New Mexico surpassed the 1,000th death related to COVID-19 Friday, which underscores the rise in recent weeks of the record number of positive cases across the nation and around the globe.
A rise in the number of positive cases also brings with it a rise in the number of hospitalizations. While early in the pandemic, mask wearing orders and closures of mom-and-pop shops were issued by the governor to “flatten the curve,” in order to give the medical community time to deal with the as yet unknown medical conditions relating to COVID-19 and to prepare for the inevitable spike to come from pushing out the time line for those contracting the disease. The curve is now seeing that spike come to fruition.
Area hospitals are feeling the pinch as the pandemic wears on, with beds filling as the case numbers rise and as staffing is being pushed to the limit, with burnout in those limited staff numbers growing ever closer.
But while area hospitals are running near capacity, that doesn’t mean they couldn’t take care of patients if there was a surge and the need was there.
“The number and severity of cases in our area escalated very quickly. We continually monitor our bed availability and supplies throughout the day and adjust our surge planning, as needed,” Lea Regional CEO Dan Springer told the News-Sun. “Monitoring of our census and bed availability is continual because it can change at any time as patients are admitted or discharged. At the moment, most of our ICU capabilities are being utilized and that is the unit designated for COVID positive patients.”
If there was a surge, the hospital could open a new unit as necessary and possibly double the number of beds, Springer said — but that is where staffing becomes an even bigger issue.
“We are prepared. We have the ability to flex, and if we were to have a surge of patients, where we’re getting overwhelmed or we’re not able to transfer (patients), we would automatically be able to expand our capacity and open up a new unit,” Springer said.
Limits on the number of beds a hospital can operate isn’t always limited by space. For instance Lea Regional is licensed for many more beds than it currently operates.
For many hospitals across the state and region, there simply aren’t enough nursing staff available to care for patients.
“About two weeks ago we were at capacity for our staffing, and we remained there for about a week,” Nor-Lea CEO David Shaw told the News-Sun. “The biggest reason is because Texas hospitals were not accepting transfers and most (other) New Mexico hospitals were not accepting transfers because they were on what’s called diversion — which means they don’t have enough beds or staff.”
That has begun to change because some hospitals in Texas have begun to take in some transfers from New Mexico, and some New Mexico hospitals have also opened up to transfers within the state. But Shaw said the New Mexico Department of Health said the entire state is again running close to capacity for all hospitals, with the total number of hospitalizations reported at 334 Friday afternoon by the governor’s office.
Like Lea Regional, Shaw said Nor-Lea is currently considered at capacity, but could admit more patients if needed.
“We’re being very vigilant here, but we’re not at a point where we couldn’t take more patients,” Shaw said. “But definitely as Texas and New Mexico hospitals fill up again where we can’t transfer it puts us in a very difficult position.”
More than nurses
Staffing a critical care COVID patient room takes a dedicated number of nurses and doctors. Where a normal nurse can float between five or maybe six rooms a day, with COVID patients, that number drops to at most three, and sometimes only one patient per day per nurse. Each area hospital is slightly different in the way it is set up for those patients. For example, at Covenant Health in Lubbock, nurses are assigned to “pods” of three patients, and their entire day is with those patients — and no others. Lea hospital varies slightly on that model.
“Our typical census at our hospital is around nine patients on a given day, so when you add a COVID patient to that mix you add a complication … that’s like putting on a spacesuit, so that it protects them (nurses) from getting the virus,” Shaw said.
And nurses in the COVID ward become more than nurses. They also become housekeeping staff and they deliver meals to the patient — because they are solely responsible for every aspect of what goes on in the patient’s room and the care received, Shaw said.
“We are now in a crisis where the hospital is full. all of the other medical conditions are still taking place,” said Covenant Pulmonologist Brian Williams. “We have to make room for the Coronavirus people, but we also have other medical conditions that would otherwise need to be in the hospital, need to be in the ICU, and all of our resources are stretched thin.”
