With Rising COVID-19 Cases in Washington, Health Officials Keep Wary Eye on Hospital Capacity

Health officials are becoming increasingly concerned about hospital capacity as COVID-19 cases continue to rise in Washington state.

"If our COVID activity continues on the same path we are on, we're going to be bumping up against our health-care capacity," said Dr. Kathy Lofy, the state's health officer, adding that case counts were "exploding in Western Washington, in particular."

Washington reported a record number of new coronavirus cases on Friday, with 1,691. The state's rolling average of daily cases is more than twice as high as it was two months ago, and climbing. Hospitalizations are trending higher also.

Washington is testing more people for the virus that causes COVID-19 compared to two months ago. But, the statewide positivity rate is higher now, an indication that the rise in cases is not merely reflective of more testing.

Statewide, about 72% of intensive care unit beds were in use as of Nov. 2, according to data from the Washington State Hospital Association (WSHA). About 62% of the state's airborne infection isolation rooms were occupied.

"We're fine today," said Cassie Sauer, WSHA's chief executive officer. "We're worried about two to three weeks from now."

Nationwide, COVID-19 cases are up 54% over the last two weeks, according to The New York Times. Daily COVID-19 cases crested 100,000 a day on Wednesday, a first during the pandemic.

Experts expected a surge in infections beginning in fall and winter, as colder weather pushes people to gather indoors and respiratory viruses commonly spike. Public fatigue over the pandemic's disruptions and increased travel during the holiday season heightens their worry.

Janet Baseman, a professor in the Department of Epidemiology at the University of Washington, said Washington state is doing better relative to other parts of the nation, but the rising case counts should be "a flashing red light."

A rise in cases precedes a rise in hospitalizations which precedes a rise in COVID-19 deaths, Baseman said.

Much as they did last spring, health experts fear that COVID-19 patients could outstrip hospital capacity.

"If you have an overwhelmed health care system and your ICU providers and your nurses and everybody is not able to manage their case loads and there are not enough beds for people, then outcomes get worse for everybody," Baseman said.

Dr. Chris Dale, a pulmonologist and chief quality care officer at Swedish Medical Group, said he felt like Seahawks quarterback Russell Wilson preparing for COVID-19 to send a "blitz" of patients in need.

"We've just got to be ready," Dale said. "Where are you going to put people, how are you going to staff them, what resources do you need to provide?"

Dale said he felt largely comfortable with the amount of personal protective gear available to staffers. Space can be created, mainly because of planning completed in advance of the spring COVID-19 surge.

"If you rewind the clock to April, we did a lot of creative re-imagining of what physical wards in the hospital could accommodate," Dale said. Swedish hospitals could scale up intensive care unit beds suitable for COVID-19 patients by 50% to 100%, he added.

Staffing is the biggest challenge.

"The market for surge ICU nurses has gotten very tight," Dale said, referring to traveling nurses who fill positions on a temporary basis across the country.

The pandemic is stressing the nation from corner to corner.

"If demand goes up in Wisconsin, Minnesota and Michigan, that can affect supply in Seattle," he said.

Sarah Gattis, an intensive care unit nurse at Swedish Medical Center on First Hill who often works with COVID-19 patients, said her unit has enough personal protective equipment and physical space for more patients, but regularly struggles with staffing.

"I get texts from our managers and supervisors probably about three to four times a week [asking] if I can come in and help. I can't. I have an 18-month-old and a 4-year-old," Gattis said. "We don't have a ton of open beds, but we're not totally full at the seams."

During the spring surge, Swedish hired traveling nurses, shut down elective surgeries and assigned nurses who handle those duties to assist in the ICU, Gattis said.

"I would anticipate in a month or by Christmas, if things continue to go in the same direction, yeah, we would need to cancel elective surgeries unless they can find us nurses or help," she said. "We would be drowning."

Reducing, delaying or canceling elective surgeries would be hospitals' first step to manage more COVID-19 patients, Lofy said. Sauer said several hospitals have scaled back on elective procedures, including some Eastern Washington hospitals that took COVID-19 patients from Idaho.

County public health officials have said private social gatherings where people do not use masks or keep their distance from others are driving the increase in transmission and illnesses.

Lofy, Sauer and Baseman insisted that people's behavior now could prevent more restrictive actions later.

"The best path forward is for everyone to come together and for all of us collectively to limit social interactions and wearing masks when people come over to our homes," Lofy said. "The last thing we want to do is stop elective surgeries or put more restrictions on businesses."

Lofy said it typically takes about three weeks for changes in people's behaviors to make an impact on the COVID-19 trajectory.

"We can't wait until they're overwhelmed" to make policy changes, Lofy said of the hospitals.

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