Montrose Memorial Hospital has been seeing more COVID-19 admissions, an uptick that was expected in light of what has been observed elsewhere in the state, but which medical experts said should serve as a warning.
“We have gone from one COVID admission to six,” Dr. Drew Bolton an internal medicine specialist who practices at MMH, said Wednesday. “Fortunately yesterday (Tuesday), we had no new COVID admissions or any so far today. But, certainly, it’s heightened awareness for us that it is knocking on the door.”
The daily hospital patient census (for all admissions) fluctuates frequently as people are either admitted or discharged as appropriate for their situation.
This week, however, Bolton noted more COVID cases at MMH and said it was reflective of the “lag” between here and the Front Range, in terms of surges on hospitals. The “second wave” of COVID admissions began in the area about two to four weeks ago, as had happened earlier on the Front Range. A similar surge-lag-surge pattern was observed in April, when the pandemic began making itself known in earnest.
Bolton said what the hospital is seeing now had been expected and this time, too, there is a surge in Mesa County admissions, which could potentially affect where COVID and other patients here are sent, if necessary.
“As the hospitals become full on the Front Range and even Mesa County, patients we would transfer for non-COVID reasons, such as traumas or dialysis (treatment) that we don’t have here, are going to be impacted,” Bolton said.
A hospital committee met Wednesday morning to discuss where patients might be sent, should the need arise; Bolton said the committee is exploring options that include means of keeping patients here, with access to consulting specialists; sending them out of state, or using the state’s “hotline” to connect with facilities that have capacity to receive MMH patients.
Bolton said statewide, the current hospitalization rate is more than was seen even during April and more ICU beds are being utilized as a result.
He said 84% of ICU beds are in use in the state, whether for COVID or another reason, dramatically up from April, when the use rate was 69%.
As of Nov. 6, the state’s COVID-19 model showed hospitalizations on a sharper rise than had been previously predicted. The Colorado Department of Public Health and Environment, in announcing its updated modeling report, said the state’s COVID hospitalizations have exceeded April’s peak and had come even faster than expected.
“If the epidemic curve is not bent, Colorado could surpass intensive care unit capacity in late December instead of January as reported in last week’s modeling report. If contacts increase over the holidays, surge capacity could be required in mid-December, unless transmission is reduced,” per the CPDHE.
The updated modeling report found the probability of coming into contact with an infected person is now higher than it has been since the virus was first detected in Colorado.
Based on extended modeling, the CDPHE estimated transmission control had dropped for all age groups, with those age 20 - 39 having the lowest estimated level. Transmission control also continues to drop for the 65-plus age group, which is a high-risk group. This suggests people in that age range are increasingly becoming infected, swelling the rate of hospitalizations for their age group, CDPHE said.
April brought near “hysteria” in some quarters about what could happen with the pandemic, but now, people are becoming complacent, “sometimes fatigued,” Bolton said.
“It really is hugely important to reduce the spike of the surge, basically, in order to take care of patients. By washing your hands, social distancing and mask-wearing in public, we can reduce the speed of the spread, the rate of the spread and not overburden what the hospital can handle,” he said.
“We can take these spikes once in a while. We’ve learned a lot as far as treatment goes. We feel more prepared and a little better armed to treat these patients that become critically ill with COVID-19, but we’re not to the point that we should open the floodgates.
“We need to recognize that doing your part — washing your hands, wearing a mask — will allow us to give each person that comes into the hospital the care they need.”
Early in the pandemic, the hospital implemented a tiered structure to deal with possible demand surge. Each tier is based on patient load, with a specific plan for staffing and infrastructure. Additionally, the hospital has lined up a resource pool of experts, from nursing to environmental services, it can tap into as needed.
San Juan Living Center serves as MMH’s offsite convalescent facility for COVID patients.
Despite the recent uptick in COVID admissions, MMH remains in Tier 1.
“We don’t have to shut down any elective surgeries. We don’t have to open any extra rooms. It’s bringing in more staff, utilizing the beds that are available,” Bolton said. At the start of the pandemic, MMH had to suspend elective surgeries, which took a giant bite from its slender bottom line.
If first-tier capacity is exceeded, the hospital would enter Tier 2 and utilize the eight beds that usually go to patients recovering from joint replacement surgeries. Those patients would be moved to another part of the hospital.
Once the hospital hits Tier 3, it would reactivate its COVID unit that had been operating in April because elective surgeries were then on hiatus.
Beyond Tier 3, the hospital would implement a plan to use large public facilities as makeshift overflow units.
The planning relies heavily on cooperation between the hospital, Montrose County Public Health, the City of Montrose, Montrose County School District, and other partner entities.
“The county can utilize some of the resources and infrastructure the hospital has, such as testing capacity, The more we can slow the spread in the community, the less taxed the hospital becomes and subsequently, able to take care of the community as usual,” Bolton said.
The partnership is integral to COVID response, Montrose County Media Relations Manager Katie Yergensen said. “All four of the entities have been working together to keep our community safe. The hospital really does play a key role here,” she said.
Bolton does see a potential bright spot with the announcement by Pfizer and BioNTech of a promising vaccine. The companies said the first results from trials showed initial evidence of the vaccine’s ability to prevent COVID-19, however, more safety data must be collected before the FDA would consider emergency authorization, published reports say.
“It’s encouraging. It’s still early,” Bolton said. “One way to look at the burdens of social distancing and mask-wearing is that it is temporary. There is light at the end of the tunnel. Once these vaccines are rolled out, tested for efficacy and safety, we can get more back to normal.”
Bolton said he hopes that will encourage people to be more vigilant about protecting themselves and others by wearing a mask and staying 6 feet apart when out in public.
The virus isn’t going anywhere anytime soon and is a significant public health threat, despite what people may choose to believe, he said.
“It’s unfortunately been politicized. The best thing we can do from a health care perspective is try to educate. It’s not a hoax. It’s not a scheme. We’re all here taking care of patients the best we can and at times, putting our lives on the line to do so,” said Bolton.
“I can certainly understand fatigue, but I can’t understand an unwillingness to believe science and believe the facts.”