“None of us could have predicted what 2020 would bring,” Covenant Director of Perioperative Services Connie Gonzales said.
It’s not only the patients needing care, but also the families. That responsibility also falls to the doctors and nurses.
“We spend hours every single day talking to families and answering questions,” said Covenant Pulmonologist Shannon Turn-bow. “Not only do we have to take care of these patients, but we also have to take care of the families too.”
What happens with a surge?
Shaw said most area hospitals continue to provide other services while dealing with the rising need to care for COVID patients. But, should a bigger surge happen, where hospitals can no longer take transfer patients, and hospitals must open additional ICU beds, halls, wings, or pods for additional COVID patients, those other services will have to be suspended.
“For two reasons. One, we need additional staff to help care for patients,” Shaw said. “Two, we have to shut down services because, for example, we have to move patients into the operating rooms and recovery rooms and we’d have to use that as patient care areas. Which means we couldn’t do surgeries.”
Because of the pandemic, nursing staff is in short supply. The administrators said many staffing agencies area hospitals typically use to fill temporary needs simply don’t have anyone available.
Some areas, like Lea County, are smaller and feel the effects more. About two weeks ago, Shaw said the hospital reached out to a staffing service normally used, but no nurses were available because the University of New Mexico put in an order for 90 nurses, taking all available nurses for the region.
Even with a shortage of nurses, regional hospitals are still working together as much as possible.
“Unlike a natural disaster, the COVID-19 pandemic has required us to sustain a higher state of alert. There are many different agencies and organizations working collaboratively to ensure medical care for those who need it,” Springer said. “We are extremely proud of the many ways in which our staff and physicians have risen to this challenge.”
Like New Mexico, neighboring states have also seen a rise in total positive cases and with that a rise in the death toll. As of Friday, Texas saw an additional 6,027 positive cases and an additional 105 deaths in the state, bringing their state totals to about 945,000 positive cases and 18,477 deaths. Colorado saw an additional 2,262 positive cases and additional seven deaths in the state, bringing their state totals to about 105,000 positive cases and 2,302 deaths. The national total as of Friday stood at about 9.12 million positive cases, and 230,000 deaths.
While those numbers can be alarming on the surface, when broken down into percentages, the death rate is still somewhat low at between 0.5-0.9%. If the sample is taken as only those tested and confirmed positive, the death rate increases to about 2.4-2.9% for those cases.
For comparison, the Center for Disease Control and Prevention estimates there were between 39 and 56 million cases of the flu in 2019-2020. Those case resulted in 410,000-740,000 hospitalizations and 24,000-62,000 deaths. The death rate among those with the flu, using these numbers, was 0.06-0.11%.
What it boils down to is the number of positive cases are rising, the number of hospitalizations are going up, and people do have the power to limit their own exposure in most cases — especially those who are most vulnerable.
“In medicine we look at two things,” Williams said. “Morbidity, which is how bad the disease affects the human body. And the other thing we look at is mortality. It’s easy to understand. The numbers for mortality are easy to calculate … right now the mortality rate (for COVID-19) is around 2-3% … that mortality rate drastically increases for anyone over the age of 50.”
Most hospital workers agree what the public can do to help is relatively simple things everyone already knows how to do.
“We cannot stress enough how important it is for our community to continue to practice the guidelines suggested by the CDC,” Springer said. “Practice social distancing, thorough and frequent handwashing, disinfect frequently touched objects and surfaces, and stay home except when in need of medical care, including testing.”
Shaw agreed and said wearing a mask doesn’t offer 100% protection, but does give some level of security and help slow down the spread.
“We need to be smart about being out in the public,” Shaw said. “We need to socially distance as much as possible, and, if you’re in a situation where you can, wear a mask. You don’t have to wear a mask all the time — I certainly don’t wear my mask all the time — but when I’m at work, when I’m around other people, when I go to the grocery store, I wear my mask.”
“If we would all wear a mask and put in place all the practices that are out there it would keep us safe,” Gonzales said. “We might be independent and head strong, but we’ve always taken care of one another.”