Colorado ICU beds fill up, hospitals beg public to get vaccinated

Colorado intensive care units are almost full, and a bad flu season could push them to the edge if coupled with continued spread of COVID-19.

Dr. Stephen Cobb, chief medical officer for Centura Health’s Denver region, said that hospitals are managing by postponing non-emergency surgeries and shifting staff around, but how the winter goes is at least partly up to the public.

It’s important to get vaccinated against both COVID-19 and the flu, to wear masks and maybe to avoid crowds for a while, he said. While most people don’t become seriously ill from the flu, older adults and young children are at higher risk.

“We desperately need the community to get vaccinated,” he said. “We’ve learned how much our behavior affects the kind of respiratory season we’re going to see.”

Last fall and winter, hospitals faced a tsunami of COVID-19, but a drop in other health care needs helped them withstand it. The flu season was almost nonexistent, due to masking and social distancing, and accidents were down as people spent more time at home. Now, people are out and about again, giving each other common viruses and getting injured.

COVID-19 patients are a minority of all patients in Colorado intensive-care units, but there’s little room to spare if the virus continues spreading.

On Sept. 10, the state reported fewer beds were available in intensive-care units than were during the worst days of the winter: 197. Scott Bookman, the state’s COVID-19 incident commander, said hospitals were activating their surge plans and converting general rooms to accept more intensive-care patients. Some also were closing outpatient clinics so they could move staff to higher-need units, he said.

The number of beds available fluctuates from day to day, and that number has risen and fallen since the state’s announcement. On Tuesday, the state reported 238 ICU beds were ready to use, but by Thursday, that dropped to 187. That’s about 11% of total capacity — the lowest level available since the pandemic started.

Those are statewide figures, though, and conditions are worse in some parts of Colorado.

Larimer County late last week alerted residents that ICU capacity in the county’s hospitals had been at or above 100% since Aug. 30 — and was at 107% on Thursday. COVID-19 hospitalizations in the county grew from 10 to 76 in the last two months, and nearly 40% of patients in the ICU in August and September had COVID-19, the county health department said.

“Once again I am pleading with our residents to take this situation seriously,” Tom Gonzales, director of the Larimer County Department of Health and Environment, said in a message to residents. “We can no longer ask our hospitals to carry the burden of this preventable disease.”

“Taking up our ‘just in case’ bed”

Colorado’s relatively fortunate to have more than 10% of beds available statewide, and hospital leaders urged residents not to delay seeking care if they’re experiencing potentially dangerous symptoms, like chest pain. While many facilities are putting off non-emergency surgeries, they still have space to treat heart attacks, strokes and other life-threatening conditions, Cobb said.

That’s not the case in some parts of the country.

In much of the South, at least 95% of ICU beds are full, and reports of patients dying for lack of a bed have started to emerge. An Alabama man died of a heart condition in early September after a full hospital called 43 intensive-care units but still couldn’t find him a bed, and a Texas man died of complications from gallstones, which could have been treated if a hospital had had space for him.

All of Idaho and parts of Alaska recently announced they were moving to “crisis standards of care,” a designation that provides legal cover for doctors and hospitals if they can’t give everyone an acceptable level of medical care. In practice, that may mean that a person who’s less likely to survive doesn’t get an intensive-care bed, to allow limited staff to focus on those who have the best chance.

Still, the situation isn’t exactly rosy in Colorado: about one in five hospitals reporting to the state said they could be short on staff in the next week, and 15% expected a shortage of ICU beds.

Colorado hospitals are managing by postponing elective procedures, discharging patients promptly, adjusting staff and declining to take transfers from other facilities when they don’t have a bed available, said Cara Welch, spokeswoman for the Colorado Hospital Association.

J.P. Valin, chief clinical officer for SCL Health, said about 90% of the people in the ICUs of their Colorado facilities are there for something other than COVID-19: accidents, strokes, emergency surgeries. They also have accepted some patients from neighboring states that have run out of space, he said.

