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Do Arizona hospitals still have capacity?

Officials respond to growing COVID-19 hospitalizations

Posted 7/10/20

Ten days after state officials enacted a crisis plan for Arizona hospitals to deal with the ongoing COVID-19 public health crisis, local health care officials say they have not yet resorted to …

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Do Arizona hospitals still have capacity?

Officials respond to growing COVID-19 hospitalizations

Posted

Ten days after state officials enacted a crisis plan for Arizona hospitals to deal with the ongoing COVID-19 public health crisis, local health care officials say they have not yet resorted to triaging patients.

On June 29, Dr. Cara Christ, director of the Arizona Department of Health Services, announced her agency had enacted the state’s Crisis Standards of Care, a guide for health care providers on how to respond to a major health crisis.

She said the move was based on recommendations from the State Disaster Medical Advisory Committee, a group of more than 40 top experts from public health and health care systems.

“That group on Friday recommended implementing the Crisis Standards of Care, which is really the framework, so that facilities can be prepared if there’s a reduction in the type of resources or their ability to be able to provide care at that specific facility,” Dr. Christ said.

The plan, devised in 2014 and revised as recently as this year, among other things lays out procedures for how to deal with a major crisis, should the number of incoming patients exceed the capacity of health care providers to treat them.

“We are recommending that they activate tactics to address space, to get their surge beds up, to make sure that they’ve got staffing and resources as necessary for that hospital’s current situation,” Dr. Christ said. “This is being put proactively into place so that hospitals who are on their own individual trajectory can implement these standards if necessary.”

Under a worst-case scenario, hospitals could be required to make difficult decisions about which patients to treat, should the capacity of beds, equipment or medical personnel be overwhelmed during a public health crisis.

Though the state’s crisis plan lays out the authority and procedures for triaging patients under those conditions, local hospitals still have enough capacity and don’t need to do so, at least not yet, according to Becky Armendariz, senior director of marketing and public relations for Banner Health.

“Banner is not triaging patients at this time and we continue to have capacity for COVID-19 and non-COVID-19 patients,” Ms. Armendariz stated. “Banner Health is committed to saving as many lives as we can during the COVID-19 pandemic. As cases and hospitalizations continue to rise in Arizona, it has put significant strain on our health care system.”

Based on data from AZDHS, hospitalizations have been on a steadily rising trajectory, along with ICU bed occupancy and ventilator usage.

As of Tuesday, 89% of ICU bed capacity had been expended with 1,497 patients under ICU care. This compares to 741 patients taking up 62% of ICU capacity as of March 26.

The continuously shrinking capacity since the end of March is also reflected in the use of ventilators.

As of March 26, 233 ventilators were in use statewide accounting for 21% of available capacity; as of Wednesday, that number had risen to 920 ventilators for 52% of capacity.

Meanwhile, hospitals are working to increase capacity to deal with a predicted continuing surge of infection cases.

“We are working very hard to address areas of need – expanding bed capacity, bringing in additional health care workers and securing the needed personal protective equipment, medications and other supplies to care for all COVID-19 and non-COVID-19 patients,” Ms. Armendariz stated. “Through enacting crisis standards of care, the Arizona Department of Health Services is providing support to health care organizations to continue to make necessary adjustments to accommodate the growing number of patients we care for.”

Abrazo Health CEO Brian Elisco said his facilities are also still ready to deal with the influx of novel coronavirus patients along with anyone else needing emergency care.

“Abrazo continues to have the ability to provide care for COVID and non-COVID patients. We closely monitor our patient census and are ready to adjust our services and processes as necessary in the event of a surge in COVID patients,” Mr. Elisco stated. “We evaluate hospital capacity on a daily basis and are currently securing additional staff to manage the increase in COVID-19 patients.”

More action requested

While AZDHS officials have instituted their crisis plan, Gov. Doug Ducey has in recent weeks taken some steps aimed at slowing the spread of COVID-19.

His June 29 executive order, titled “Pausing of Arizona’s Reopening — Slowing the Spread Of COVID-19,” brought back some of the social distancing restrictions the governor imposed back in March, which Mr. Ducey allowed to expire on May 15.

Among the measures included in the recent order, events of more than 50 people are prohibited in most cases; bars, indoor gyms and movie theaters, and water parks and tubing operators are closed to public access; and most public pools must also close.

The order, which provides police the authority to enforce its requirements, remains in place until July 27, after which the measures may be reconsidered every two weeks for revision or repeal.

Asked to reveal the expert basis of the order’s 50-person limitation or if the governor will institute further restrictions – including closing restaurants again to dine-in service or mandating face masks as a statewide requirement – Mr. Ducey’s spokesman had not responded as of press time.  

But while leaders and health officials weigh their response to the escalating crisis, a group of more than 1,000 experts has called for stronger measures.

In a petition addressed to Mr. Ducey and Dr. Christ – launched via ipetitions.com on June 28, the day before the governor’s recent news conference and executive order – concerned health care workers called on officials to enact the Crisis Care Standards and to reenact and enforce stricter social distancing requirements, among other measures. 

“We are asking for permission to utilize crisis care standards, something that most of us, when choosing our career, thought we would never be doing. Historically, our use of crisis care standards in the United States has been limited to terrorist attacks, mass shootings, battlegrounds, and aviation accidents. What pains us most is that this was avoidable,” the petition narrative states.

The petition’s signers call for the following actions:

  • Reenact the shelter-in-place order and enforce it
  • Close bars and nightclubs
  • Limit restaurants to take-out and delivery while requiring transparency about employees that test positive for COVID-19
  • Mandate masks statewide and impose real consequences for those who refuse to wear masks in public
  • Increase testing capacity
  • Expand contact tracing
  • Enforce quarantine for those with suspected or confirmed COVID-19

Nurse Practitioner Laura Hatfield signed the petition and commented at the petition website, suggesting officials should take a phased approach to reopening the economy.

“I am a psychiatric nurse practitioner and concerned about the long-term consequences of SARS-CoV-2 on the physical, emotional, behavioral, and financial aspects of our communities and state. Knowing what we do about other pandemics is that they can last years. My suggestion to reopen businesses in the future during this pandemic (and future ones) is to do so in incremental phases ... and to evaluate the success of each phase ... before moving on to the next.”

More restrictions coming?

The health department’s enactment of the crisis standards for a viral outbreak was, according to multiple reports, a first for Arizona and the first time any state has done so in the country.

Seeking clarification about the unprecedented move and what other measures Arizonans may expect in the coming weeks, should the rate of hospitalizations continue to increase, Daily Independent posed the following questions to the governor:

  • In light of the rising ICU bed and ventilator numbers and multiple reports citing Arizona as the hottest COVID-19 infection outbreak in the world as of this week based on per capita infection rate, what other moves will the governor take in the near future to mitigate?
  • If AZDHS deems the crisis of such severity to enact crisis care standards, why has the governor not issued a statewide mandate for face masks?
  • If AZDHS deems the crisis of such severity to enact crisis care standards, why has the governor not reinstituted a stay at home order similar to that issued in March?
  • How does the governor respond to growing criticism – as reported in numerous of media outlets – that states like Arizona opened up again too quickly and exacerbated the outbreak as a result?

Mr. Ducey and his representatives had not responded to multiple requests for comment as of press time.

For most people, the coronavirus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. But for some — especially older adults and people with existing health problems — it can cause more severe illness, including pneumonia and death. Learn more at azdhs.gov and cdc.gov.