By Melanie Evans, Joseph Walker and Stephanie Armour
As the pandemic pushes U.S. hospitals in the South and West near
capacity, the urgent need for available beds has stranded patients
in emergency rooms, scrambled ambulances and forced patients to
relocate hundreds of miles to relieve overcrowded wards.
In Arizona, hospitals are using a statewide transfer center to
move 30 to 50 patients between hospitals each day, according to the
director of the state's Department of Health Services. In Florida,
hospital giant HCA Healthcare Inc. isn't accepting patients
transferred from other overflowing hospitals. In Houston, the daily
hunt for empty beds has left critically ill patients to wait hours
or days in emergency rooms for vacancies.
A dozen Houston-area hospitals had a combined 273 patients
holding in emergency rooms for an empty bed Tuesday, including
about 40 in need of intensive care, said Darrell Pile, chief
executive of the Southeast Texas Regional Advisory Council, which
tracks bed availability and helps hospitals coordinate transfers.
"This disaster beats all disasters," he said.
The sustained surge in hospitalizations there and in other
cities like Phoenix and Miami is straining the response effort, as
the need for beds is running up against shortages of staff -- and
in some cases space. Hospitalizations elsewhere in the U.S. have
intensified demand for health-care workers, he said. The public's
noncompliance with mask or social-distancing guidelines further
allows the virus to spread, he said.
"What we're facing has gotten much worse than anyone ever
imagined and much worse than anyone could ever prepare for," Mr.
Pile said. "The public has to do its part."
Hospitals in Arizona reported nearly 3,500 coronavirus patients
Tuesday, a figure that has climbed steadily after the state
reopened its economy and coronavirus cases surged. Texas in late
June moved to scale back its reopening, halting some nonessential
surgeries in certain counties and rolling back bar openings, as
hospital intensive care units grew full. But occupancy rates
continue to climb in Texas hot spots.
The surge in patients and rising numbers of deaths in some U.S.
communities follow the increase in cases that has happened
alongside efforts to restart local economies.
Across the U.S., more than 3.43 million people have been
infected, and 136,466 have died, according to data compiled by
Johns Hopkins University. States like Florida and Arizona have hit
new highs in recent days, and now other states, including
Tennessee, West Virginia, Oklahoma and South Carolina, have seen
new coronavirus cases jump 20% or more from a week ago.
A clear picture of hospital strain is limited, however, by
uneven public reporting across states and hospitals and ad hoc
efforts by federal officials to collect data since the pandemic
began.
Federal officials on a call with reporters Wednesday defended a
decision to have hospitals report data on Covid-19 cases, critical
supplies and staff to the U.S. Department of Health and Human
Services rather than the Centers for Disease Control and
Prevention.
Critics fear the move would enable the Trump administration to
politicize hospital virus data by impeding access to or sharing of
information.
"Rather than strengthening the public health data system to
improve hospital reporting, the administration has chosen to hand
data to an unproven, commercial entity, reporting to political
appointees, not scientific experts," Dr. Tom Frieden, who ran the
CDC during the Obama administration, tweeted Wednesday. The data
collection will be overseen by a private contractor,
TeleTracking.
Michael Caputo, a spokesman for HHS, said the CDC system is no
longer adequate for monitoring hospital information and that the
agency can't keep up with the pandemic.
CDC Director Robert Redfield told reporters Wednesday that no
one is taking access or data away from CDC.
He said the White House coronavirus task force had for months
urged improvements.
Hospital surge response differs across states, which have taken
varied roles in tracking patient capacity and transfers. States
also have taken mixed approaches to mandates to halt nonessential
hospital services.
In New York, where the pandemic overwhelmed hospitals early on,
there were fewer than 1,000 coronavirus patients in hospitals
Tuesday with roughly 12,700 available hospital beds. This is down
from a high on April 12, when nearly 19,000 Covid-19 patients were
hospitalized across the state and hospitals were ordered to
increase their bed capacity by 50%.
Hospitals saw revenue plunge as most halted some surgeries in
late March and April, either voluntarily or under state orders,
then rapidly ramped back up as states eased restrictions.