The situation isn’t a “crisis,” but it’s important to reduce the strain on the system, so that beds are available for anyone who needs one, Valin said.

“We think a fair amount of this is still the legacy from delayed and deferred care,” he said. “What COVID patients are doing, they’re taking up our ‘just in case’ bed.”

Other hospitals also have seen a rise in patients. HealthOne reported admissions for COVID-19 had tripled in recent weeks, though they still are a relatively small fraction of all patients. About one-third of those patients need ICU care, which is in line with previous waves, spokeswoman Stephanie Sullivan said.

“There is no question that the current surge has put a strain on staffing across Colorado and the entire region, but we are grateful that our hospitals have been able to meet the needs of our patients,” she said in a statement.

Number of beds dependent on staff

As of 2018, Colorado had about 3.2 ICU beds for every 10,000 people, according to the Kaiser Family Foundation. That’s higher than the national average, but still doesn’t leave much room for surges. Hospitals don’t build substantially more space for patients than they expect to need on a regular basis, let alone employ enough nurses to handle unusually high levels of demand for months on end.

The discussion about beds is really about staff to care for the people in them, Valin said. Some ICU nurses have gone to work on less-demanding units, while others have left hospitals altogether or taken higher-paying jobs as travel nurses in the Southern states that are dealing with worse surges, he said.

“We have plenty of beds. We have plenty of ventilators. We have plenty of PPE,” he said, referring to personal protective equipment like masks and gloves.

Dr. Adit Ginde, an emergency medicine physician at UCHealth, said hospitals also are dealing with some vaccinated staff having to stay home because of COVID-19 symptoms. They haven’t become seriously ill, but it’s one more strain on a system that’s at capacity, he said. While severe illness is rare after COVID-19 vaccination, milder breakthrough infections are less so.

“We’re asking the community to do their part” by getting vaccinated and taking precautions, he said.

As of Thursday morning, UCHealth had 265 COVID-19 patients, which is just over the number at the peak of the first wave in April 2020, and some hospitals are following “surge plans” to free up beds, spokesman Dan Weaver said.

Both the UCHealth and SCL hospitals have been postponing some non-emergency care. That’s a category that includes anything that can be scheduled, including removing tumors or performing open-heart surgery, Valin said.

“You can imagine how hard that is for patients and families,” he said.

El Paso County Public Health announced late last week that it was changing its regional hospital capacity designation from level orange to level orange-red as beds continue to fill.

Dr. David Steinbruner, chief medical officer for UCHealth Memorial in Colorado Springs, said the network’s hospitals in the Pikes Peak region were seeing record numbers of patients seeking care for COVID-19 and other health issues. On Thursday, UCHealth’s hospitals in the region were treating 90 patients with COVID-19, a number not seen since the deadly winter wave was subsiding in January.

“This is extremely worrisome, considering we are also about to enter flu season,” Steinbruner said in a news release.

While some people have suggested prioritizing vaccinated patients if beds become scarce — and a group of Texas doctors conducted a thought experiment about doing so, because unvaccinated people are less likely to survive COVID-19 — it’s unlikely to become a policy anywhere. It’s considered ethical, in a crisis, to offer less care to people who are less likely to survive, but not to do so based on judgments about whether patients could have prevented their illness.

Neither the state nor the Colorado Hospital Association tracks how many patients transferred from elsewhere.

While it can be intuitively appealing to say Colorado hospitals should turn away COVID-19 patients from other states, that won’t happen for at least three reasons, Valin said. Federal law requires hospitals to take transferred patients if they have the ability to care for them, and most people who get into medicine would feel that turning away someone who’s sick violated their duty, even if it were legal, he said.

And of course, it’s best not to antagonize others who might help if Colorado hospitals ever need a backup.

“At the end of the day, there’s probably an element of ‘pay it forward,’” he said.

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