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Another COVID surge threatens to overwhelm Colorado’s hospitals

New transfer policies could help ferry patients around the state, but staff shortages remain
Vanessa Meisner, CNA, left, and Melanie Meador, CNA, attend to a COVID-19 patient Friday in the non-intensive care unit of Mercy Regional Medical Center’s COVID-19 ward. (Jerry McBride/Durango Herald)

Entering the third year of the coronavirus pandemic, the numbers are shocking.

Gov. Jared Polis announced Nov. 2 that one out of every 51 Coloradans is infected with the virus.

Cases across the state have ballooned, up 21% the week of Oct. 24-30 and 12% the week the week of Oct. 17-23. An average of 2,550 people have tested positive every day over the last week, according to the Colorado Department of Public Health and Environment.

Colorado has the fifth highest transmission rate and the 10th most daily average hospitalizations in the U.S., according to The New York Times data. CDPHE data shows 92% of ICU beds across the state are full.

“The last couple of days we have continued to see an increase in our overall number of hospitalizations here in the state,” state epidemiologist Dr. Rachel Herlihy said Tuesday during a news conference. “We have 1,254 Coloradans that are currently hospitalized. That is the highest number that we have seen in Colorado since Dec. 20, 2020.”

“We are on trend with the number of people that we are adding to the hospitals daily and weekly to potentially entirely overwhelm our health care system by the end of this month,” said Liane Jollon, executive director of San Juan Basin Public Health.

Vanessa Meisner, CNA, left, and Melanie Meador, CNA, attend to a COVID-19 patient Friday at Mercy Regional Medical Center. Across Colorado, hospitals are filling with COVID-19 patients amid another surge. Liane Jollon, executive director of San Juan Basin Public Health, said 80% to 85% of those hospitalized in Southwest Colorado are unvaccinated. (Jerry McBride/Durango Herald)

The surge has left the governor searching for solutions.

On Oct. 31, Polis signed a pair of executive orders stopping some elective surgeries and allowing CDPHE to transfer or stop the admission of patients to hospitals throughout the state.

The orders will help hospitals transfer patients around the state more efficiently as patient loads swell.

Hospitals across the state have already been preparing for the surge.

On Wednesday, Colorado hospitals and health systems moved to Tier 3, the highest designation, of the Combined Hospital Transfer Center, according to a news release from the Colorado Hospital Association.

The move will ease patient transfers and allow hospitals statewide to work more collaboratively, said Cara Welch, a spokeswoman for CHA.

“Typically, a hospital might have to call around to a couple of the systems to find a place for that patient to go. So this is a way to kind of streamline that process,” Welch said.

Hospitals that lack the capacity or the facilities to care for patients can transfer them to other medical centers in the state. They can also move recovering patients to hospitals with more staff members and space, according to the release.

That includes both COVID-19 and non-COVID patients.

Lindsay Radford, a spokeswoman for Centura Health, which operates Mercy Regional Medical Center in Durango, said Centura’s hospitals would try to avoid transferring patients.

Vanessa Meisner, CNA, left, and Melanie Meador, CNA, put on the required personal protective equipment to enter a COVID-19 patient’s room Friday at Mercy Regional Medical Center. Gov. Jared Polis signed two executive orders to ease the strain on hospitals, stopping some elective surgeries and streamlining patient transfers around the state. (Jerry McBride/Durango Herald)

“Within our 17 hospitals across Colorado and western Kansas, including Mercy, our goal is to keep our patients in our facilities, and only transfer if a higher-level of care is needed based on patient acuity,” Radford said in a statement. “We know how important it is to care for patients in their local community and our priority is to keep them close to friends and family.”

Hospitals across the region have already begun to see the surge.

San Juan Regional Medical Center in Farmington announced this week it is implementing crisis standards of care.

The hospital’s ICU was at 129% capacity as of Thursday, president and CEO Jeff Bourgeois said in a news conference.

Over the course of the pandemic, the facility has expanded its ICU capacity from 14 to 23 beds. Yet, it still can’t handle the number of patients who are seeking care.

Mercy Regional Medical Center staff members work Friday in the non-intensive care unit COVID-19 ward. Staff shortages remain an issue for many hospitals in Colorado. Colorado Department of Public Health and Environment data shows almost 40% of hospitals expect staff shortages within the next week. (Jerry McBride/Durango Herald)

“Here we are again with what is likely to be our greatest surge ever,” said Brad Greenberg, an emergency medicine physician at San Juan Regional.

“We do have to accept that there are resource challenges,” he added.

