasty virus,” he said. “Even if the numbers go down, that’s not the same as saying it magically went away.”
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