Arizona requires hospitals that have capacity to accept patients
from its state transfer coordination center, said Cara Christ, head
of Arizona's Department of Health Services. That prevents any one
hospital system from bearing a disproportionate share of the surge,
she said. Some hospitals in the state have voluntarily halted
nonessential surgery. The state requires hospitals to suspend the
procedures when total occupancy levels exceed 80%, a spokeswoman
said.
In Florida, HCA Healthcare said last week it would limit
scheduled surgeries and cancel those that could safely be
postponed.
To preserve hospital capacity in Texas, Gov. Greg Abbott in late
June halted surgery across four counties, including Harris County,
which is home to Houston. Since then, intensive-care occupancy
across the county's hospitals has increased to 98% from 92%, SETRAC
data show. Mr. Abbott later expanded the number of counties subject
to the order.
Creating more intensive-care beds will be challenging with acute
staffing challenges, Mr. Pile said. "This virus has gone on so long
and has consumed staff from all parts of the state," Mr. Pile said.
"There are no longer enough staff to put a patient in all of those
beds."
Memorial Hermann Health System continued to add beds with its
Houston-area hospitals near capacity, a spokeswoman said. It has
received 60 nurses deployed by the state to provide relief and
hired additional staff through temporary agencies.
The Texas Department of State Health Services as of July 8 had
sent roughly 1,200 health-care workers to hospitals and had another
576 on standby, said agency spokesman Chris Van Deusen.
Some hospitals say they can't add any more beds. Harris Health
System, which operates two public hospitals in Houston, is at its
maximum, said Charlie McMurray-Horton, its associate administrator
for clinical integration and transformation.
Harris's hospitals have struggled to find empty beds elsewhere
for 10 to 30 patients who need transfers each day. That has left
some patients stranded in the emergency room until a vacancy
appears and forced its hospitals to turn away ambulances.
More capacity for Harris Health's hospitals depends on other
Houston-area hospitals adding beds to accept more transfers, Ms.
McMurray-Horton said. "We are intertwined," she said. "Wherever
there is an increase in beds, it helps out the community."
The Texas Department of State Health Services generally doesn't
coordinate patient transfers, which is done between hospitals or
with aid of regional coalitions, Mr. Van Deusen said.
In Laredo, Texas, a surge in new Covid-19 infections was
overwhelming the city's hospitals, which were running out of
inpatient beds, medical equipment and health-care workers to treat
patients, said Victor Treviño, Laredo's Health Authority.
"We're in a crisis mode," said Dr. Treviño, 72 years old. "In my
40 years of practice I've never seen anything like this."
At one city hospital, patients seeking care in the emergency
room were overflowing into the hallways last week, and ambulances
idle outside and wait for space to be cleared to bring in new
patients, Dr. Treviño said. The city's hospitals converted more
beds into space for Covid-19 patients and health-care workers
deployed by the state have added capacity, but it likely won't
last, he said.
Hospitals don't have enough high-flow oxygen devices, a
less-invasive method than ventilators to provide oxygen support to
patients with respiratory problems, Dr. Treviño said.
"Intubations are not ideal because the outcome of the patient is
worse if he's intubated," he said. "We would prefer the high-flow
oxygen therapy, but where are the machines? They're not here."
The city is out of the antiviral drug remdesivir made by Gilead
Sciences Inc. used to treat Covid-19 patients, the second time it
has run out. The city received 200 vials of the drug on July 4 --
or enough to treat about 33 patients at the most common dosage --
after it ran out of the drug the prior week, Dr. Treviño said.
"We're putting out fires constantly, constantly, constantly," he
said.
--Melanie Grayce West contributed to this article.
Write to Melanie Evans at Melanie.Evans@wsj.com, Joseph Walker
at joseph.walker@wsj.com and Stephanie Armour at
stephanie.armour@wsj.com
(END) Dow Jones Newswires
July 15, 2020 20:58 ET (00:58 GMT)
Copyright (c) 2020 Dow Jones & Company, Inc.
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