Greenberg said San Juan Regional has tried to transfer patients to larger cities like Denver and Salt Lake City.

However, “it’s becoming very challenging to do so,” he said.

According to CDPHE’s most recent hospital data, only 4% of ICU beds are available in Southwest Colorado – 24 of 25 beds were in use.

Mercy declined to specify how many beds the hospital has available.

In a statement, Dr. Christopher Hudson, the chief medical officer for Mercy, said: “Although all of our hospitals in Colorado and western Kansas remain very busy, we are able to serve patients in need of our care. As the pandemic looms on, around 80% of our COVID-19 patients are unvaccinated. We have had surge plans in place since the beginning of the pandemic, and we have utilized them as needed throughout; many of our hospitals are currently implementing them. Some of our hospitals are postponing non-urgent and non-emergent procedures to preserve capacity. This decision is made in conjunction with our physician leaders and is based on needs at a particular facility.”

Vaccination mandates for Colorado health care workers
Vanessa Meisner, CNA, left, and Melanie Meador, CNA, attend to a COVID-19 patient on Friday at Mercy Regional Medical Center. The Colorado Board of Health’s vaccine mandate required health care workers to be fully vaccinated by Nov. 1 or face termination. (Jerry McBride/Durango Herald)

A statewide deadline for health care workers to become vaccinated or face termination was Oct. 31. By Nov. 1, health care workers in direct contact with patients had to be fully vaccinated or receive a medical or religious exemption.

Of the 266,313 workers reporting so far statewide, more than 90% are fully vaccinated, according to CDPHE’s COVID-19 vaccination reporting dashboard.

About 11,000, or 4%, qualified for religious exemption and 3,225 (1.2%) qualified for medical exemptions.

That leaves about 7,600 employees who chose to remain unvaccinated and can no longer work in health care.

“We've been pleased to see that hospitals have such a high vaccination and compliance rate amongst their staff,” Welch said. “We do have a few areas, especially in more rural parts of the state, where there may be more vaccine hesitancy or just difficulty getting staff to either apply for medical or religious exemption or take the vaccine.”

Vanessa Meisner, CNA, left, and Melanie Meador, CNA, attend to a COVID-19 patient Friday at Mercy Regional Medical Center. Though more than 90% of health care staff members chose to comply with the state’s vaccine mandate, losing some 7,600 employees puts further strain on Colorado’s hospital system. (Jerry McBride/Durango Herald)

The Centura Health network has 47 unvaccinated employees who are now on unpaid administrative leave, Radford said.

According to CDPHE data, 19 employees at Mercy Regional Medical Center are unvaccinated, though Radford said that of the 2,232 personnel, Mercy reported only about 1,100 are directly employed by Centura Health. She declined to say how many of the 1,100 Centura employees at Mercy remain unvaccinated. Those not employed by Centura but who work at the hospital may include janitorial staff, contract workers and even those who deliver goods such as food and supplies.

Across the state, concerns about health care worker shortages have grown amid the spike in cases.

In late September, Colorado health officials considered weakening the vaccine mandate and allowing religious exemptions to count toward a medical facility’s vaccination compliance rate, in part to relieve staff shortages.

However, the Colorado Board of Health’s emergency rule remains in place. It requires a 100% vaccination rate, but medical facilities can request a waiver for religious exemptions.

In Cortez, more than 14% of Southwest Memorial Hospital’s staff members received religious exemptions, almost four times the statewide average of 4.1%, according to CDPHE data.

The Colorado Board of Health’s rule directs each hospital to develop their own policies for both medical and religious exemptions.

Though the majority of Colorado’s health care workers have complied with the mandate, losing an additional 7,600 staff members could strain hospitals still struggling to find the workers they need.

Almost 40% of hospitals across the state expect staff shortages within the next week, according to CDPHE data.

“We are facing recruiting challenges like we’ve never seen before,” Radford said. “So many individuals have self-selected out of health care after the first wave of the pandemic, but the need for care hasn’t gone down.”

Said Welch: “In the long term, I think it’s about funding for the workforce pipeline, education programs, support for our existing staff. There’s going to be a lot of work to do to really shore up our health care workforce in the years ahead.”

ahannon@durangoherald.com

Angela Whitten, an occupational health nurse at Mercy Regional Medical Center, administers the first COVID-19 vaccination in La Plata County to physician Jennifer Heinicke on Dec. 17, 2020, at the hospital. Health care officials continue to encourage vaccinations to combat rising COVID-19 cases in Colorado. (Jerry McBride/Durango Herald file)
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